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.

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.

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.

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.