Why didn't you say that to start with.

We were toned out for a medical call for a 67 year old male who had a syncopal episode at one of our local businesses.  The business was right by the station and this call really didn't sound like it would amount to much.  Syncopal episodes happen all the time and they usually aren't a big deal unless the person actually falls and gets hurt.  That is the kind of information I like to know when I'm going into the scene:  is the patient conscious?, did they fall or hit their head?, are they talking?, etc.

We were met by some wavers directing us through the parking lot to the entrance.  As I gathered up my gear I asked what was going on and was told, "I don't know, he passed out in the bathroom."  We headed into the building and were met by the next set of escorts who started us down a long hall.  Each step of the way the people we saw seemed more and more tense and hurried.  I asked this new escort if the patient was talking and he responded, "No, they're doing CPR on him."  Well, shit, why didn't somebody mention this rather important fact from the get-go.  I immediately sent my firefighter back to the rig to get the Lucas Device (our automatic CPR machine) and headed into the bathroom to see my patient.

I found an adult male on the floor of the bathroom stall, the big one fortunately, and another employee standing over him doing compression-only CPR.  I think he was very happy to see me arrive and started to step out of the way.  My firefighter wasn't back yet so I told him to just keep doing what he was doing.  He probably doesn't like me anymore.  I cut the patients shirt off and put the defibrillator pads on him as my firefighter came in with the Lucas.  We quickly got that set up and went to work getting an airway and oxygen into him as well as establishing IV access.  He had surprisingly good veins for pretty much being dead (thanks probably to the Lucas device) and I quickly had my line in and flowing like a champ.  The ambulance arrived and put a King tube in him (it was a tight space and not very conducive to trying to put an endotracheal tube in).  I did a heart rhythm check and he was in asystole.  I then found out that the last time he had been seen was an hour prior to someone discovering him on the floor of the bathroom.  That didn't sound promising.  I pushed three rounds of epinephrine and atropine into his IV and he never changed from that initial asystolic heart rhythm.  We made a declaration of death in the field, stopped resuscitation efforts, notified PD and the coroner, and began cleaning up.

It's weird, sometimes, to realize how different your perspective can be when your job is dealing with this kind of thing.  For me, I was mostly thinking about how smoothly the code ran and that it was relatively clean.  Not only was there only a minor amount of blood (from falling forward off the toilet) but there was no vomit and even the amount of garbage and debris we usually produce during a code was kept to a minimum.  I headed out to the rig to get some cleaning supplies to decon our equipment when the receptionist asked me, "Is he okay?".  I can't legally discuss any confidential patient information and everyone there was going to know he was dead in a minute anyway, but I couldn't really stop and politely explain the situation in a grief support kind of way.  I simply said, "No.  They are making some notifications right now."  A few minutes later a manager asked me how long it usually takes for the coroner to arrive so she could decide what to do with her work force.  I told her I couldn't really estimate because it just depended on how busy they are and how many people they had working that day.  It struck me as an odd question though.  My first reaction was: close off the bathroom, inform the staff, and go about your business if possible.  But I do realize that while I see this often, most people rarely have people die during their work day and it is liable to be upsetting.  What I don't get is how that changes depending on how quick the coroner comes?  If they move the body quickly everyone can stay at work but if they don't then everyone goes home?  No matter what, while we go back to our station and have lunch and move on with our day waiting for the next call, they are stuck with the aftermath of a traumatic event and a dead co-worker or friend.  It really is just two entirely different worlds.

We are not uncompassionate in any way.  On the contrary most people who do this job are here because we are compassionate and we want to help and make things better.  But we also enjoy what we do and like using our skills, even if it doesn't always work out in the end.  My firefighter even commented that, as morbid as it sounds, since codes are going to happen anyway, he's glad he gets to work them because it keeps up his skills and keeps his hands on the equipment.  In this case, even though there was nothing we could have done for this man and it is quite sad, as a crew we did an excellent job and that feels good.  We can't always control the outcome but we can be happy and proud that we did the best we possibly could for our patients.

Caution: Children At Work

I really like chemistry and I have sometimes thought that it might be fun to go to HazMat school.  But, more often than not, exceedingly more often, Hazmat calls are long and boring and uninteresting and don't involve much chemistry.

As a general rule, it's not a good idea to keep a group of adult 12 year olds (AKA firemen) bored and uninterested.

This time we got called out for a hazmat involving a rail car full of dry carbon powder, the stuff that goes into computer ink cartridges.  The product was somehow smoldering or having some form of reaction inside the container car.  It had actually melted the vacuum tube that was being used to offload the stuff into the warehouse.  We took some temperature readings with our TIC from the outside and it was definitely heating up in there, plus the car itself was warm to the touch.  That's not good.  As a precautionary measure we got some hoselines in place.  The hydrant was about 200 feet away so we stretched 225 feet of 5" large diameter supply hose and then pulled 150 feet of 1 3/4 inch attack hose to one side of the car and 250 feet of 2 1/2 inch hose to the other side. 

The hazmat team arrived, suited up and went up on top of the car, popped the hatches and took some readings of the product itself.  It was over 700 degrees inside.  There was no smoke, flames, or gasses present though.  It was essentially acting like a giant powdered charcoal briquette.  After much deliberation and contacting of subject matter experts it was decided that the rail car should first be moved to a more open space away from the building before taking any action.  This involved moving two other cars first.  The only means of moving the cars was to push them on down the track using forklifts.  And since firefighters live in a state of suspended adolescence and we'd been standing around with nothing to do for far too long we started rifling through our turnout pockets for loose change to put on the tracks as the cars rolled slowly past.  Yes, we are children and yes we get bored easily.

 

To steal a line from a fellow fire blogger: A child stopped a firefighter in the store and told him, "I want to be a fireman when I grow up".  The firefighter responded, "Sorry son, you can't do both".

In the end the car was moved, the hazmat team sent home, and an employee was sent to get four to five hundred pounds of dry ice to put in the car and create a CO2 blanket to cool and smother the product.  That part I actually wish I could have seen.  Instead, we reloaded our hundreds of feet of unused hose and went back to the station.

We were on scene for a little over five hours and had to return a few hours later to make sure the clean up company showed and that they had posted a fire watch.  I think I'll skip Hazmat school after all..