So, I worked Christmas Eve this year. I had an overtime captain and my usual firefighter. We got our food shopping done early in the morning and even then the store was pretty crowded and crazy. We thought we might be in for a crazy day.
Turns out that we only had one medical call during the shift, which was nice, because I usually get at least one code-blue around Christmas time every year. Beyond that, the most excitement we got was when an apartment fire in a Senior Living complex came in in the next district over. It was close to the border of our district but we were not on the first alarm, which was frustrating because it was so close. But, we couldn't just assign ourselves to the call without causing problems (and probably getting in trouble). We knew we would be the first engine in if it went to a second alarm. We grabbed a radio and listened in on the tac channel. Rigs started to arrive and they had smoke showing and were grabbing a water supply. We quickly donned our gear and rushed out to the rig to await the inevitable second alarm. Unfortunately (for us, anyway) it never came. They quickly got it under control and released the other units.
We put our gear away and were able to relax again.
We slept peacefully through the night, which has become unusual at my station, and came home to our families on a chilly Christmas morning.
Merry Christmas everyone.
Sunday, December 25, 2011
Friday, December 16, 2011
What Has Been Seen....
Just down the street from the station is the house of one of our regulars with some psychological issues. We got called over there most recently by his family because he was unresponsive on the floor of his room. However, when we arrived he was standing in his bathrobe in the middle of the living room. Now, while I was standing on the porch waiting for someone to open the door I had set my equipment down at my feet. I was the second one to enter the house and as I bent down to pick up my gear I heard our patient say, "Hey, wanna see something gross?" Usually this is a bad sign, and this was no exception. I was already bent over and involuntarily looked up to find him standing directly in front of me with his bathrobe open and, right at eye level, were his testicles that were swollen to the size of a cantaloupe. Fortunately he closed his robe immediately as we were followed in by the police.
As to the report of unresponsiveness, he tried to explain that he had been faking unconsciousness as an April Fool's Day practical joke on his family. When we pointed out that it was October he said that he had not done anything on the actual first of April so he was making up for it now. We informed him that we would like to examine him and that he might have to go to the hospital. He was not at all happy about this and proceeded to pace laps around the room ranting about a whole host of nonsensical and bizarre things. He wasn't behaving in an overtly threatening manner and, eventually, he seemed to be losing steam, so all we could do was watch the spectacle. He finally ran out of ravings and stopped, leaning against the living room wall. In a delicious stroke of timing, he stopped directly beneath a clock at exactly the turn of the hour. As he completed his last lunatic statement and leaned on the wall, the clock over his head chimed in with what we were all thinking, "Cuckoo! Cuckoo! Cuckoo!". The beauty of it was that the humor and serendipity of this was not lost on any of us and I don't think anyone held in their laughter.
The ambulance arrived and the patient was 5150ed by the police. We wound up having to restrain him onto the gurney. The ambulance medic, who had not been witness to the earlier flashing incident and didn't know about the testicular malady wound up leaning on and across the patient's lower half to secure the seatbelt and restraint. As you can imagine, this elicited quite a reaction from our patient who screamed out in pain at the very confused medic.
There's one police officer who still thinks I'm the one who leaned on the patient and he frequently tells the story of this call.
As to the report of unresponsiveness, he tried to explain that he had been faking unconsciousness as an April Fool's Day practical joke on his family. When we pointed out that it was October he said that he had not done anything on the actual first of April so he was making up for it now. We informed him that we would like to examine him and that he might have to go to the hospital. He was not at all happy about this and proceeded to pace laps around the room ranting about a whole host of nonsensical and bizarre things. He wasn't behaving in an overtly threatening manner and, eventually, he seemed to be losing steam, so all we could do was watch the spectacle. He finally ran out of ravings and stopped, leaning against the living room wall. In a delicious stroke of timing, he stopped directly beneath a clock at exactly the turn of the hour. As he completed his last lunatic statement and leaned on the wall, the clock over his head chimed in with what we were all thinking, "Cuckoo! Cuckoo! Cuckoo!". The beauty of it was that the humor and serendipity of this was not lost on any of us and I don't think anyone held in their laughter.
The ambulance arrived and the patient was 5150ed by the police. We wound up having to restrain him onto the gurney. The ambulance medic, who had not been witness to the earlier flashing incident and didn't know about the testicular malady wound up leaning on and across the patient's lower half to secure the seatbelt and restraint. As you can imagine, this elicited quite a reaction from our patient who screamed out in pain at the very confused medic.
There's one police officer who still thinks I'm the one who leaned on the patient and he frequently tells the story of this call.
Monday, December 5, 2011
Are We First In?
We were just about to clear a false alarm in the East end of our district when a structure fire call came in. It was on the Northwest border of our district and the next one over, technically the next station's first in, but there were a lot of units from our battalion working another structure fire at the time. As I turned the rig around and put on the lights and siren, my firefighter said, "Guys, we've got smoke behind us". When I got out onto the main streets again, we could indeed see a pretty good column starting to form.
Since we were on this other call when the fire was reported we were not initially attached to the alarm assignment. My captain kept trying to tell dispatch to attach us so we could get the address sent to our MDC (mobile data computer in our rig). There was so much radio traffic that they weren't answering him. Fortunately, I knew the street and could pretty much follow the smoke. When I got within a couple blocks of the street I needed to turn on, Truck 56 showed up behind us and followed us in. The smoke was really pumping now, dark and heavy. Finding the address was easy enough with the smoke and flames and crowd of people on the street, but not having a chance to see the map and not having it on our MDC, we didn't know where the hydrants were on this street and so far I hadn't seen any on the whole block driving in. As we approached the address, my firefighter suddenly spoke up from the backseat, "Are we first in?" Hard to believe, but we were. Now he would get to fight fire.
Turns out the fire was burning up an awning, a fence, some trees, and a boat in the backyard of the residence. The fuel and fiberglass of the boat were causing the thick, black smoke. I committed the rig to the long driveway but had to stop short due to some very low hanging cable/phone wires. I angled the rig to the left and my crew pulled a mobile standpipe (2 1/2 inch supply hose with 100 feet of 1 3/4 inch attack hose) to attack the fire. I heard some radio traffic about another engine who found a hydrant and would be bringing me a water supply (thank god) and more engines going to the court behind this house for a better point of attack. I got my crew's line flowing and waited for the engine to show up with my water supply before my tank ran out. I have a 500 gallon tank and the attack line flows 160 gallons per minute, so there really isn't much time.
Waiting.
Waiting.
Ahh, hell...no engine and no other crews or rigs except the empty truck on the block with me. A second BC pulled up and I asked him if there was a rig coming to give me a supply and he said he didn't know. Great. I radioed my crew and told them we were at 1/4 tank and had no supply. A minute later I radioed that I was shutting down their line. Fortunately, this was an outside fire, had they been inside a burning structure this could have been very bad.
Turns out, the supply engine went to the street behind and supplied the engine on that side and I was forgotten about. Meanwhile, another engine was getting ready to clear the scene as most of the fire had been knocked down. I stopped the captain of that rig and told him I needed his water. They quickly pumped their tank into mine so we could continue with our operation. It was pretty much just mop up work at that point so we were able to do it with just the newly filled tank.
A lot of little lessons learned on that one and fortunately a positive outcome despite all the miscommunications.
Since we were on this other call when the fire was reported we were not initially attached to the alarm assignment. My captain kept trying to tell dispatch to attach us so we could get the address sent to our MDC (mobile data computer in our rig). There was so much radio traffic that they weren't answering him. Fortunately, I knew the street and could pretty much follow the smoke. When I got within a couple blocks of the street I needed to turn on, Truck 56 showed up behind us and followed us in. The smoke was really pumping now, dark and heavy. Finding the address was easy enough with the smoke and flames and crowd of people on the street, but not having a chance to see the map and not having it on our MDC, we didn't know where the hydrants were on this street and so far I hadn't seen any on the whole block driving in. As we approached the address, my firefighter suddenly spoke up from the backseat, "Are we first in?" Hard to believe, but we were. Now he would get to fight fire.
Turns out the fire was burning up an awning, a fence, some trees, and a boat in the backyard of the residence. The fuel and fiberglass of the boat were causing the thick, black smoke. I committed the rig to the long driveway but had to stop short due to some very low hanging cable/phone wires. I angled the rig to the left and my crew pulled a mobile standpipe (2 1/2 inch supply hose with 100 feet of 1 3/4 inch attack hose) to attack the fire. I heard some radio traffic about another engine who found a hydrant and would be bringing me a water supply (thank god) and more engines going to the court behind this house for a better point of attack. I got my crew's line flowing and waited for the engine to show up with my water supply before my tank ran out. I have a 500 gallon tank and the attack line flows 160 gallons per minute, so there really isn't much time.
Waiting.
Waiting.
Ahh, hell...no engine and no other crews or rigs except the empty truck on the block with me. A second BC pulled up and I asked him if there was a rig coming to give me a supply and he said he didn't know. Great. I radioed my crew and told them we were at 1/4 tank and had no supply. A minute later I radioed that I was shutting down their line. Fortunately, this was an outside fire, had they been inside a burning structure this could have been very bad.
Turns out, the supply engine went to the street behind and supplied the engine on that side and I was forgotten about. Meanwhile, another engine was getting ready to clear the scene as most of the fire had been knocked down. I stopped the captain of that rig and told him I needed his water. They quickly pumped their tank into mine so we could continue with our operation. It was pretty much just mop up work at that point so we were able to do it with just the newly filled tank.
A lot of little lessons learned on that one and fortunately a positive outcome despite all the miscommunications.
Tuesday, November 22, 2011
A Toast To A Job Well Done
What is going on behind closed doors on your quiet, tree lined, suburban street in the middle of the night? You honestly just don't know.
I still don't know all the details of how this one unfolded, but here it is from my perspective and pieced together the best I could.
A third party called the police to report an assault in a house in a residential neighborhood, unknown address. Police respond to the neighborhood and find a twenty-something hispanic male wandering the streets with a bloody lip. He is intoxicated and Spanish speaking only but is able to lead them to a house where he claims he got into a fight. We are cleared to enter and this is what we find:
The homeowner is a larger man in his late forties-ish wearing a bath robe. He is inebriated but only enough to be beligerent to the police which, all arguments regarding the Occupy movement aside, is pretty much never a good idea. There is a bookcase knocked askew and a few items scattered on the floor giving credence to the claim of a scuffle. There is a kitchen table inside and a patio table outside both covered in wine bottles and other liquor bottles (good stuff too). And curled up on the living room floor, completely hammered, is another twenty something hispanic male with his pants undone and down around his ankles. As I started assessing the guy on the floor, the homeowner again started getting feisty with the cops and me, so I stepped back for a minute to be on guard. It was at this point that I looked down the hall and saw a tripod with video camera attached set up in the bedroom.
We removed the patients from the house for treatment and ambulance transport and let the cops deal with the homeowner.
So, the best we could figure out from the drunken patients was that they were landscapers who had just completed work on a job in this man's backyard and he invited them to have a drink and celebrate before they left, which they did. And then they had another and another and another. The first guy must have fallen asleep or passed out and then awoke to find his partner on the floor with his pants down being spooned by the homeowner in the bathrobe.
You could say, he freaked out a little and that is when he and the homeowner got into their scuffle, during which he was hit in the mouth. He then fled the house (leaving his partner behind) and called his or the other guys' girlfriend who then called the cops who called us in.
One thing that struck me as odd (one thing?) was that, as rude and uncooperative as the homeowner was and the seemingly obvious nature of what had gone down, as far as I could tell, the police just let him be, cleared out and said goodnight. It could be that they had to wait until they could talk further with the landscapers, get statements, and find out if they wanted to press charges before anything further could be done but I kind of doubt that will happen.
Suburbia...what are you gonna do?
Saturday, November 12, 2011
Paging Dr. Google
Ohhh, the internet. You gotta love it.
We responded at about 8:30 pm for a 23 year old male having a panic attack. When we arrived at the house the rest of my crew remembered that they had been on this guy before a couple months back.
We found him sitting on the couch complaining of rapid heart rate and some hyperventilation. He did not appear to be in any distress at all. He said he had been practicing the relaxation tips the doctor had told him to use but it wasn't working. He was speaking normally and his pulse was barely over 100. He had no tingling in his hands or chest pain or any other symptom that we would worry about so we really weren't too concerned. Nor were any of his family, as evidenced by the fact that his sister (?) appeared in the hallway, glanced back into the living room, saw a crew of firefighters, turned and went on her way without a word.
Our patient decided that he didn't want to go to the hospital by ambulance after all, because he didn't want to "waste our time". I'm sure we all mentally said, "Too late". So we cancelled the ambulance and he signed out AMA. As we got back on the rig the firefighter said, "He's gonna call us back you know that, right?"
Fast forward eight hours...yes, at just after four in the morning, thank you very much, we got toned out for the same address. When we walked in this time the first words out of his mouth were, "I'm going to the hospital this time." Oh, we already knew that. Again, he was in no apparent distress and in fact his heart rate was in the high 80's and his pressure was fine and his ekg normal.
He, however, had spent his time between our visits cruising the web for information on all the things that could be wrong with him (which probably triggered the second event).
As we waited for the ambulance to arrive he peppered us with questions. Could it be tachycardia? Well, tachycardia just means a heart rate greater than 100 beats per minute and you don't even have that right now. What about palpitations? Well, a palpitation is just a sensation in which a person is aware of an irregular, hard, or rapid heartbeat, which...again...you don't have. And so on.
In defense of his research, he stated that he had a lot of time on his hands, which I took to mean that he was jobless. He also stated at one point that this was his grandmother's house. So, I thought to myself, you're 23 years old with no job and living free at grandmas house.
If that's the case, what are you so stressed about?
We responded at about 8:30 pm for a 23 year old male having a panic attack. When we arrived at the house the rest of my crew remembered that they had been on this guy before a couple months back.
We found him sitting on the couch complaining of rapid heart rate and some hyperventilation. He did not appear to be in any distress at all. He said he had been practicing the relaxation tips the doctor had told him to use but it wasn't working. He was speaking normally and his pulse was barely over 100. He had no tingling in his hands or chest pain or any other symptom that we would worry about so we really weren't too concerned. Nor were any of his family, as evidenced by the fact that his sister (?) appeared in the hallway, glanced back into the living room, saw a crew of firefighters, turned and went on her way without a word.
Our patient decided that he didn't want to go to the hospital by ambulance after all, because he didn't want to "waste our time". I'm sure we all mentally said, "Too late". So we cancelled the ambulance and he signed out AMA. As we got back on the rig the firefighter said, "He's gonna call us back you know that, right?"
Fast forward eight hours...yes, at just after four in the morning, thank you very much, we got toned out for the same address. When we walked in this time the first words out of his mouth were, "I'm going to the hospital this time." Oh, we already knew that. Again, he was in no apparent distress and in fact his heart rate was in the high 80's and his pressure was fine and his ekg normal.
He, however, had spent his time between our visits cruising the web for information on all the things that could be wrong with him (which probably triggered the second event).
As we waited for the ambulance to arrive he peppered us with questions. Could it be tachycardia? Well, tachycardia just means a heart rate greater than 100 beats per minute and you don't even have that right now. What about palpitations? Well, a palpitation is just a sensation in which a person is aware of an irregular, hard, or rapid heartbeat, which...again...you don't have. And so on.In defense of his research, he stated that he had a lot of time on his hands, which I took to mean that he was jobless. He also stated at one point that this was his grandmother's house. So, I thought to myself, you're 23 years old with no job and living free at grandmas house.
If that's the case, what are you so stressed about?
Thursday, November 3, 2011
test post for email
I am posting this simply as a test of the Email subscription. If you received email notification please make a comment to this post as confirmation.
Thank you.
Thank you.
Tuesday, November 1, 2011
Halloween
I signed up to work overtime at my old station with my old captain. The engineer on duty the next day was working overtime at a station right by my current one so he asked if we could swap. No big deal, I still had a good crew to work with and would be closer to my home station in the morning.
Unfortunately that station can get busy, especially at night. They had actually been shut out the day before (no calls) which is pretty unheard of for them so we kind of knew we were going to pay for that. We drilled and ran a couple calls during the day. As predicted, we wound up being up all night (four calls after midnight). Our first night call was for a diabetic who is one of their regulars. His blood sugar was in the teens and we started an IV and gave dextrose. He came around and of course didn't want to go with the ambulance. This sometimes happens and we just make sure the patient has some real food (longer lasting sugar) and someone to watch over them. We have to make sure they eat and are mentating well enough before we can leave. In this case we were on scene for an hour getting this guy to eat and stabilize. We probably should have just pulled the plug and made him go to the hospital but we were being excessively nice. After that we got up at 2 o'clock for back to back calls and again at 5 o'clock a.m. It was one of those nights where the calls are spaced just far enough apart to never get back to sleep again.
I went from that station to my regular house for my regular 48 hour shift. My house is supposed to be the slow one, but once again we ran a couple calls in the day and 2 more after midnight. I think I got 3 hours sleep on the overtime and maybe 4-4 1/2 on my first shift. The second shift wasn't as bad until the next morning when I was getting ready to come home.
At 7:30ish that morning I got a call from the BC telling me to stay put at my station because I might get mandatoried. They had one person to call before me but he was out on a medical call and they had to wait for him to get back to the station.
Did I mention this was Halloween?
Well, the guy ahead of me claimed Family Care issues (which is the only thing that can get you out of a mandatory) and so I got stuck with it. The mandatory was at my old station with my old firefighter so at least that part was good, but it meant that I would miss going out with my kids and that my wife would be stuck dealing with them for an additional 24 hours (now 96) by herself.
The firefighter had also been mandatoried and was as unhappy as I was about it. He made a good point that Halloween was the one holiday we can't do on a different day. If we work Christmas or Thanksgiving, we celebrate the day before or day after, no big deal. He asked if I though his neighbors would look at him funny when he took his kids trick or treating on November 1st.
We had an overtime captain with us for the first 12 hours and the regular captain was coming in at 8 that night. We kept the day low-key and did our regular engine and tool service and decided to just go pick up burritos instead of shopping and cooking. There is a small taqueria right across the street and down a couple so we decided to just walk over there and get dinner. So, at about 5:30 we put on our uniforms, grabbed radios, and headed across the street. We had just reached the door of the place when the radios went off: "Engine 56, Truck 57, Engine 57, Engine 40, Rescue 19 respond for a structure fire residential".
Well we took off running back to the station pulling off our uniform shirts as we went. I must admit, I always think of the scene in the Superman movie where he is running and pulls his shirt open to reveal the iconic S whenever we do that. In any case, as I put my turnouts on and checked the map for hydrant locations I knew that it was going to be a race to see who got there first. The house was in the next district over, but pretty close to the border of our district. As we flew down the street towards the address I commented that I couldn't see any smoke. Just as I said that though we could all smell it. We saw the other engine coming towards us from the opposite direction. We pretty much met at the intersection but they made the turn first and took command. We swung in after them and went to assess the structure for ventilation. There was a decent amount of light colored smoke coming from the garage as we made our way around the house. We could see in almost every window and most of the way through the house and it was all clear of smoke so we were pretty confident that whatever fire there was would be confined to the garage. A crew went upstairs to confirm there was no fire or people inside: all clear. The initial engine crew made there way into the garage by way of a side door and were able to move through the cluttered and smoky garage to unlatch the garage door which allowed us to open it up from the outside.
There was a smoldering fire in the middle of the packed garage which was quickly and easily extinguished. It really didn't classify as a 'structure fire' but it gave us something to do and added a little excitement to my day. We helped pick up and load all the hose for the attack engine and went back to our station. I realized on the way back that we didn't have anything to hand out to trick-or-treaters if we got any. We stopped at the little market on the corner and the firefighter ran in and got a bag of blow pops.
If we weren't hungry before we certainly were now, so we put our uniforms back on and went back to the taqueria. This time we got our food and ate without interruption. We only had one small group of kids come to the door but at least we were prepared.
That night, the engineer due to relieve me called in sick and I almost got mandoed again. There was only one guy ahead of me on the list with the proper qualifications and if he had cried Family Care, I would have been hit again. Fortunately he accepted the mando and I was able to go home.
Unfortunately that station can get busy, especially at night. They had actually been shut out the day before (no calls) which is pretty unheard of for them so we kind of knew we were going to pay for that. We drilled and ran a couple calls during the day. As predicted, we wound up being up all night (four calls after midnight). Our first night call was for a diabetic who is one of their regulars. His blood sugar was in the teens and we started an IV and gave dextrose. He came around and of course didn't want to go with the ambulance. This sometimes happens and we just make sure the patient has some real food (longer lasting sugar) and someone to watch over them. We have to make sure they eat and are mentating well enough before we can leave. In this case we were on scene for an hour getting this guy to eat and stabilize. We probably should have just pulled the plug and made him go to the hospital but we were being excessively nice. After that we got up at 2 o'clock for back to back calls and again at 5 o'clock a.m. It was one of those nights where the calls are spaced just far enough apart to never get back to sleep again.
I went from that station to my regular house for my regular 48 hour shift. My house is supposed to be the slow one, but once again we ran a couple calls in the day and 2 more after midnight. I think I got 3 hours sleep on the overtime and maybe 4-4 1/2 on my first shift. The second shift wasn't as bad until the next morning when I was getting ready to come home.
At 7:30ish that morning I got a call from the BC telling me to stay put at my station because I might get mandatoried. They had one person to call before me but he was out on a medical call and they had to wait for him to get back to the station.
Did I mention this was Halloween?
Well, the guy ahead of me claimed Family Care issues (which is the only thing that can get you out of a mandatory) and so I got stuck with it. The mandatory was at my old station with my old firefighter so at least that part was good, but it meant that I would miss going out with my kids and that my wife would be stuck dealing with them for an additional 24 hours (now 96) by herself.
The firefighter had also been mandatoried and was as unhappy as I was about it. He made a good point that Halloween was the one holiday we can't do on a different day. If we work Christmas or Thanksgiving, we celebrate the day before or day after, no big deal. He asked if I though his neighbors would look at him funny when he took his kids trick or treating on November 1st.
We had an overtime captain with us for the first 12 hours and the regular captain was coming in at 8 that night. We kept the day low-key and did our regular engine and tool service and decided to just go pick up burritos instead of shopping and cooking. There is a small taqueria right across the street and down a couple so we decided to just walk over there and get dinner. So, at about 5:30 we put on our uniforms, grabbed radios, and headed across the street. We had just reached the door of the place when the radios went off: "Engine 56, Truck 57, Engine 57, Engine 40, Rescue 19 respond for a structure fire residential".
Well we took off running back to the station pulling off our uniform shirts as we went. I must admit, I always think of the scene in the Superman movie where he is running and pulls his shirt open to reveal the iconic S whenever we do that. In any case, as I put my turnouts on and checked the map for hydrant locations I knew that it was going to be a race to see who got there first. The house was in the next district over, but pretty close to the border of our district. As we flew down the street towards the address I commented that I couldn't see any smoke. Just as I said that though we could all smell it. We saw the other engine coming towards us from the opposite direction. We pretty much met at the intersection but they made the turn first and took command. We swung in after them and went to assess the structure for ventilation. There was a decent amount of light colored smoke coming from the garage as we made our way around the house. We could see in almost every window and most of the way through the house and it was all clear of smoke so we were pretty confident that whatever fire there was would be confined to the garage. A crew went upstairs to confirm there was no fire or people inside: all clear. The initial engine crew made there way into the garage by way of a side door and were able to move through the cluttered and smoky garage to unlatch the garage door which allowed us to open it up from the outside.
There was a smoldering fire in the middle of the packed garage which was quickly and easily extinguished. It really didn't classify as a 'structure fire' but it gave us something to do and added a little excitement to my day. We helped pick up and load all the hose for the attack engine and went back to our station. I realized on the way back that we didn't have anything to hand out to trick-or-treaters if we got any. We stopped at the little market on the corner and the firefighter ran in and got a bag of blow pops.
If we weren't hungry before we certainly were now, so we put our uniforms back on and went back to the taqueria. This time we got our food and ate without interruption. We only had one small group of kids come to the door but at least we were prepared.
That night, the engineer due to relieve me called in sick and I almost got mandoed again. There was only one guy ahead of me on the list with the proper qualifications and if he had cried Family Care, I would have been hit again. Fortunately he accepted the mando and I was able to go home.
Saturday, October 22, 2011
Coward
Normally, I try to keep these posts relatively light but this was messed up.
The tones went off and we were dispatched to a motor vehicle crash. En route we were given the update that it was a vehicle versus pedestrian with multiple patients. We were the second rig on scene and the first paramedic had already done a quick triage. I was split off from my crew and told by the IC to grab my monitor and go confirm the death of one of the patients. Over by some bushes at the base of a light pole there was a yellow highway blanket covering a body. I started to head over when somebody, I can't even remember who - a cop I think, stopped me and said, "Just so you know, it's a kid."
I later found out that what had happened was that two twenty-something idiots decided to peel out while leaving a gas station. They started to fishtail, lost control, and over-corrected sending them onto the sidewalk and right into two pre-teen skateboarders. The first kid tried to jump out of the way and was just grazed by the car. The other took the full force of the car and was sent flying.
I lifted the blanket and saw a twelve year old boy with his obviously lifeless eyes staring straight up at the sky. He had been thrown through the air and into the pole. He must have hit hard enough and in just the right position for it to immediately stop all his momentum because he seemed to have dropped like a stone right to the base of the pole. I thought to myself that normal physics would have had him bounce off or spin around the pole. I still don't get how he landed where he did. In any case, everything conspired against this kid that day, because if the car and hitting the pole alone didn't kill him, the four inch bolt sticking up from the bottom of the pole that went through the base of his skull certainly did. Of course, I didn't learn about the bolt until later when the coroner went to remove the body, but it didn't matter, there was no question he was dead. He had been triaged correctly. I still had to follow the protocol and hook him up to my monitor and run a strip showing him to be asystolic. I did so, and covered him back up then went to help in the extrication and treatment of the idiots in the car.
The driver of the car turned out to be a Mexican national without a driver's license who wound up leaving the hospital, fleeing the country, and supposedly returned to Mexico. I don't know how much more unlucky this kid's family can get.
Please, teach your children to respect the lives of other people, respect the power and force of a moving car and don't screw around with either. That way, maybe they won't wind up killing somebody else's kid. But if they do, I hope they are noble enough to stand up and face the consequences. I don't know how that driver can can live with himself and I can only hope that he is tortured every day by what he did.
The tones went off and we were dispatched to a motor vehicle crash. En route we were given the update that it was a vehicle versus pedestrian with multiple patients. We were the second rig on scene and the first paramedic had already done a quick triage. I was split off from my crew and told by the IC to grab my monitor and go confirm the death of one of the patients. Over by some bushes at the base of a light pole there was a yellow highway blanket covering a body. I started to head over when somebody, I can't even remember who - a cop I think, stopped me and said, "Just so you know, it's a kid."
I later found out that what had happened was that two twenty-something idiots decided to peel out while leaving a gas station. They started to fishtail, lost control, and over-corrected sending them onto the sidewalk and right into two pre-teen skateboarders. The first kid tried to jump out of the way and was just grazed by the car. The other took the full force of the car and was sent flying.
I lifted the blanket and saw a twelve year old boy with his obviously lifeless eyes staring straight up at the sky. He had been thrown through the air and into the pole. He must have hit hard enough and in just the right position for it to immediately stop all his momentum because he seemed to have dropped like a stone right to the base of the pole. I thought to myself that normal physics would have had him bounce off or spin around the pole. I still don't get how he landed where he did. In any case, everything conspired against this kid that day, because if the car and hitting the pole alone didn't kill him, the four inch bolt sticking up from the bottom of the pole that went through the base of his skull certainly did. Of course, I didn't learn about the bolt until later when the coroner went to remove the body, but it didn't matter, there was no question he was dead. He had been triaged correctly. I still had to follow the protocol and hook him up to my monitor and run a strip showing him to be asystolic. I did so, and covered him back up then went to help in the extrication and treatment of the idiots in the car.
The driver of the car turned out to be a Mexican national without a driver's license who wound up leaving the hospital, fleeing the country, and supposedly returned to Mexico. I don't know how much more unlucky this kid's family can get.
Please, teach your children to respect the lives of other people, respect the power and force of a moving car and don't screw around with either. That way, maybe they won't wind up killing somebody else's kid. But if they do, I hope they are noble enough to stand up and face the consequences. I don't know how that driver can can live with himself and I can only hope that he is tortured every day by what he did.
Wednesday, October 19, 2011
Moonlight Serenade
You never know what lies in store when you respond to a neighborhood park for a man down at 10:30 at night. Could be an assault victim, an overdose, or anything under the sun...er, moon. But most often it is just a drunk, or I should say an allegedly intoxicated person. In any case it is always a little touchy and you have to be on your guard because altered people are always unpredictable.
The guy we went on tonight was no exception. We arrived to find him sitting on the ground and the PD sitting (very relaxed) on the picnic bench in front of him. Apparently he is well known to them, but my crew is all new to this district and we had never met him. He was surrounded by empty vodka bottles and was slurring his words. He jumped with a start when my firefighter approached him but calmed down quickly. I took up a position at his side in anticipation of taking his vitals (pulse and blood pressure). He somewhat answered some of the questions my firefighter/medic was asking him and then he paused and stopped talking. I then spoke up to tell him I wanted to take his blood pressure. I guess he hadn't noticed me before then because he jumped and started crawling backwards away until we convinced him I was just another one of the firemen. Of course, we had just come from a report of a car fire and I was dressed in my full turnout gear which should have been a tip off but, as I said, the altered are unpredictable.
I took his pulse, checked his blood sugar, and got the automatic blood pressure cuff going when our patient suddenly broke into song. "I see trees of green, (mumble mumble) too". My firefighter perked up with recognition and looked over at me smiling. I looked back at him and said, "Hey man, it's a wonderful world". We had been out on the water boat training earlier in the day and had been running a few calls in the evening and we were all feeling pretty good so it was a pretty true statement. Our patient continued to attempt the song as we got him loaded up for the ambulance, "I see blue...jeans, and more trees too". Being drunk and homeless he even had a bit of that raspy, gravely quality to his voice that old Louis had.
When's the last time someone sang to you at work?
The guy we went on tonight was no exception. We arrived to find him sitting on the ground and the PD sitting (very relaxed) on the picnic bench in front of him. Apparently he is well known to them, but my crew is all new to this district and we had never met him. He was surrounded by empty vodka bottles and was slurring his words. He jumped with a start when my firefighter approached him but calmed down quickly. I took up a position at his side in anticipation of taking his vitals (pulse and blood pressure). He somewhat answered some of the questions my firefighter/medic was asking him and then he paused and stopped talking. I then spoke up to tell him I wanted to take his blood pressure. I guess he hadn't noticed me before then because he jumped and started crawling backwards away until we convinced him I was just another one of the firemen. Of course, we had just come from a report of a car fire and I was dressed in my full turnout gear which should have been a tip off but, as I said, the altered are unpredictable.
I took his pulse, checked his blood sugar, and got the automatic blood pressure cuff going when our patient suddenly broke into song. "I see trees of green, (mumble mumble) too". My firefighter perked up with recognition and looked over at me smiling. I looked back at him and said, "Hey man, it's a wonderful world". We had been out on the water boat training earlier in the day and had been running a few calls in the evening and we were all feeling pretty good so it was a pretty true statement. Our patient continued to attempt the song as we got him loaded up for the ambulance, "I see blue...jeans, and more trees too". Being drunk and homeless he even had a bit of that raspy, gravely quality to his voice that old Louis had.
When's the last time someone sang to you at work?
Sunday, October 9, 2011
Sounds Good On Paper & The Dangers Of Code 3 Driving
I worked a trade for the engineer at my old station the other day. The captain was an overtime captain and the firefighter was one of our new probies and we had a reserve firefighter riding along for the first eight hours. We did some rescue training during the day but the ride along curse was in full effect and we were shut out for calls...until bedtime.
I was just turning in for the night knowing that the odds of us getting up later was pretty good. Then in the space of a couple of hours we responded to a series of calls that all sounded very exciting and dramatic.
The first came in as an unknown medical with staging required, which means police are on the way and it is not safe for us to enter until police have secured the scene. Our update stated we were responding for a possible stabbing/shooting/penetrating trauma. When we arrived on scene at the gated apartment complex, the police were trying to punch in the code to activate the gate. I have a remote for the gate on my rig so I opened it for them as we pulled up and followed them into the complex where a man came running up towards us waving and directing us in.
As we rolled in the radio dispatched a call for the next district over that we would have gone to if we weren't already engaged: "Enging 59, Truck 41 respond to a vehicle accident with rescue - police car on its roof". I thought, damn, I'd much rather be going to that call, although I do have a pretty good trauma waiting for me just ahead. Dispatch immediately updated that the officer is fine and no medical needed, all units can cancel.
We were waved in by the cops in front of us and we approached the patient and the small crowd around her. She was a 20 year old girl who was bleeding from her........pinky.
Apparently she got in an argument with her boyfriend who grabbed her keychain out of her hands. Her keychain has a very small knife on it and her finger got cut. This happened approximately a half hour ago several cities away. She got her keys back and drove home and then called 9-1-1. And, in responding code 3 to this dangerous stabbing, a police car flipped over. We wrapped her finger with guaze and sent her away with the ambulance.
We decided to drive by the police accident scene to check it out and go over vehicle stabilization with our probie. The officer was fine, though covered in coffee. The car looked terrible. The right front end was pushed in and it was still upside down with the lights on and airbags deployed.
The funny thing is that the car was by itself in an empty school parking lot. Turns out that the officer was patroling by the school when the stabbing call came in and when he went to turn on his lights, he hit his radio instead. He momentarily looked down to correct it and when he looked up he was running into a stanchion pole. He was only going about 15 mph because he hadn't hit the gas yet but the impact caused his foot, hovering over the gas pedal, to "punch it" which sent him flying off the stanchion and on to his roof. We waited until we got back to our rig before we started laughing.We got back to the station and headed for bed. I was pulling my sweatshirt off over my head when the lights and tones went off again. I slid back down the pole and we responded to a man having a heart attack at the gas station. This could be another good call for the probie. Of course, when we arrived on scene we found one of our new regular drunks sitting on the planter. He does have a cardiac history but by his own admission he was drunk and not all of his symptoms were jiving with a real cardiac event. I did a 12 lead ekg to be sure, shaving enough hair off his chest to cover a small animal in the process, and there was nothing glaring or alarming at all on the printout. The ambulance was right on our heels so we let them have the patient and headed home.
Of course, the next morning during shift change, my report to the oncoming medic just said that we had a busy night with a stabbing, a heart attack, and a code 3 police rollover. They don't need to know the details.
Friday, October 7, 2011
New Digs
Well, I decided to put in my bid for a new station. After my 3 station department joined the county department I have worked at about ten new (to me) stations. Some were places I knew I didn't really want to work and others were fine but didn't present an overwhelming reason to leave my comfort zone of the station and town I'd been in for so many years. The one that did intrigue me was the station that houses the rescue boat. I figured that was something so different than what I've done so far in my career that it could be worth the move. The station is in another city which is about 20-25 minutes closer to home for me, so it will improve my commute a bit as well.
A spot opened up at that station and the firefighter there was already someone I knew from my old department so it would make the transition even easier. I was awarded the bid and had my first tour at the new station. The boat was in the shop so I didn't get to check it out but the engine there is pretty good. It's old and has some problems but it's not bad. It is nice to be back on an engine after the cramped/crowded Quint I've been driving. The rumor is that the department will be getting 2-4 new engines and one of them may be slated for my new station.
I fear this blog may suffer a bit though. The district is small, pretty well kept, and has a predominately older population. It is also pretty slow. We had one call in the next district over for a kid on a special needs bus who got punched by another kid on the first day and one in our district the next day for an elderly woman with back pain. We are, however, surrounded by some busier stations and could get their overflow and respond in to any structure fire in those districts, so here's hoping.
Once the boat comes back and I get to start training on it, there should be enough to occupy my time but I think the volume and variety of calls I will be going on will be quite diminished from what I'm used to.
The firefighter is two spots away from a promotion so he will probably be gone by mid-next-year and there is a temporary captain there right now. So, I don't really know who my crew will end up being, but however it works out, hopefully the boat will make it worthwhile.
Friday, September 16, 2011
Sayings
There's a saying in the fire service that goes "Something will always go wrong. It's all about the recovery." This proved very true today.
We were having a badge pinning/promotion celebration for one of our departments newest engineers and had about 50 people at the station. It was just winding down when the tones went off. The crew from the neighboring district was at our station meeting with the Battalion Chief so the call was given to us. I didn't hear the nature of the call until we were on our way and the captain told me it was a 41 year old female unconscious, not breathing. We had a little bit longer of a drive than usual and a piece of equipment (the AutoPulse, automatic CPR device) that was being temperamental lately, so my captain called for another engine to respond with us.
We got an update en route that the police department was on scene and had CPR in progress. We arrived a minute later and brought all our gear in, the captain bringing the auto pulse. My firefighter took over CPR, I got out the BVM and dropped an OPA in the patient (is that enough acronyms for ya?). We got the patient put on the auto pulse and immediately had a battery failure. OK, recovery, switch batteries and turn the machine on again. This time it ran fine but the captain radioed the second crew to bring in extra batteries just in case. The second crew and the ambulance arrived, just as the auto pulse died again. We swapped batteries out again and it ran fine. I assigned one of the ambulance medics to the airway while I looked for IV access. The ambulance medic got the tube and although it was virtually a blind stick, I got a flash in my IV catheter that meant I was in. I turned to get the IV tubing and hook it into place and somehow bent the IV catheter in the process. It's flexible so I hoped it would still work. It didn't, I had no flow from the IV bag. The medic from the other crew was setting up for an IO or intra-osseous IV, that is, one that is drilled into the bone of the tibia (literally with a small drill).
I found the landmark for him and he went ahead and drilled. This woman was pretty large and the drill isn't the best for large people but he got in, bone marrow was aspirated, the IV was flowing, and we started pushing medications. Recovery.
We hooked up the CO2 monitor to the tube the ambulance medic had put in and got no reading. All other signs that the tube was good were present but we decided to pull it and put in a different kind of tube. This one got a reading and we went with it. Recovery.
It was at this time that I glanced at the IO and noticed a lot of swelling at the site meaning the needle was dislodged from the bone and the fluid and meds we were giving were not getting into the patients circulation.
At this time we decided to get moving and loaded the patient into the ambulance. My firefighter and I jumped aboard and rode along to the hospital. On the way, the ambulance medic got a new IV in the patients other arm (recovery) and after one more round of drugs we got the patient's pulse back. We still couldn't get a blood pressure and the patient wasn't breathing on her own, but we were able to stop CPR. We also checked her blood sugar level and it was high at 343. The heart rate was fast but looked good. I don't believe this was actually cardiac related and am quite curious as to the cause of this woman's arrest.
By the time we brought her into the hospital she had palpable pulses all the way down to her wrist, a heart rate of 120-150, and perfect CO2 numbers.
Now she too has at least a fighting chance at recovery.
Sunday, September 11, 2011
9/11
I had some people ask me recently where I was on 9-11, so in case you wondered and though not very exciting, here it is.
I was working on 9/10 and had just gotten up on the morning of 9/11 at the firehouse. I had only been a firefighter for a little over a year. It was just before 7 a.m. and when I walked out of the dorms into the day room I found my crew and another firefighter from the oncoming shift who had arrived early all with their arms folded standing behind the lounge chairs staring at the TV. I could tell right away that something was wrong. No one was sitting in the chairs, they were all standing as if at attention and above all else, everyone was silent. That rarely happens in the firehouse, especially if the news is on because there is usually a sarcastic running commentary or jokes about the top stories by at least one member of the crew if not several. Also, no one acknowledged me entering the room. I joined the crew in watching the story unfold. I didn't say a word or ask any questions. As the first tower fell, the only thing I could even think to say in my head was, "Holy shit, I don't believe what I'm seeing."
At that same time, another of our crews (my crew now) was responding to a call in our six story City Hall building and was walking up the interior stair well. They stepped out into an office on one of the floors and heard the news. The only one who wasn't with them was the engineer who sat blissfully on the fire engine completely unaware that the world had changed.
I was working on 9/10 and had just gotten up on the morning of 9/11 at the firehouse. I had only been a firefighter for a little over a year. It was just before 7 a.m. and when I walked out of the dorms into the day room I found my crew and another firefighter from the oncoming shift who had arrived early all with their arms folded standing behind the lounge chairs staring at the TV. I could tell right away that something was wrong. No one was sitting in the chairs, they were all standing as if at attention and above all else, everyone was silent. That rarely happens in the firehouse, especially if the news is on because there is usually a sarcastic running commentary or jokes about the top stories by at least one member of the crew if not several. Also, no one acknowledged me entering the room. I joined the crew in watching the story unfold. I didn't say a word or ask any questions. As the first tower fell, the only thing I could even think to say in my head was, "Holy shit, I don't believe what I'm seeing."
At that same time, another of our crews (my crew now) was responding to a call in our six story City Hall building and was walking up the interior stair well. They stepped out into an office on one of the floors and heard the news. The only one who wasn't with them was the engineer who sat blissfully on the fire engine completely unaware that the world had changed.
Saturday, September 10, 2011
Ingenuity
Never count out the ingenuity of the drunks at the local pub. Their judgement and ability to think things through all the way...that you can call into question.
We responded to a call for a man down in the parking lot of one of my district's local watering holes. This is not a pub we go to routinely, they don't usually fight or get into trouble. We'd gone there a couple of times because they had an illegal outdoor fire pit, things like that. So, this was a little unusual.
As I drove through the parking lot and was about to turn in the direction of the front door of the pub, we were flagged down and directed to the opposite end of the parking lot. I turned that way and headed toward the small group of people circled around a man laying on the ground. I got out and went to the man on the ground who was conscious and perfectly able to talk to me. He didn't even appear really drunk. He and the excited, sometimes laughing crowd proceeded to explain that he was on the ground because he had crashed. Crashed? There were no cars or bikes or motorcycles on this end of the parking lot. Crashed what? And then, from behind the half circle of bar patrons, someone revealed the motorized bar stool my patient had been riding.
Yes, somewhere, somehow, someone thought this would be a great idea. They did an okay job of putting the thing together too. I can only imagine the excited yells and cheers and laughter of the crowd as this guy took off from the doorway of the pub and went zipping off across the parking lot. This was of course followed by the wincing, cringing, "Ooohhh"s and probably more laughter as he attempted to turn the thing. I'm guessing the stool probably cornered fine, however the close to 200 pound driver sitting, unsecured, high atop the careening barstool....well, if you remember anything from physics class about momentum and centrifugal force then you can pretty much picture the scene.
My patient was banged up and scraped up enough to go to the hospital for x-rays but I don't think he was seriously hurt in any way. He may be rethinking the logic of the motorized barstool now, but I think it's probably more likely that he is pondering how to solve the cornering problem. Only time will tell.
We responded to a call for a man down in the parking lot of one of my district's local watering holes. This is not a pub we go to routinely, they don't usually fight or get into trouble. We'd gone there a couple of times because they had an illegal outdoor fire pit, things like that. So, this was a little unusual.
As I drove through the parking lot and was about to turn in the direction of the front door of the pub, we were flagged down and directed to the opposite end of the parking lot. I turned that way and headed toward the small group of people circled around a man laying on the ground. I got out and went to the man on the ground who was conscious and perfectly able to talk to me. He didn't even appear really drunk. He and the excited, sometimes laughing crowd proceeded to explain that he was on the ground because he had crashed. Crashed? There were no cars or bikes or motorcycles on this end of the parking lot. Crashed what? And then, from behind the half circle of bar patrons, someone revealed the motorized bar stool my patient had been riding.
Yes, somewhere, somehow, someone thought this would be a great idea. They did an okay job of putting the thing together too. I can only imagine the excited yells and cheers and laughter of the crowd as this guy took off from the doorway of the pub and went zipping off across the parking lot. This was of course followed by the wincing, cringing, "Ooohhh"s and probably more laughter as he attempted to turn the thing. I'm guessing the stool probably cornered fine, however the close to 200 pound driver sitting, unsecured, high atop the careening barstool....well, if you remember anything from physics class about momentum and centrifugal force then you can pretty much picture the scene.
My patient was banged up and scraped up enough to go to the hospital for x-rays but I don't think he was seriously hurt in any way. He may be rethinking the logic of the motorized barstool now, but I think it's probably more likely that he is pondering how to solve the cornering problem. Only time will tell.
Sunday, September 4, 2011
Not a leg to stand on.
We got called out for a non-emergency lift assist. Basically, a "I've fallen and I can't get up" call. No lights, no sirens, it should have been simple. However, the first thing we encountered was that the front door was locked. I was able to communicate with the patient through the door as the rest of the crew looked for another way in. Fortunately they found the back slider unlocked. Unfortunately they also found a large wasp nest right over the door. We slowly opened the slider and the firefighter ducked in. He then went and unlocked the front door for the rest of us.
When I walked into the house I immediately had to start breathing through my mouth. It had the overpowering and undeniable smell of necrotic tissue, neglect, and decay. Our patient was sitting on the floor in front of her lounge chair (where I think she lives most of the time) wearing only a very large, over-sized t-shirt. Her legs, from the knees down, were black, pitted, and looked on the verge of rotting. My captain stated later, that it looked like you could scrape off a half inch of flesh from her legs and she wouldn't notice or feel a thing. She had called because she didn't have the strength to get herself back in the chair and not for any medical care. My captain asked her if she was sure she was OK because her legs didn't look good. She shrugged that off and said she was fine and just needed help into her chair. When asked, she said she was over 300 pounds but I think she might not have weighed herself in a while because she felt closer to four. We wound up using a tarp with handles under her and all three of us lifting just to get her lying half way on the chair. We had to readjust, re-grip, and lift again to get her all the way into the chair. We then had her lean one way and then the next to get the tarp back out from under her. We put back the furniture we had moved to accomplish our task and returned to quarters.
I don't know if that smell had penetrated my shirt or my nose or what, but I kept getting phantom/memory smells of that leg. Perhaps it is some form of olfactory post traumatic stress disorder. I wound up taking a shower and changing my clothes, hoping that that would take care of it and finally put an end to the call that kept on giving.
When I walked into the house I immediately had to start breathing through my mouth. It had the overpowering and undeniable smell of necrotic tissue, neglect, and decay. Our patient was sitting on the floor in front of her lounge chair (where I think she lives most of the time) wearing only a very large, over-sized t-shirt. Her legs, from the knees down, were black, pitted, and looked on the verge of rotting. My captain stated later, that it looked like you could scrape off a half inch of flesh from her legs and she wouldn't notice or feel a thing. She had called because she didn't have the strength to get herself back in the chair and not for any medical care. My captain asked her if she was sure she was OK because her legs didn't look good. She shrugged that off and said she was fine and just needed help into her chair. When asked, she said she was over 300 pounds but I think she might not have weighed herself in a while because she felt closer to four. We wound up using a tarp with handles under her and all three of us lifting just to get her lying half way on the chair. We had to readjust, re-grip, and lift again to get her all the way into the chair. We then had her lean one way and then the next to get the tarp back out from under her. We put back the furniture we had moved to accomplish our task and returned to quarters.
I don't know if that smell had penetrated my shirt or my nose or what, but I kept getting phantom/memory smells of that leg. Perhaps it is some form of olfactory post traumatic stress disorder. I wound up taking a shower and changing my clothes, hoping that that would take care of it and finally put an end to the call that kept on giving.
Monday, August 29, 2011
Smooth Cluster
The nature of this business is, essentially, bringing order to chaos. It doesn't always go smoothly, but I love it when everything falls into place, all the jobs get done, and the team works together.
We responded to a report of a 25 year old male unconscious. No other information. Well, this could be anything. It turned out to be a combination of things. When we arrived on scene, we found our patient passed out in the driveway just outside the front door of the house. There were a couple of steps up to the door and at the top of the steps sat an empty wheelchair. According to the other people on scene, they were bringing him into the house in the wheelchair and he fell out face first on to the cement. They had rolled him over to his back which is how we found him. He didn't have any obvious trauma or bleeding of any kind although he was incontinent to urine (maybe more). I don't know how hard he hit the ground but he was out, out, out. I directed the firefighter to take manual c-spine and asked about the patients medical history and if he was perhaps diabetic. He was. I checked his sugar and it came back at 57. Now, this is low and low enough to be treated with IV glucose, but not so low that he should be this unconscious. So what was the real cause here? Did he fall out because he was hypoglycemic or did the fall knock him out and he also happens to be a little low on blood sugar? Chicken/egg, egg/chicken.
Well, the low blood sugar I can fix so we started there. Unbeknownst to me, while I was getting the blood sugar, my captain (also a medic but usually working the clipboard and not the patient) had begun setting up for the IV. I gave the firefighter the IV bag to spike and flood. He had to hold c-spine with his knees while he flooded the bag but the patient was so deeply unconscious he wasn't moving anyway. I started looking for IV access on the other arm just in case the captain didn't get it but since he had a headstart he got the IV (his first in about a year I think) before me. I got the glucose ready while the captain secured the IV and, warning the firefighter to be ready on the c-spine for when this guy woke up, pushed the sugar in. The ambulance crew arrived at this time and began setting up for full spinal precautions (rigid neck collar, long backboard, pads and tape for his head, and straps to hold him to the board).
The patient started to come around with the sugar on board and could now talk to us. I'm still not convinced this was purely a sugar problem alone since 57 really isn't that low, but it got our patient back to alert and oriented before he went off to the hospital.
There wasn't really any major chaos or anxiety, but I appreciated how all the jobs got done, and done well, with a minimum of verbal communication. Everybody knew what needed to be done and did what the other person wasn't doing. We had a bit of a confusing mystery, more or less solved and a patient who was deeply unconscious in the driveway talking and answering questions by the time the ambulance arrived. The firefighter was multi-tasking, the captain was using his rusty medic skills, and all the right care was being given. When scenes run smooth and the outcome is good it just make you appreciate professionals.
We responded to a report of a 25 year old male unconscious. No other information. Well, this could be anything. It turned out to be a combination of things. When we arrived on scene, we found our patient passed out in the driveway just outside the front door of the house. There were a couple of steps up to the door and at the top of the steps sat an empty wheelchair. According to the other people on scene, they were bringing him into the house in the wheelchair and he fell out face first on to the cement. They had rolled him over to his back which is how we found him. He didn't have any obvious trauma or bleeding of any kind although he was incontinent to urine (maybe more). I don't know how hard he hit the ground but he was out, out, out. I directed the firefighter to take manual c-spine and asked about the patients medical history and if he was perhaps diabetic. He was. I checked his sugar and it came back at 57. Now, this is low and low enough to be treated with IV glucose, but not so low that he should be this unconscious. So what was the real cause here? Did he fall out because he was hypoglycemic or did the fall knock him out and he also happens to be a little low on blood sugar? Chicken/egg, egg/chicken.
Well, the low blood sugar I can fix so we started there. Unbeknownst to me, while I was getting the blood sugar, my captain (also a medic but usually working the clipboard and not the patient) had begun setting up for the IV. I gave the firefighter the IV bag to spike and flood. He had to hold c-spine with his knees while he flooded the bag but the patient was so deeply unconscious he wasn't moving anyway. I started looking for IV access on the other arm just in case the captain didn't get it but since he had a headstart he got the IV (his first in about a year I think) before me. I got the glucose ready while the captain secured the IV and, warning the firefighter to be ready on the c-spine for when this guy woke up, pushed the sugar in. The ambulance crew arrived at this time and began setting up for full spinal precautions (rigid neck collar, long backboard, pads and tape for his head, and straps to hold him to the board).
The patient started to come around with the sugar on board and could now talk to us. I'm still not convinced this was purely a sugar problem alone since 57 really isn't that low, but it got our patient back to alert and oriented before he went off to the hospital.
There wasn't really any major chaos or anxiety, but I appreciated how all the jobs got done, and done well, with a minimum of verbal communication. Everybody knew what needed to be done and did what the other person wasn't doing. We had a bit of a confusing mystery, more or less solved and a patient who was deeply unconscious in the driveway talking and answering questions by the time the ambulance arrived. The firefighter was multi-tasking, the captain was using his rusty medic skills, and all the right care was being given. When scenes run smooth and the outcome is good it just make you appreciate professionals.
Saturday, August 20, 2011
Decompression
This is not an easy job, for all the reasons I'm sure you've heard or can imagine and then some. I can't imagine doing it without the support of my family. From the time and effort put into training and traveling to take every test I could afford to reach to the heartache of constant rejection and struggling to achieve something I knew I wanted so much. But, having achieved my goal of joining the fire service, now more than anything it is having a place to go when things go bad on the job that, I believe, can make or break a fireman.
I responded to a call for a female, I'll say girl because that's the way I remember it although I can't recall her age, experiencing a miscarriage. I was on a crew with another medic but I was the lead medic on this call so I was the patient person. When we arrived we were led to the bedroom where the girl sat on a mattress on the floor bleeding. It was dark in the room and as I moved to examine her I could already see the umbilical cord. Worse, I could see something at the other end of the cord. This girl was only 18 weeks pregnant and with a baby that young there is nothing at all we can do. There would not be any attempt made at resuscitation. It was too late for that anyway. I used my pen light to examine the baby and found it to be surprisingly well formed and more identifiable than I would've expected. It didn't seem like a fetus, though that's what it was. It seemed like a miniature baby. I remember not knowing what to say and that it was so quiet in the room. Everyone just knew and accepted it. Not accepted it in the sense that they were okay with it but in the sense that they knew it was a time to mourn and be respectful.
The girl still had to be transported to the hospital as the placenta had not delivered and she needed further care. I asked the firefighter to get me an emesis basin from the rig while I wrapped the baby in gauze. When he returned I placed the baby in the basin, a beige square bucket about 10" by 10". This seemed so wrong to me, but it was really the best and only way to do what needed to be done. i tried to pad the basin and make it more like a bed than a receptacle but it still didn't feel right. The girl's bleeding had stopped and it was really just a matter of getting them to the hospital and consoling her now, though there was really nothing to say. The ambulance arrived and they all left silently.
When we returned to the station the captain asked us if we were okay and if we needed anything, like a stress debriefing. We both declined and said we were alright. I thought I was alright at the time too, sad but okay. This certainly is a part of my job. But it was a call and an image I couldn't shake. I couldn't help but think about it over and over again for the rest of the shift.
By the time I left work, I was just down. It was a weekend day when I drove home so everyone was home when I got there, my wife and all the kids. I didn't say anything and went about my normal routine when I got home. I was definitely affected and although I didn't realize it, I was projecting. My wife didn't get exactly what was going on but she could sense it. In fact, she started to get upset with me, saying, "God, you just got home and you're just thoroughly depressing." This is where it was vitally important to be honest and communicate. I could've gotten upset right back or ignored it but I didn't want to. I told her I had a really bad call last night and I couldn't shake it. I told her what had happened and she asked me what I wanted to do. I told her I just wanted to go out and have a day with the kids. We all loaded up in the van and went out to a park near the lake, had a picnic, played on the swings, and walked around the lake.
It was perfect. It literally made all the difference. I relaxed, I let it go, I enjoyed my family and my life. I believe that kind of outlet is essential to anyone in this type of work. Any type of work really. I don't know where I would be without it.
I will still never forget that call or that image, but it has softened considerably. I struggled to remember the details of the call as I wrote this; did I cut the cord?, what did the girl look like?, did she say anything? I don't remember. Those moments are awful. Those moments are heartbreaking. But, I'm glad to be the one to help those going through it. And I'm thankful for those in my life who help me move past it, re-energize, and go back each day to face it again.
I responded to a call for a female, I'll say girl because that's the way I remember it although I can't recall her age, experiencing a miscarriage. I was on a crew with another medic but I was the lead medic on this call so I was the patient person. When we arrived we were led to the bedroom where the girl sat on a mattress on the floor bleeding. It was dark in the room and as I moved to examine her I could already see the umbilical cord. Worse, I could see something at the other end of the cord. This girl was only 18 weeks pregnant and with a baby that young there is nothing at all we can do. There would not be any attempt made at resuscitation. It was too late for that anyway. I used my pen light to examine the baby and found it to be surprisingly well formed and more identifiable than I would've expected. It didn't seem like a fetus, though that's what it was. It seemed like a miniature baby. I remember not knowing what to say and that it was so quiet in the room. Everyone just knew and accepted it. Not accepted it in the sense that they were okay with it but in the sense that they knew it was a time to mourn and be respectful.
The girl still had to be transported to the hospital as the placenta had not delivered and she needed further care. I asked the firefighter to get me an emesis basin from the rig while I wrapped the baby in gauze. When he returned I placed the baby in the basin, a beige square bucket about 10" by 10". This seemed so wrong to me, but it was really the best and only way to do what needed to be done. i tried to pad the basin and make it more like a bed than a receptacle but it still didn't feel right. The girl's bleeding had stopped and it was really just a matter of getting them to the hospital and consoling her now, though there was really nothing to say. The ambulance arrived and they all left silently.
When we returned to the station the captain asked us if we were okay and if we needed anything, like a stress debriefing. We both declined and said we were alright. I thought I was alright at the time too, sad but okay. This certainly is a part of my job. But it was a call and an image I couldn't shake. I couldn't help but think about it over and over again for the rest of the shift.
By the time I left work, I was just down. It was a weekend day when I drove home so everyone was home when I got there, my wife and all the kids. I didn't say anything and went about my normal routine when I got home. I was definitely affected and although I didn't realize it, I was projecting. My wife didn't get exactly what was going on but she could sense it. In fact, she started to get upset with me, saying, "God, you just got home and you're just thoroughly depressing." This is where it was vitally important to be honest and communicate. I could've gotten upset right back or ignored it but I didn't want to. I told her I had a really bad call last night and I couldn't shake it. I told her what had happened and she asked me what I wanted to do. I told her I just wanted to go out and have a day with the kids. We all loaded up in the van and went out to a park near the lake, had a picnic, played on the swings, and walked around the lake.
It was perfect. It literally made all the difference. I relaxed, I let it go, I enjoyed my family and my life. I believe that kind of outlet is essential to anyone in this type of work. Any type of work really. I don't know where I would be without it.
I will still never forget that call or that image, but it has softened considerably. I struggled to remember the details of the call as I wrote this; did I cut the cord?, what did the girl look like?, did she say anything? I don't remember. Those moments are awful. Those moments are heartbreaking. But, I'm glad to be the one to help those going through it. And I'm thankful for those in my life who help me move past it, re-energize, and go back each day to face it again.
Tuesday, August 9, 2011
Hey, look! A train.
A friend and co-worker recently blogged about a fire he had near the railroad tracks which reminded me of a call I had early in my career which taught me a valuable lesson.
In the back of the district I was working in then there is a business park. Behind the business park is a small sound wall separating it from the railroad tracks. Behind the tracks is an empty field that runs right up to a freeway overpass. This field and the space under the overpass is routinely used as a homeless encampment and subsequently catches fire just about once a year.
We responded to a report of smoke in the area of the business park. We drove to the back of the buildings along the sound wall. This district and the overpass happen to border the city limits so we had an engine from the neighboring city responding as well. They were a few minutes behind us.
From over the sound wall we could see that there was a tree on fire across the tracks and that the field was starting to take off as well.
With our not so great position and lack of a convenient water supply and the real potential for the fire to spread quickly, my captain decided that we should use our deck gun and quickly knock down whatever we could hit. The deck gun is a large, turret mounted, fog nozzle up on the top of the rig. It is capable of putting out 1000-1200 gallons per minute. The water tank on the engine holds 500 gallons and without a water supply that meant we had less than 30 seconds to accomplish our goal before we had to shut down or risk cavitating the pump on the engine. We had a pretty good angle of attack over the sound wall and decided to douse the tree and whatever grass we could hit.
As we began to put water on the fire, the engine from the other city arrived. We knocked down a good chunk of the fire on the tree but not a lot of the spreading grass fire. Our water ran out and the field was still burning, so this other engine crew pulled a line off their rig, climbed over the sound wall, crossed the railroad tracks and began putting out the fire. In their minds, I'm sure it was a cool, cowboy move and they would be able to brag about how they put out our fire.
\We, on the other hand, were thinking like the one smart kid from Stand By Me who said, "Anybody know when the next train is due?"
As if on cue, we heard the horn in the distance.
"Trraaaaaaaainnnnnn!"
The other crew had about 100 feet of hose stretched across the tracks, fully charged. Which meant they couldn't just disconnect it because the pressure was too great. We shouted to the engineer to shut down and to the hose crew to 'bleed the line' (that is open the bale and let the water flow to help drain the hose) and, of course, to drop the hose immediately. We then joined the engineer in frantically pulling the line hand over hand back over the tracks and the sound wall. It was like a game of tug of war where the loser, instead of falling in the mud, gets hit by a train. In hindsight, it was quite comical. Even in the moment it was funny but we were a little too busy racing the train to laugh just yet.
We literally pulled the end of the line over the soundwall about 100 feet in front of the passing train. So, the valuable lessons learned were:
#1 - Don't ever stretch lines over train tracks.
#2 - Cowboys are stupid.
We work on the tracks plenty, but we never stretch lines across an active railroad track. If we are going to work on an active line, we radio whichever railroad runs on it and have them shut it down. We then confirm it is shut down before we go to work on it.
One of the things I did find funny about that incident was the fact that in most Fire Department Entry Level Physical Agility Tests there is an evolution in which you pull a hose 100 or so feet and then hand over hand pull all the hose over the finish line as fast as you can. I guess I now know why that's in the test.
In the back of the district I was working in then there is a business park. Behind the business park is a small sound wall separating it from the railroad tracks. Behind the tracks is an empty field that runs right up to a freeway overpass. This field and the space under the overpass is routinely used as a homeless encampment and subsequently catches fire just about once a year.
We responded to a report of smoke in the area of the business park. We drove to the back of the buildings along the sound wall. This district and the overpass happen to border the city limits so we had an engine from the neighboring city responding as well. They were a few minutes behind us.
From over the sound wall we could see that there was a tree on fire across the tracks and that the field was starting to take off as well.
With our not so great position and lack of a convenient water supply and the real potential for the fire to spread quickly, my captain decided that we should use our deck gun and quickly knock down whatever we could hit. The deck gun is a large, turret mounted, fog nozzle up on the top of the rig. It is capable of putting out 1000-1200 gallons per minute. The water tank on the engine holds 500 gallons and without a water supply that meant we had less than 30 seconds to accomplish our goal before we had to shut down or risk cavitating the pump on the engine. We had a pretty good angle of attack over the sound wall and decided to douse the tree and whatever grass we could hit.
As we began to put water on the fire, the engine from the other city arrived. We knocked down a good chunk of the fire on the tree but not a lot of the spreading grass fire. Our water ran out and the field was still burning, so this other engine crew pulled a line off their rig, climbed over the sound wall, crossed the railroad tracks and began putting out the fire. In their minds, I'm sure it was a cool, cowboy move and they would be able to brag about how they put out our fire.
\We, on the other hand, were thinking like the one smart kid from Stand By Me who said, "Anybody know when the next train is due?"
As if on cue, we heard the horn in the distance.
"Trraaaaaaaainnnnnn!"
We literally pulled the end of the line over the soundwall about 100 feet in front of the passing train. So, the valuable lessons learned were:
#1 - Don't ever stretch lines over train tracks.
#2 - Cowboys are stupid.
We work on the tracks plenty, but we never stretch lines across an active railroad track. If we are going to work on an active line, we radio whichever railroad runs on it and have them shut it down. We then confirm it is shut down before we go to work on it.
One of the things I did find funny about that incident was the fact that in most Fire Department Entry Level Physical Agility Tests there is an evolution in which you pull a hose 100 or so feet and then hand over hand pull all the hose over the finish line as fast as you can. I guess I now know why that's in the test.
Saturday, August 6, 2011
Breaking and Entering
There are a lot of times and a lot of reasons why we in the fire service might have to force entry into a building, vehicle, or what-have-you. We have a variety of tools to accomplish this, from simply kicking down a door, to using the 'irons' or haligan/axe combo, taking a circular saw to a roll up door, or using specialized auto tools to get into a locked car without damaging it.
For the most part we try to do as little damage as possible unless it is an absolute emergency. My favorite trick for avoiding damage was one my captain pulled out of his mental toolbox a little while back.
We were called to a house where the resident had locked herself out with her child still inside. Normally, we try to get in through a window or other entry point before we start destroying things, but there was no way into this place. We knew we were going to have to force the front door. This of course is usually quite destructive and costly no matter how well you do it. However, my captain figured out a great way to get in with the most minimal amount of damage. We took our reciprocating saw with a metal cutting blade and simply cut off the doorknob. This way we only had to use pliers to turn the inner mechanism and open the door (house thieves, please disregard the preceeding instructions).
The homeowner now only had to replace and re-key her doorknob instead of replacing an entire front door. It worked great.
The golden rule in all forcible entry, though, is 'Try Before You Pry'. That is, always try to open a door or find another way in before you resort to forcing anything.
Sometimes you need to try twice.
For example, I worked with a different captain and we responded to a report of an unknown medical. When we arrived on scene the captain went to the front door and tried it, only to find that it was locked. He radioed dispatch to see if they could call back the RP (reporting party) to let them know we were there and to let us in. The ambulance pulled up and I went around to the back of the house to look for another way in. I found that the sliding glass door to the backyard was unlocked. I went and got my captain and he followed me around to the back and we entered in through the slider. We moved through the kitchen to the living room where we ran into our firefighter and the ambulance crew. My surprised captain asked how they got in, to which they responded, "The door was unlocked".
So, maybe we need to revise our rule to Try Before You Pry And Then Try Again. Or, to quote my abashed and colorful captain, "Open the door with your man-hand like the firefighter did and not with your pussy-hand like the captain."
Of course, it turns out that our potential patient had decided to just drive himself on to the hospital. I guess he didn't want to wait the full 3-4 minutes it took us to get there. He was very fortunate that the sliding door was unlocked or he would have come home to a lot of damage and no one to blame but himself. If you call 9-1-1 and then leave, do us all a favor and call back to inform the dispatchers. It could save us all a whole lot of trouble.
For the most part we try to do as little damage as possible unless it is an absolute emergency. My favorite trick for avoiding damage was one my captain pulled out of his mental toolbox a little while back.We were called to a house where the resident had locked herself out with her child still inside. Normally, we try to get in through a window or other entry point before we start destroying things, but there was no way into this place. We knew we were going to have to force the front door. This of course is usually quite destructive and costly no matter how well you do it. However, my captain figured out a great way to get in with the most minimal amount of damage. We took our reciprocating saw with a metal cutting blade and simply cut off the doorknob. This way we only had to use pliers to turn the inner mechanism and open the door (house thieves, please disregard the preceeding instructions).
The homeowner now only had to replace and re-key her doorknob instead of replacing an entire front door. It worked great.
The golden rule in all forcible entry, though, is 'Try Before You Pry'. That is, always try to open a door or find another way in before you resort to forcing anything.
Sometimes you need to try twice.
For example, I worked with a different captain and we responded to a report of an unknown medical. When we arrived on scene the captain went to the front door and tried it, only to find that it was locked. He radioed dispatch to see if they could call back the RP (reporting party) to let them know we were there and to let us in. The ambulance pulled up and I went around to the back of the house to look for another way in. I found that the sliding glass door to the backyard was unlocked. I went and got my captain and he followed me around to the back and we entered in through the slider. We moved through the kitchen to the living room where we ran into our firefighter and the ambulance crew. My surprised captain asked how they got in, to which they responded, "The door was unlocked".
So, maybe we need to revise our rule to Try Before You Pry And Then Try Again. Or, to quote my abashed and colorful captain, "Open the door with your man-hand like the firefighter did and not with your pussy-hand like the captain."Of course, it turns out that our potential patient had decided to just drive himself on to the hospital. I guess he didn't want to wait the full 3-4 minutes it took us to get there. He was very fortunate that the sliding door was unlocked or he would have come home to a lot of damage and no one to blame but himself. If you call 9-1-1 and then leave, do us all a favor and call back to inform the dispatchers. It could save us all a whole lot of trouble.
Sunday, July 24, 2011
Lost & Found
A little over a year ago, my small town, three station department merged with the County Department (now 28 stations big). When that happened, of course, all of our uniforms changed. Our badges, patches, t shirts, jackets, hats, etc. had to have the County name and logo instead of the old City name. The one uniform piece that the County FD didn't have that the City FD did was a Tilly or Boonie style shade hat. As a balding guy, I viewed my City FD Tilly hat as a piece of safety equipment and even though I'm not technically allowed to wear it, I held on to it. I carry it in my wildland bag and I will use it around my station if I'm out in the sun detailing the rig or doing yard work.
Today, I was out doing the weekly service of our reserve rig and wearing my shade hat. My captain told me we had to go out to a station a couple of districts over and retrieve some equipment left by the previous shift. I must have set my hat and gloves down on the sideboard of the front line rig while getting ready to go and forgotten about them. We headed out to the other station and just before getting there we got a call for an auto accident one district over from where we started but in the opposite direction. I put the Code 3 lights on and we drove all the way back to the accident. After treating one of the patients on scene we were released and set off back to retrieve the equipment. When we got to that station I noticed my gloves were on the sideboard and put them away. It didn't occur to me that my hat was missing. When we got back to our station I needed to finish up with the reserve rig and couldn't find my hat. I then put two and two together and realized what I had done and that the hat must have blown off somewhere while we were driving around. It's amazing to me that the gloves stayed put that whole time. We had gone all over and in and out of other districts so we couldn't just go retrace our steps to go look for it. I was pretty much resigned to the fact that I had lost my hat. I used that hat for camping and other things too and although I could always get another one of that style, it wouldn't have the fire department logo on it and it had sentimental value.
Later that night we responded to a small house fire and after going to the roof and raking shingles and checking for extension I decided it would be worth mentioning to the other crews in case someone turned in my hat to another station. Unfortunately, I don't think the hat had my name in it. Although, there were really only two of us who wore that style hat in my old department and the other guy is now retired. Well, as we were cleaning up I stopped the other engineer and told him what had happened. He started laughing and called his firefighter over. He then told me to tell the firefighter my story, which I did, and he started laughing and shaking his head.
They then told me the story of their day:
They had started off responding to the corner at the freeway offramp for the homeless guy in the wheelchair I have written about previously (see blog entry 'They Just Keep Rolling Along'). He refused ambulance transport and they went on their way. After that they responded to the next city over for an apartment fire. It turned out to be nothing and they were released to go back to quarters. They took the freeway back and as they came down the offramp they saw our wheelchair bound homeless regular giving them a big smile and a thumbs up while pointing at his head with the other hand. He was, of course, pointing at the fire department shade hat he was wearing. My hat! They knew it must have been mine but didn't know the story until I told them what happened while at the fire that night.
Now I'm very conflicted. I really like that hat and would love to have it back, but, knowing what I know about the person wearing it now, I wonder if there is any amount of washing and sterilizing that would make me comfortable about putting it on my head again. Plus, they said he looked so happy about having it I would almost feel bad about reclaiming it. However, this is not exactly the advertisement or endorsement I think is best for our department, now defunct or not. And who knows, maybe it does have my name in it.
Today, I was out doing the weekly service of our reserve rig and wearing my shade hat. My captain told me we had to go out to a station a couple of districts over and retrieve some equipment left by the previous shift. I must have set my hat and gloves down on the sideboard of the front line rig while getting ready to go and forgotten about them. We headed out to the other station and just before getting there we got a call for an auto accident one district over from where we started but in the opposite direction. I put the Code 3 lights on and we drove all the way back to the accident. After treating one of the patients on scene we were released and set off back to retrieve the equipment. When we got to that station I noticed my gloves were on the sideboard and put them away. It didn't occur to me that my hat was missing. When we got back to our station I needed to finish up with the reserve rig and couldn't find my hat. I then put two and two together and realized what I had done and that the hat must have blown off somewhere while we were driving around. It's amazing to me that the gloves stayed put that whole time. We had gone all over and in and out of other districts so we couldn't just go retrace our steps to go look for it. I was pretty much resigned to the fact that I had lost my hat. I used that hat for camping and other things too and although I could always get another one of that style, it wouldn't have the fire department logo on it and it had sentimental value.Later that night we responded to a small house fire and after going to the roof and raking shingles and checking for extension I decided it would be worth mentioning to the other crews in case someone turned in my hat to another station. Unfortunately, I don't think the hat had my name in it. Although, there were really only two of us who wore that style hat in my old department and the other guy is now retired. Well, as we were cleaning up I stopped the other engineer and told him what had happened. He started laughing and called his firefighter over. He then told me to tell the firefighter my story, which I did, and he started laughing and shaking his head.
They then told me the story of their day:
They had started off responding to the corner at the freeway offramp for the homeless guy in the wheelchair I have written about previously (see blog entry 'They Just Keep Rolling Along'). He refused ambulance transport and they went on their way. After that they responded to the next city over for an apartment fire. It turned out to be nothing and they were released to go back to quarters. They took the freeway back and as they came down the offramp they saw our wheelchair bound homeless regular giving them a big smile and a thumbs up while pointing at his head with the other hand. He was, of course, pointing at the fire department shade hat he was wearing. My hat! They knew it must have been mine but didn't know the story until I told them what happened while at the fire that night.
Now I'm very conflicted. I really like that hat and would love to have it back, but, knowing what I know about the person wearing it now, I wonder if there is any amount of washing and sterilizing that would make me comfortable about putting it on my head again. Plus, they said he looked so happy about having it I would almost feel bad about reclaiming it. However, this is not exactly the advertisement or endorsement I think is best for our department, now defunct or not. And who knows, maybe it does have my name in it.
Wednesday, July 6, 2011
The Dead Walk Among Us
"It is alive!"
I found out recently there is a guy in the next district over who is living without a pulse.
Here's how:
An artificial heart has been developed that involves the use of centrifugal pumps instead of relying on a pulsatile form of pumping. This results in a constant blood flow instead of the high and low pressures of a heartbeat.
If you listened to the patient's chest with a stethoscope, you wouldn't hear a heartbeat. If you examined the arteries, there's no pulse. If you hooked him up to an EKG, he'd be flat-lined. It's the strangest thing.
(Edited from the article):
The doctors who created the pump did not start totally from scratch. They took two medical implants known as ventricular assist devices and hooked them together. A ventricular assist device has a screwlike rotor of blades, which pushes the blood forward in a continuous flow. Thousands of people have these implanted in their hearts. By using two, the doctors replaced both the right and left ventricles — the entire heart.
The doctors say the continuous-flow pump should last longer than other artificial hearts and cause fewer problems. That's because each side has just one moving part: the constantly whirling rotor. But Cohn says they will still have to convince the world that you don't need a pulse to live because by every metric we have to analyze patients, they're not living.
I found out recently there is a guy in the next district over who is living without a pulse.
Here's how:
An artificial heart has been developed that involves the use of centrifugal pumps instead of relying on a pulsatile form of pumping. This results in a constant blood flow instead of the high and low pressures of a heartbeat.
If you listened to the patient's chest with a stethoscope, you wouldn't hear a heartbeat. If you examined the arteries, there's no pulse. If you hooked him up to an EKG, he'd be flat-lined. It's the strangest thing.
(Edited from the article):
The doctors who created the pump did not start totally from scratch. They took two medical implants known as ventricular assist devices and hooked them together. A ventricular assist device has a screwlike rotor of blades, which pushes the blood forward in a continuous flow. Thousands of people have these implanted in their hearts. By using two, the doctors replaced both the right and left ventricles — the entire heart.
The doctors say the continuous-flow pump should last longer than other artificial hearts and cause fewer problems. That's because each side has just one moving part: the constantly whirling rotor. But Cohn says they will still have to convince the world that you don't need a pulse to live because by every metric we have to analyze patients, they're not living. "We look at all the animals, insects, fish, reptiles and certainly all mammals, and see a pulsatile circulation," he says. "And so all the early research and all the early efforts were directed at making pulsatile pumps."
However, the only reason blood must be pumped rhythmically instead of continuously is the heart tissue itself.
"The pulsatility of the flow is essential for the heart, because it can only get nourishment in between heartbeats," Cohn says. "If you remove that from the system, none of the other organs seem to care much."
The only thing I'm wondering is what we're going to do if the thing stops working. CPR won't do anything for him, he has no heart. Neither will any of the medications we use as most of them are designed to work on the heart itself. Maybe it's got a hand crank or something.
The times they are a-changing.
Saturday, June 25, 2011
"Let Go Of My Eye!"
Head injuries are interesting. I can do without the secondary projectile vomiting that comes with some of them, but watching people's change in behavior is a curious phenomenon. I guess it's just a primal fight or flight thing but the universal reaction seems to be violence and combativeness.
We were second in on an auto vs. bicyclist (I drive the "truck" in my district so we respond to all auto accidents). In this case it was actually a bicycle vs auto since the guy on the bike was riding against traffic and ran into the side of the car waiting to make a right turn. He went right over the hood of the car and onto the ground.
The accident occurred at the exit of a housing development with one way in and one way out. I parked just inside the entrance and as we left the rig the engine captain came over waving us off. He said they only had the one patient and that they could handle it. We were free to leave but the accident was blocking the way out and cop cars were blocking the way we came in. We were stuck on scene so we walked over to see if we could help anyway.The bicyclist was sitting up in the street with a bystander holding c-spine and the engine crew trying to talk to him. I put on my medical gloves and took over c-spine from the civilian. I'm glad I did because it was at this point that he started fighting us. I'll say this: people who are altered or scared are STRONG. I once had to hold down a 7 year old in the hospital who was getting stitches right next to his eye and it took everything I had to keep him still. This healthy twenty-something male took all of us (ambulance crew included). We put a collar on his neck and I tried my best to keep his head still while he cursed and screamed at phantom women who had taken his money and of course at us. He only had a little road rash to the side of his face (no helmet) but he obviously got his bell rung because he was completely delusional. While the firemen held him down the ambulance crew put the leather restraints on him, securing his wrists and ankles to the backboard.
He kept yelling, "Let go of my eye!" I looked down at him and told him I was holding his head still because he got hit by a car and that no one was touching his eye. He raised his right hand the best he could, spread his fingers, and yelled at me, "This IS my eye! Pay attention!"
Okaaaay, I'll put that down as altered level of consciousness.
Once fully restrained we tried again to explain to him that he had been hit by a car to which he responded "No, I wasn't". With that we put him into the ambulance and got out of the way in case the vomiting was coming next. His ranting makes me wonder what his mental state was like before the accident. Was he already a little nuts or was this all purely head injury related?
Wear your helmets kids and be safe out there.
Monday, June 20, 2011
A Comedy Of Errors
I'm sure it wasn't viewed as hilarious by the patient or by the restaurant owners but this was one of those calls that kept us laughing all day long.
We were called to a restaurant for a waitress with abdominal pain. The restaurant was a steak house in an old converted ranch style house. We were taken upstairs to what I guess was the employee lounge where we found our patient. She was in her twenties, very thin, and curled up on a couch. The cause of the abdominal pain was unknown, but her pregnancy status was in question as was her possible history of drug use. Since we were upstairs, the ambulance couldn't bring the gurney up to us so we had to carry the patient down to the gurney. Because she was so light and it would have been harder to move her down the stairs with two people. I decided to just carry her myself. I scooped her off the couch and moved toward the stairs. She wasn't heavy but I didn't have the best grip on her so I tried to readjust. Without even thinking I automatically did what anyone does when holding a child in their arms, I bounced her up to move my grip further underneath her. This is usually fun for the child but not so good for the patient with abdominal pain as evidenced by her groan and the "what the hell are you doing" look the firefighter gave me.
Meanwhile, my captain was making room for me at the bottom of the stairs so I could get the girl to the ambulance crew. There was a cluster of restaurant supplies and an assortment of maintenance odds and ends being stored there. As I descended the staircase, the captain moved the first piece from the pile, a metal shelf. What followed was straight out of a Ben Stiller movie. The piece he moved was apparently tenuously supporting a crate of glassware which then crashed to the floor. In an effort to stop the cascade of falling glasses he dropped the metal shelf which loudly clanged to the floor and continued to resonate as it wobbled around. This is when the rest of the pile began to give way and we watched as he helplessly turned from one piece to the next, unable to stop a single one from crashing to the floor. As he frantically turned in circles, clutching at falling objects, I stood on the stairs holding our patient in my arms trying desperately not to laugh out loud and listening to the 'crash, crash, clang, (pause) crash, (pause) clang, (longer pause) crash, crash, crash, clang (pause) crash' that seemed to go on for about five minutes. My captain finally had to just step away as anxious busboys rushed in and tried unsuccessfully to salvage the situation.
I carefully made my way through the debris field and delivered the patient, gently, to the gurney. We then returned to quarters where, over the course of the shift, my captain's face eventually returned to a normal color and the firefighter and I continued to laugh every time we looked at each other.
Thursday, June 9, 2011
Our Good Deed For "D" Day
We do some interesting public assistance calls from time to time. There are some things that the fire department is uniquely equipped for that no one else can really handle. It is not an emergency in any way, but 'who you gonna call'?
Today (D-Day) we brought our ladder truck out to repair an 80 foot tall flag pole for the Masons. The wire that runs inside the pole and to which the flag is attached had gotten caught and they were unable to put their flag up. They had no way of getting up to the top of the pole without renting a crane. So, in the interest of good will and PR, we went out with our reserve ladder truck which has a 105' aerial ladder to see if we could fix it.
It was a steep angle but we were able to reach the top easily and the firefighter went up to free the wire. He had quite a view from up there.
He was able to unhook the wire and send it back down without a hitch. We stuck around to help raise the flag which was huge (20' x 30') and get a tour of the place before returning to quarters.
Today (D-Day) we brought our ladder truck out to repair an 80 foot tall flag pole for the Masons. The wire that runs inside the pole and to which the flag is attached had gotten caught and they were unable to put their flag up. They had no way of getting up to the top of the pole without renting a crane. So, in the interest of good will and PR, we went out with our reserve ladder truck which has a 105' aerial ladder to see if we could fix it.
It was a steep angle but we were able to reach the top easily and the firefighter went up to free the wire. He had quite a view from up there.
He was able to unhook the wire and send it back down without a hitch. We stuck around to help raise the flag which was huge (20' x 30') and get a tour of the place before returning to quarters.
Sunday, June 5, 2011
Hand Holding
A lot of times my job amounts to hand holding and reassuring. It's not dramatic, daring, or exciting but it needs to be done and I think it is important to do it with true compassion and professionalism. I found myself doing this a few times this past tour.
We responded out to the same address twice in the same day for a "lift assist". The 80-something year old female who lives there has very little use of her legs and gets around in a motorized wheelchair. She can usually get herself from the bed to the commode by her bed and back as well as into her wheelchair and back. Today her feet slipped out from under her while trying to get to her chair and she slid off the bed to the floor. She lives with a couple of forty-something year old males, at least one of whom I believe is related to her. The other gentleman has a bad back and cannot assist in lifting her and it truly is more than a one man job. So, we go out and help her up and into her wheelchair.
The first time we went out there the woman was quite embarrassed and apologetic. We assured her that it was no problem and we were glad to help. The second time we went out she was just despondent over the situation and crying (not from pain but from frustration at her situation and inability to handle it without calling us). This time it took a bit more talking and reassuring on our part. I hope we left her feeling a little better about the situation and that there is nothing to be embarrassed or ashamed of. I hope she understands that this is indeed one of the things we are here to do and that we will gladly help whenever needed.
The second situation of that shift came in the form of a very upset 17 year old girl. The call came in as a report of a 17 year old female with difficulty breathing. When we arrived we were told the girl had asthma and they had given her albuterol (which would have been fine if this had actually been an asthma attack). The girl was on the couch crying and hyperventilating and complaining of chest pain, headache, and low back pain. We went immediately into calm and reassure mode and set to work getting her to slow her breathing down and relax. I listened to her lungs and they were clear, definitely not asthma. I never even found out why she was upset but spent a good twenty minutes holding her hand, supporting her back and coaching her breathing until she slowed down enough to talk in full sentences again.
Once she was able to talk normally I asked some of our standard medical history questions and found out she also has a history of stress induced ulcers (at seventeen). I wasn't about to get into what had triggered this whole episode and risk her getting worked up again so I avoided that whole line of questioning. We were in an upstairs unit and when we tried to get the girl to stand she felt too weak so the firefighter and I picked her up and carried her to the ambulance gurney downstairs.
Now, I'll admit, our whole crew was probably picturing the scene from Airplane where Leslie Nielsen was slapping the hysterical woman while a line of passengers waited with a variety of weapons for their turn, but we never showed it.
She was still upset when we loaded her onto the gurney and embarrassed to be seen like that by the neighbors but she was breathing at a much more reasonable rate and her hands had stopped tingling. It was definitely going to take a lot longer for that headache to go away but she'd be OK.
Of course the next day, I got to wrestle in the street with a combative bicyclist who had been hit by a car and was seriously altered and fighting us, so I guess it all balances out.
We responded out to the same address twice in the same day for a "lift assist". The 80-something year old female who lives there has very little use of her legs and gets around in a motorized wheelchair. She can usually get herself from the bed to the commode by her bed and back as well as into her wheelchair and back. Today her feet slipped out from under her while trying to get to her chair and she slid off the bed to the floor. She lives with a couple of forty-something year old males, at least one of whom I believe is related to her. The other gentleman has a bad back and cannot assist in lifting her and it truly is more than a one man job. So, we go out and help her up and into her wheelchair.
The first time we went out there the woman was quite embarrassed and apologetic. We assured her that it was no problem and we were glad to help. The second time we went out she was just despondent over the situation and crying (not from pain but from frustration at her situation and inability to handle it without calling us). This time it took a bit more talking and reassuring on our part. I hope we left her feeling a little better about the situation and that there is nothing to be embarrassed or ashamed of. I hope she understands that this is indeed one of the things we are here to do and that we will gladly help whenever needed.
The second situation of that shift came in the form of a very upset 17 year old girl. The call came in as a report of a 17 year old female with difficulty breathing. When we arrived we were told the girl had asthma and they had given her albuterol (which would have been fine if this had actually been an asthma attack). The girl was on the couch crying and hyperventilating and complaining of chest pain, headache, and low back pain. We went immediately into calm and reassure mode and set to work getting her to slow her breathing down and relax. I listened to her lungs and they were clear, definitely not asthma. I never even found out why she was upset but spent a good twenty minutes holding her hand, supporting her back and coaching her breathing until she slowed down enough to talk in full sentences again.
Once she was able to talk normally I asked some of our standard medical history questions and found out she also has a history of stress induced ulcers (at seventeen). I wasn't about to get into what had triggered this whole episode and risk her getting worked up again so I avoided that whole line of questioning. We were in an upstairs unit and when we tried to get the girl to stand she felt too weak so the firefighter and I picked her up and carried her to the ambulance gurney downstairs.
Now, I'll admit, our whole crew was probably picturing the scene from Airplane where Leslie Nielsen was slapping the hysterical woman while a line of passengers waited with a variety of weapons for their turn, but we never showed it.
She was still upset when we loaded her onto the gurney and embarrassed to be seen like that by the neighbors but she was breathing at a much more reasonable rate and her hands had stopped tingling. It was definitely going to take a lot longer for that headache to go away but she'd be OK.
Of course the next day, I got to wrestle in the street with a combative bicyclist who had been hit by a car and was seriously altered and fighting us, so I guess it all balances out.
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