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Saturday, February 25, 2017

Every Day Heroes

We were toned out for a medical aid on the freeway that runs through our district. It's a bit unusual to be sent to the freeway for a medical aid instead of an accident but it's not unheard of.


We pulled up to the silver quad cab Tacoma which was sitting the side of the road. The rain was really coming down. Visibility was really limited. I approached the truck from the passenger side and opened the front door. Inside I found a woman about 30 years old sitting on her husbands lap with his seat reclined almost all the way. She was shaking and in tears and he was unresponsive.

I moved to the back seat and encourage the wife to sit in the front seat. She explained that her husband had been driving and then had had a grand mal seizure. This woman couldn't have done things more right.

She had first reached over and taken control of the steering wheel. She then stretched with her left foot and tried to find the brake pedal. After first depressing the emergency brake she was able to slow the car down to a stop, still in traffic lanes, before shifting the transmission into park. She quickly unbuckled her seat-belt and reclined the drivers seat. She was then able to hop onto her husbands lap and drive the truck to the side of the road. At that point she broke down and cried from all the stress.

Once I got to the patient I was able to determine that he was post-ictal. Within a few minutes he was able to answer basic questions. By the time the ambulance arrived on scene he was completely alert and oriented. His sugar had been checked and a head to toe exam performed.

Five minutes later the patient was on his way to the hospital and we were on our way back to the station discussing how that lady was a hero. Because of all the rain we wouldn't make it home. Dispatch had yet another traffic accident for us to respond to.

Tuesday, February 14, 2017

Truck 51, Responding.

The tones chime around 21:30. A medical aid. I've picked up an overtime shift and am driving at my own station. Always a plus. I listened to the address and go to the map. I knew the street but I want to check exactly which house it was. As I stepped into the rig my captain said in a tense voice, "Get us there!"


In the dispatch notes my captain had read that we were headed to a pediatric full arrest. In plain English we were headed out for a baby that no longer was breathing or had a beating heart. 

Normally when driving a fire truck with lights and sirens there's a lot of caution involved. A 70,000 pound vehicle rolling through red lights can be dangerous. On the way to this call the limits were pushed. Seconds counted. We listened above the growl of the siren to the dispatcher rattle off all the units that were responding. Truck 51, PD, AMR, AMR Supervisor and at our request, Engine 52. Dispatch informed all responding units that CPR instructions were being given and that this was for an 8 month old boy. 

One police officer made it to the scene before us, He had just enough time to go in and grab the lifeless kid and bring him out to us. I started chest compressions while my firefighter set up the BLS airway. After a minute of CPR the AMR unit pulled up. Without hesitation we moved. As a cohesive unit we transferred the entire operation from the front of the house to the back of the ambulance.

On our way to the hospital, in the back of the ambulance, there were three medics and an EMT. My firefighter continued with compressions gently forcing the child's heart to pump blood. I inserted an intubation tube into the airway of my patient. With that in I then connected the end tidal CO2 tubing and continued to breath for the baby. The AMR supervisor used a drill gun to sink in an IO needle for vascular access. He then was able to administer what we hoped would be life saving drugs. The AMR medic watched the heart monitor for a rhythm and kept track of time for us. It's remarkable easy to lose track of time on a full arrest.

By the time that we reached the hospital the RNs were waiting for us at the door. Our ACLS protocols had been followed perfectly. Even better than they would have been in the hospital. This is what we do.

Inside the ER the staff takes over continuing with ACLS. Another 20 minutes go by and there's been no change. The family has arrived. Mom and dad stand in the hallway looking for a miracle. As I come out of the room they look to me for answers. The hospital staff hasn't had time to talk to them yet and I'm the one the parents remember rushing their baby away giving them hope. The father asked what his vitals were in a way that told me they had heard that on a medical show on TV and were sure their boy was supposed to have some sort of vitals.

I take my time with the family explaining what was going on. I prepared them for the worst because I knew it's coming. Years of experience told me what the end result of this call would be. After a few questions another ER doc came by and took over for me. As he was talking I slipped away.

I headed back out to the ambulance bay and helped my firefighter put all of our gear back together. Just as we were leaving the AMR supervisor came out, caught my eye, and shook his head. Nothing more needed to be said.

The ride back to our station was quiet. Somber. None of the usual banter and at times dark humor that usually follows a serious call. None of us talk about it but we're all fathers. This one hit close to home. As we approached the station the radio beeped and the dispatcher came on.

"Truck 51, medical response...." I knew where were headed. I reached up and flipped on our lights. My foot stepped on the floor button that winds up the siren. Over its high pitched scream I hit the air horn.

Truck 51, responding.

Thursday, January 28, 2016

And I Thought I'd Heard It All

At 0530 the tones went off. Just early enough to make me grumble about missing a little bit of precious sleep but late enough that I knew I was up for the day.


We were being dispatched for a 14 year old male feeling ill. That's dispatcher speak for 'we have no idea what's wrong with this person.'

When we pulled up we were waved down by a friend of our patient. By the looks of him, something serious must be wrong.

We walked into the apartment and found our patient. He was sitting on the couch and looked to be in zero distress. I walked up to him, sat down on my drug box (which doubles as my chair on a lot of calls), and introduced myself.

During introductions I evaluated his pulse (steady and strong), his airway (completely patent), his respiratory effort (breathing nice and easy), and his skin signs (completely normal). Not being able to detect a reason for the 911 call I then asked the question...

"So, why are we here?"

His answer was one that I haven't heard before. He had called 911 because, and I quote, "I was feeling lazy."

My mind raced! Really?! LAZY??!? I really wanted to say that I had toilets at the station he could scrub as a cure. Heck, he had a toilet there at his own home he could scrub. But before I could figure out which smart a** response to go with AMR showed up. And with them, a paramedic intern.

As the intern walked in I gave him a quick report. 14 year old male, chief complaint...feeling lazy. The poor medic intern didn't know what to do with that one.

I talked for a moment with his preceptor and then we cleared the call. The last thing I heard from the AMR crew was them explaining to the patients father, who was already at work, that he had to come home to sign his son out AMA since his son called 911 and was a minor.

I think dad will correct that situation.

Sunday, January 25, 2015

Complacency

The familiar click of the speakers turning on let me know we were getting a call about a second before the tones went off. If you're used to working at my station you can hear that quiet click over all kinds of ambient noise. We were being dispatched for a residential fire alarm.


We roll on a lot of false alarms. Residential fire alarms are almost always the result of someone over cooking their dinner or a bag of popcorn. So many false alarms can lead to complacency, just like the villagers in the story of the boy that cried wolf. We were just like those villagers, unprepared to act when the time came.

We pulled up to the 3 unit apartment complex and found the courtyard between that building and the one next to it full of people, including a lot of kids. It was a weekend, it wasn't too cold, and it wasn't too late. Besides, the fire department was coming. Everyone likes to see a spectacle.

My captain and I were both "turned out" but neither of us had our bottles (SCBA) on. There was no smoke, This was another false alarm.

We headed over to the apartment and someone approached us. They said that they lived above the unit in question. They heard the smoke detector going off below them and smelled something like burning food. They had knocked on the door but no one answered.

It wouldn't be the first time that we've been to a house where someone left a pot on the stove. We knocked on the door again just to be sure. We also checked the windows. They were all closed and locked with the curtains drawn. The windows and the door were cool to the touch so there was little concern.

We determined that the renters and the manager had been called but there was no answer. With the indications we had that something wasn't right, my captain gave me the word. It was forcible entry time.

Let me just take a moment to say how much I love being a firefighter. It's fun. Especially at times like this.

I was already lined up with the front door. I did a forward kick that would have made my kids MMA instructor proud. When the door flew back I was greeted by a wall of smoke that extended from the ceiling to the ground.

*CRAP*

My captain and I ran back to the rig to grab our SCBAs. We should have had them on already. Crap. I hate that feeling.

I grabbed the pack from my seat and threw it on while I walked back to the apartment. Now the crowd had moved back. No one wanted to get in our way. By the time I reached the door I was masked up. I stepped up to the doorway then disappeared into the smoke.

While the entire place was filled with smoke is wasn't thick and black. There was also no accompanying heat. The fire had snuffed itself out, suffocated....starved for precious oxygen. I made my way to the kitchen and found that there was indeed a pot on the stove with the burner going. The family had placed several baby bottles in a pot of boiling water to sterilize them and forgotten about it.

Once the water had boiled off the plastic started to burn. The knobs on the stove were melted and the paint on the wall was charred and blistered.

We opened the windows and doors and used a fan to remove the smoke. We moved the burnt items out of the house and then disconnected the stove and moved it to the center of the kitchen. With all that done we again checked to make sure the fire hadn't moved into the walls or the cabinets.

It could have been much worse. At least they had working smoke detectors.

And I learned a valuable lesson about complacency.

Thursday, September 18, 2014

Postponing The Inevitable

In my area resources are dispatched to EMS calls in two waves. First, as soon as the location of the medical emergency is confirmed, the fire department is dispatched. We roll with lights and sirens to all of them because the person calling 911 doesn't always get things right (for instance calling because their husband fell and needs help getting up only for us to find out he fell because he's dead). The call taker in dispatch then triages the call (using an EMD program). Once the severity of the call is determined the ambulance is dispatched with the appropriate response (code 2/3, low, medium or high priority). This allows the most critical patients to have access to an ambulance sooner....in theory. Once the ambulance is dispatched the dispatcher will inform us on the radio the nature of our call.


We were on our way to get dinner in the East end of our district. While sitting at a signal light waiting for the green arrow the radio chirped. Beep beep, "Truck 51, medical response. 1234 5th street. Map page 117 xray."

We were only a couple of blacks from the address and we were facing the right direction. My engineer flipped on the lights and hit the air horn. We were no longer waiting for that green arrow.

We pulled up to the house less than a minute later. The 911 call taker was still getting information from the caller when we walked up. The ambulance had yet to be dispatched.

I asked the lady what was going on. She replied that her husband had collapsed in the bathroom and was no longer breathing. The call had taken a turn for the more serious.

I turned to my captain and asked him to go grab the Autopulse. I grabbed the victim and drug him out into the bedroom where we would have enough room to work. I immediately checked for a pulse and then started on chest compressions. He couldn't have been down very long.

My engineer grabbed the BVM and started breathing for the patient. My captain soon returned and let me know he had called for the next due engine just in case we needed the manpower. Once the Autopulse was on things started to get a little less hectic. I placed the defib pads on the patients chest and checked a heart rhythm. PEA or pulseless electrical activity.

PEA is a heart rhythm where the heart, electrically speaking, is working ok. The problem is the muscles are not responding to the electrical impulses telling them to pump.

We resumed resuscitation efforts. AMR showed up and they had an intern with them (the son of a member my department). I allowed him to start the IO and then to intubate the patient. The intern performed both skills perfectly.

We then settled into a routine of medication administration, CPR and heart rhythm/pulse checks. My captain had already talked to the wife and explained what was going on. She was prepared for the worst.

After a third round of Epinephrine and some more chest compressions we preformed another rhythm/pulse check. On the heart monitor the wave form had changed. And at my patients neck there was a corresponding pulse of blood.

 He had a pulse.

We quickly but carefully moved our entire operation to the back of the ambulance. There the poor intern tried to remember all that he had to do while being peppered with questions from his preceptor and me. He did a good job.

Before arriving at the ER we had a repeat set of vitals, a 12 lead EKG and had started inducing hypothermia. My patient was even starting to fight the ET tube. A good sign. He might actually live.


***********

A couple of weeks later we stopped by the house where my patient had lived to check on him. His wife informed us that he had lived for 10 days in the ICU under heavy sedation. He had suffered a stroke which had caused the cardiac arrest. There was no possibility for recovery. All we did was postpone the inevitable and give the family a chance to say good bye.
© FireMedic and Firefighter/Paramedic Stories, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to FireMedic and Firefighter/Paramedic Stories with appropriate and specific direction to the original content.

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