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?

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.

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.

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.