Skills

Firemen are supposed to be jacks of all trades. We are called to handle not only emergency situations but, for some reason, any possible situation that people can't handle on their own. We go to water leaks, lock outs, stuck wheel chairs, open cans of paint on the sidewalk, chemicals in the storm drain, ducklings in the storm drain, cats stuck in fences or up power poles, downed power lines or phone lines, and so on and on and on. I've responded code three for a man who, it turns out, couldn't get his voice mail on his answering machine. We are expected to mitigate any situation we are called for. We can't always do it, but we certainly try. Most of us therefore become jacks of all trades and masters of none. We know just enough about a lot of different things to hopefully do something about it and not get ourselves killed.

That...or we just wing it and hope for the best.

The cool thing about this aspect of the job is the exposure you get to these skills and tricks and access to the knowledge that each of us brings to the job from our own unique pasts. For example, just the other day we were responding to a lockout at the local elementary school. When the dispatch came in, we didn't know if it was a lock out of a building or a car. My firefighter quickly grabbed his lock pick tools in case it was a building we needed to get into. In the rig he informed us he had his tools. I responded, "Lock pick set? You have a lock pick set?" He replied very matter of factly, "Yeah, just in case."

Cool.

The call turned out to be for a car and they had it open before we got there but as soon as we got back to the station the questions began. Turns out this fireman had worked for a locksmith for a couple of years and learned a lot of great tricks for getting into locks.

 

I'm used to the fact that we normally just break things, in the cleanest way possible of course, to get in where we need to go so this peaked my interest. He had several tools for picking locks and I immediately went grabbed our door lock prop. This is basically a 16" by 20" solid piece of wood with four different door knobs it, each with a different style of lock. He proceeded to teach me about locking mechanisms, most of which I knew from basic firefighting books, and then how to pick the locks with different style tools. It's not easy and it is not an exact science but after only a few minutes I had successfully picked my first deadbolt lock.

I love learning new skills and getting to do things that I would never have learned, seen, or done in any other occupation. Now I can add cat burglar to that list.

Hazards Of The Job (In 3 parts)

ONE:
The increased risk of cancer in my profession is very high. Years of breathing in diesel fumes from our fire engines, smoke from fires, chemical vapors and anything else you can imagine coupled with the myriad problems and decreased immune response caused by sleep deprivation creates a ripe environment for the big C. 

These are known risks and risks we accept but try to minimize with safer work practices and better safety equipment, etc.

My very first chief retired three months after hiring me. He got sick and was dead within 6 months after that. He never saw a healthy day in retirement.

Most recently in my department, a beloved senior fireman -still on the job in his 60s- passed away from lung cancer. He never smoked a day in his life.

But, it is not always the retired guy or the senior guy who gets sick...

TWO:
Obscenity. Atrocity. Injustice. I don't use these words much, but they seem appropriate in this situation.

In the 12 years I have worked in the fire service I have worked with a lot of really good people. But, in that time, there have only been a handful (five to ten?) that I really connected with, would do things with off duty, and truly call real friends. Now, one of them is sick. Really sick. He has been diagnosed with Stage 4 colon cancer and just started chemotherapy.

He is 31 years old.

He has always been one of the most selfless people I know. If you need a trade, a ride, help moving, whatever it is, he's there for you. It could be argued that as a young guy with no kids he is in a position to do that. But, it's not that simple, it goes beyond that. It just is who he is.

I worked with him in his probie academy and when he was a brand new fire-medic as a sort of field mentor. We have a ten year age difference but hit it off right away. It could also be argued that this is because I live in a state of suspended adolescence (as most firemen do). But it's not that simple. We share a similar twisted sense of humor and love of movies and other pop culture geekery. We 'get' each other's references and what they might mean in the broader/deeper context of the conversation. Back at that field mentor time, we worked with a captain ten years my senior (20 years his) and I pretty much considered my role on that crew to be translator, explaining to him what the captain means and wants, and explaining to the captain what he needed and expected. There was definitely some butting of heads between those two and I think my role in the whole thing really helped bond us. He later got switched to a different shift, but still at my station, so I saw him in the mornings and when one of us got to work overtime with the other.

He just passed the test to become an engineer (my position) which means (when he promotes) we wouldn't get to work together anymore until one of us promoted to captain. The engineers exam is a tough test and I was proud of him and glad he did so well, but also bummed that we wouldn't have the opportunity to work on the same crew anymore.

I don't have much first hand experience with major illness or death and, I shouldn't be, but I've been surprised at how much this has bothered me and how often I'm thinking of him. I suppose it could be argued that it is simply the fact that it is the first time I've had to face this sort of thing on a personal level or that he is so young and this is so wrong.

But, it's not that simple, it goes beyond that.

THREE:
It is now a year and a half later. My friend has gone through chemo, surgery to remove part of the colon, weight loss, and weakness. He has been off of work this entire time. He was young and strong going into this ordeal and I think that made a huge difference. He never laid down or quit. He approached this as a fight he not only could win but would win.

He responded well to the treatments and the surgery got the rest of the cancer. He got stronger. He went from barely being able to walk around his block to jogging up the highest peaks in town. Stage 4 remission brings with it a high likelihood that the cancer may come back some day. But for now he is free and clear. He beat odds that were roughly 96% against him.

Yesterday I signed up for overtime and was expecting to get the vacancy at our old station. When they called me for the overtime they told me I was going to a different station. I checked the roster to see why I didn't get to go to my old house and found that my friend (and newly promoted engineer) was working in that spot that day. I hadn't seen his name on the roster for a year and a half without the workers comp code next to it. It was pretty amazing to see.

I'll take my second choice station any day to see that.

No 'signs' of life.

I took basic and intermediate sign languages courses in college and really wish I had kept it up. I've had only a handful of calls where I could have used it (here's one I was on from a fellow fire bloggers site) but when you need it you need it.

On this particular occasion we were called out for a possible DOA. I was met outside the house by a woman who immediately told me that she was deaf and waved for me to follow her in. Inside I found our patient deceased in a recliner in the living room. She was very much dead but still warm and had no rigor which means I would have to work her up anyway unless there was paperwork to support a request for no resuscitative efforts. I put the ekg leads on her (asystole) and my captain wrote a note to the woman who'd met me at the door asking about advanced directives. The woman ran off and returned with paperwork stating exactly what I needed to know: no cpr, no machines, etc. This woman was not family but had power of attorney and the paperwork was all in good order (you don't know how important that is, really I can't stress this enough). While she was retrieving the paperwork a man came out of the bedroom and I turned to him to ask him a question and he smiled and gave me the universal "I'm deaf" sign of pointing to his ear and shaking his head.

Neither the man nor the woman seemed overly distraught and were really very pleasant to us. Turns out they were husband and wife and the dead woman was a friend who lived with them (who also happened to be 90 years old). We cancelled the ambulance and called for PD. I think it must have been shift change or something because it took a long time to get an officer out there. In the meantime we conversed the best we could and passed the notepad back and forth when we couldn't understand each other, basically letting the couple know what would happen, answering questions, and really just chatting. We were asked about our families, how many kids, etc. I remembered enough to sign the number of kids I had as well as their genders and ages which earned me a little applause from the woman. We found out where they were from and where their daughter lived. Despite the dead woman on the floor and the barriers to communication it was really very nice. I wish I knew more sign language just so I could have talked more with this lovely couple.

Right Before My Eyes

We were responding for an elderly female with breathing problems just before eight o'clock in the morning.  When we arrived we were led to a room in the back of the house where my patient was sitting in a chair unresponsive. She was moving her lips a little, drooling (her dentures were still on the dresser), and had pretty shallow respirations with no palpable radial pulse.  I asked the first obvious question of "Is she diabetic?" and was told by the family that yes she was.  Bingo, no problem. I quickly took a blood sugar reading and it came back well into the normal range. Oh, okay, time to start thinking and acting quickly. My firefighter had obtained vitals and had the patient on oxygen by this time. Her blood pressure was quite low and we weren't getting a very good reading off of the pulse oximeter (to read pulse and blood oxygen saturation).  She was completely unresponsive but was still breathing and had some purposeful movement. I checked her pupils which were smallish and not very reactive. The ambulance arrived and I gave them a quick rundown and suggested that we not muck around on scene getting the IV and 12 lead ekg but instead move straight to the ambulance and work there on the way to the hospital - I didn't like the way this was going. The ambulance crew went to ready the gurney and my firefighter and I picked the woman up and carried her outside to the waiting gurney and in so doing apparently killed her.

By 'we killed her' what I mean is, when we set her down on the gurney I noticed that she was no longer breathing and after a quick pulse check discovered that she was also pulseless.  She must have coded right in our arms. My firefighter had immediately headed back into the house to gather up our gear and clean up. I called after him to get the Lucas (CPR) Device but he didn't hear me. I sent the captain off to the rig to retrieve it while we started chest compressions and quickly loaded the gurney in the ambulance.

The captain and I climbed aboard the ambulance and put the Lucas on the patient and fired it up. At this point my firefighter arrived back from getting our gear and, not seeing us anywhere by the fire engine, popped his head in the open door of the ambulance. He of course had no idea that any of this was going on and was quite surprised to see that we were now working a full code in the back of the ambulance. He merely said, "Oh" and got to work helping us out. I wasn't able to get an IV so went quickly to the IO, easily screwing the needle into her tibia and got the line flowing. The ambulance medic got us a good ET tube and we were off to the races. I administered one round each of Epinephrine and Atropine and after circulating the drugs for a couple of minutes we stopped CPR for a rhythm check and found our patient to be in a sinus tachycardia (rapid heart rate) with a corresponding carotid pulse. A quick blood pressure check yielded results of almost 200 over 100 and her capnography (CO2) numbers were dead on - no pun intended. She still wasn't breathing on her own so we continued with the assisted ventilations but stopped the IV fluids and chest compressions. The hospital was only about five to ten minutes away so it was a pretty short trip. The ambulance had rung down the ER and told them what we had and the staff was waiting for us when we arrived.

When we moved the patient to the ER bed, the ambulance medic gave a rundown of the call, and before I left the room I heard the ER doctor saying something to the effect of "they did an excellent job" - rare praise from an ER doc. Five minutes later we were deconning our equipment outside by the ambulance when my captain came out and told us that our patient was now breathing on her own and had a BP of about 140 over 80.

This call definitely demonstrates the truth and importance of the Chain Of Survival:

This woman had no down time since she coded right in front of us, had immediate and proficient CPR, an advanced airway, IO access, and medications all within a matter of minutes after she coded.
I still don't know what the underlying cause was, although the ambulance medic said it sounded like she had fluid in her lungs, and I don't know if she will leave the hospital neurologically intact or if she will leave the hospital at all. But, leaving the scene with a dead patient and arriving at the hospital with a live one is a pretty good run for us.

Hello? Fire Department!

We had two distinctly different Life Alert calls this tour.  Most of the time these calls are accidental activations, requests for lift assist only, or minor injuries. Rarely are they serious medical calls.

Often people who have these monitors know enough to leave a hide-a-key for us or have a KnoxBox on their house.  A KnoxBox is a small box like a little safe requiring a fire department specific key to open it. They are usually mounted near the front door and contain a key to the house or business or what have you.

Dispatch will give us the key info on our update: "the key is located under the ceramic turtle on the porch" or "the code is 2742" or "the knox box is on the delta side of the building". Without these keys we would most likely be forcing entry into the house and doing damage.

This time it was the ceramic turtle kind. We found the key, knocked loudly and called out "Fire Department. Hello?" We got no response so we unlocked the door and headed in, again calling out loudly as we went. Still no response. We had worked our way back to the bedroom with the captain leading the way. From the doorway of the bedroom we saw a 90 year old woman wearing nothing but a shower cap, her back to us, inching her way extremely slowly out of the bathroom which was still steamy from the shower. We had been calling out the entire time and did so again from the doorway. Still no response. At this point we knew we were likely to terrify this woman when she finally turned around and saw us, so myself and my equally brave firefighter began backpedaling our way out of the room leaving my poor captain to confront the naked woman alone.

(But...you know...90. And with no towel.)

We retreated to the living room but heard no cries of alarm or objects being hurled - a good sign. This woman, though startled, responded rather calmly to appearing naked before a strange man who had entered her home without her knowledge. It was confirmed that it was an accidental activation of the panic button and we went on our way with only a sarcastic, "Thanks a lot guys" from our abandoned captain.


The second call ran much the same way but with the addition of the captain ordering us not to leave him alone this time. We got no response to our calls initially but found our patient down on the floor in the hallway pretty quickly. She was very out of it and was definitely having a medical emergency of some kind (possibly a seizure or a stroke). The ambulance had arrived right behind us and by the time we had made entry and found the woman they were on our heels. Although her eyes were open and she did not appear to have any obvious fall related injuries she could not respond to us appropriately and we got her going off to the hospital pretty rapidly. I never followed up to find out what had actually happened to her. In any case, we turned her lights off and locked her doors and returned the key to the KnoxBox.

I have run a lot more medical monitoring calls that turned out to be false alarms than actual emergencies. But when it is a true emergency those things are definitely life savers.

EMS With Staging

My firefighter was off on vacation and we got toned out for his favorite type of call:  EMS with staging.  Usually, this means that the police need to secure the scene before we can enter and do our jobs.  Sometimes, it involves a larger police action.  This time it was the latter.

We were called down to the waterfront, where we usually launch our boat, for a person with a gun.  We staged about a block away from the location they gave us and tuned into the police radio frequency to listen in.  An off duty officer had spotted this guy sitting on the rocks by the water with a pistol.  Turns out that where I parked the rig (facing a T-intersection) was dead ahead of where the guy was sitting on the other side of the water.  I busted out the binoculars and got a good view of him.  He was sitting down and not doing much of anything, at least from my view.  The police had a fixed wing in the air with a high powered camera on the guy and they could see that he also had a knife and was cutting at his arms and bleeding.

It took a while to discreetly evacuate the park next to where he was sitting and call in the police rapid response team.  That's when it got exciting.  An armored vehicle (BearCat), K-9 unit, and SWAT team arrived.  Suddenly there were armed men belly crawling over grassy knolls and taking up sniper positions.

We heard over the police band that they were calling for a PD boat from a neighboring jurisdiction to come to the Marina in case he went into the water.  There was no way we were going to have another agency pull someone out of the water in our Marina so we called for our boat which was literally just down the street.  They were suited up and in launch position in no time.

We got a report that this was a missing, at risk, young man who had posted a farewell/apology on facebook and was known to carry a BB gun.  The police action was in full swing and we moved our rig down to the command post, closer to where we could move in to help if someone got hurt.  Now that the park was clear, the BearCat and the K-9 unit started moving in.  The suspect started shuffling down the path towards them shifting the gun from one hand to the other and in and out of his pocket.  We were standing in a parking lot watching through the binocs as this all went down.  From behind the BearCat they told him to drop the gun.  I couldn't tell exactly what happened next but I saw him stagger back a couple of steps, flinch a couple of times, double over and then stand still.  They had shot him a few times with plastic projectiles (picture a solid nerf dart shot from a real shotgun).

They ordered him to remove his jacket and lay down which he did.  He was then cuffed and we were called in with the ambulance.

When we went to bandage him up, I expected to see some superficial, 'cry for help' type cuts on his arm (which there were) but he had also done a legit job of slashing his wrist.  That is, he cut deep and he cut up his arm, not across his wrist. That explains why he was shuffling, he had probably lost a decent amount of blood.  He also had some damn good welts from the non-lethal bullets they shot him with.  All in all the whole thing took about three hours and was pretty damn interesting to watch.

One of the most interesting things to come out of it, though, was what I learned later.  The K-9 officer is a friend and he comes by our station frequently with his dog.  The next day we asked him a practical question, "If you get hurt or shot on a call and we have to help you, will the dog let us?"  The answer was, of course, "No."  The dog will most likely be very protective and won't respond to commands.  If the officer can talk he might be able to get the dog to obey, otherwise, this is what he said we should do:  Go to his patrol car and grab the leash, then pop the trunk and grab the 'sleeve'.  One person holds the leash and gets ready to clip into the dogs collar.  The other person puts on the sleeve and gets attacked by the dog!!!

Yes, that is the plan. Now, as I said, this guy is a friend so if his life is in danger then that is what we are going to do, especially since the alternative is shooting the dog.  I'm just not sure how we will decide who gets which job, Rho-sham-bo? I'm the medic and will have to go treat the officer afterwards, so, maybe I shouldn't be the one to be eaten by the dog, just sayin'. Although, if it worked, that would be one awesome story.

If It Weren't For The Courage Of The Fearless Crew or Why You Should Always Monitor The Radio

                  

At my station we not only hear the departments fire dispatch radio for my battalion but, since we are one of the two rescue boat houses, we also monitor the Coast Guard hailing frequency.  I was on the front office computer placing an ems order when I heard traffic over the CG radio.  Now, most of what we hear over that channel are mariner notifications, vessels overdue, and other non emergency traffic as well as info for distant locales that aren't in our response area at all.  This time what I heard was an unexpected Mayday distress call, not from the CG, but from a capsized boat with people in the water.  A man and his kid in the water!  In the water in our part of the bay!!  My captain was walking by at the same time and as I started writing down the info he jumped on the phone to the BC to tell him we needed to respond.  We got the go ahead and quickly loaded the boat and took off for the marina.

We launched the boat and I came up on step, speeding down the channel.  I was able to do about 32-34 knots even though the water was pretty choppy.  As I drove, the captain worked the radios, and my firefighter got suited up to go in the water.  I was very grateful to have one of the regular water rescue captains that day since he had to listen to, monitor, and talk on three different channels: the fire radio (main channel and tactical channel) as well as the Coast Guard radio, responding to the BC, the CG, and the other responding rescue boat; very confusing.  We got such a jump on this call that CG was way behind us in their response plus they were coming from farther away.  The capsized vessel was reportedly a mile South of the bridge and it took us about 15 minutes to get there.  The waters really changed on me as I got closer to the bridge.  The swells dramatically increased to about 4 feet, the wind had picked up, and the tide was going out.  It was like being in a washing machine there for a bit.  

I was just slowing down to pass under the bridge when suddenly the CG helo flew over us and out past the bridge to try to get an eye on the vessel.

(Okay, maybe, it wasn't that dramatic, but it felt kind of like it.)  

I passed under the bridge and the captain grabbed the binoculars to search for the victims.  The CG helo was nowhere to be seen.  After driving on a bit further we spotted the capsized boat off to our 11 o'clock.

( Kind of like this but way more 'sinky'.)

A second later we spotted the pair in the water about 200 feet off of our 2 o'clock.  There was an adult male and a teenage female in the water.  They both had life jackets on and were clinging to each other and just bobbing in the swells.  I moved the boat toward them cautiously.  The swells were big enough that they couldn't even see our boat until we were almost right to them.  I stopped a short distance away and threw both motors into neutral and my firefighter went into action, "Swimmer in the water".  

He swam out and made contact with the pair and had both of them hang on to our flotation tube.  His plan was to swim them back to the boat but the current was just taking them all farther away and he couldn't swim against it.  I had to power the motors back up and circle around to where we could throw a rescue rope to him.  I put the engines in neutral again, we threw the rope and hauled them to the side of the boat.  The captain and I pulled the two castaways aboard and our swimmer climbed in after them.  The man and his daughter had been in the water for just about an hour, but other than being a little hypothermic they were fine.

We put them down in the cabin, gave them towels and blankets and water and cranked up the heater for them.  Before leaving to bring them ashore I drove us up to the capsized boat and marked it's lat and long position.  The captain radioed this info to the CG who would be able to come out with Vessel Assist and retrieve the boat.

Now, the title of this entry does not refer to my crew (though they did an outstanding job) but to the crew of the capsized boat.  The father, in this case, made a very difficult but excellent decision that probably saved both of their lives.  The seas got too rough for their tiny boat and they were heading home when they got caught in the swells.  Their boat began to dolphin, nose diving into the waves, and took on water faster than they could bail.  Eventually the whole thing went over sideways and they were tossed.  They were able to hang onto the boat initially but all their gear was jettisoned and was now at the mercy of the current, including the small bag containing their marine radio.  

They made the decision to abandon the boat and swim out together to get to the bag and the radio.  There was no one out on the bay that day and if they had not retrieved that radio they would have been doomed.  The other smart thing was that they stayed together.  If the father had swam for the radio there was no way he could have made it back to the boat against the current and they would have been separated.  So, I applaud him for not only being prepared but for making the right calls.

We delivered them to a dock across the bay, warmer and in good spirits (considering), where we were met by a fire crew from that city, two ambulances, a fire chief, a couple of cops, and a very friendly brown pelican who decided to join the circle of conversation.

                    

We said our goodbyes and headed back home at a slightly less hurried pace.  Once back in quarters we washed the boat, readied all the gear for the next call, and ordered ourselves a pizza.  Needless to say I was pretty excited to get my first real legit water rescue out on the boat and that it all ended well.  Makes for a great day at work.