This is a great training video from LAFD. It shows what fighting a commercial structure fire is like for those not in the fire service and provides great training and talking points for those in the fire service.
As the saying goes, you never get a second chance to make a first impression.
My department recently merged with the larger regional department in the area. For most of us this is a great thing. We now have easier access to resources and training, have more job diversity and have more promotional ability.
A little while ago some of us were able to start the integration process by being stationed at some of our new department's busier stations. One firefighter was lucky enough to catch a working fire his first shift. Unfortunately, he threw up while working the fire. I'm not sure of the details. Hopefully he had just eaten a large meal or has been sick lately. As for now, there are a lot of people making the running joke that this firefighter is allergic to smoke and/or fire. It's all in good fun and, as my captain said, he'll live it down eventually....in 15-20 years.
I heard a quote once describing the fire service that can seem fairly accurate at times. "The fire service. 200 years of tradition unimpeded by progress."
I know at times it can seem that fire departments are slower than molasses at accepting and embracing change but if you look back at our history I think you'll find that we have changed rather dramatically in recent years.
The Romans were the first to employ "firefighters." They were a group of men that watched for fire and then tried to stop it using a bucket brigade, water pumps, and various tools to rip down buildings in the path of the fire.
In 1679, the first fire department was established in Boston, MA. By 1715, Boston had 6 engine companies.
It wasn't until 1853 that the first fully paid fire department was established in Cincinnati OH. Horse drawn fire apparatus were state of the art at this time.
In the early 1900's the first motorized fire engines came into service.
In 1967, the Los Angeles County Fire Department made another huge step. The first paramedics we're put into the field on two squads. While initially met with resistance from the fire service, paramedics today have become standard on most metropolitan fire departments. Part of the early success of the paramedic program is due to the show Emergency.
Since that time the fire service has grown in size, technology and scope. We no longer just respond to fires. Firefighters are trained in advance emergency medicine, vehicle extrication (no small feat considering all the different types of vehicles out there today), hazardous materials, technical rescues of any and all kinds, skydiving, flying, boating, prevention...just to name a few. And we strive to be experts in every one of these areas.
Here are a few of the modern apparatus that we use today.
ARFF (Aircraft Rescue Fire Firefighting)
Type 1 Engine
I just thought you might like a very brief look into the history behind the fire service and that firefighter/paramedic treating you or your family member.
Frequent flyers. To most people this term brings to mind someone that travels a lot, usually on business. In EMS it's a term we use to describe someone that calls 911 over and over again.
You know it's bad when your crew finishes the dispatch in sync with the computerized dispatch voice, "apartment 208!" And then the moan. We have been to this apartment 30 or so times this year. Every time it comes in as something potentially serious and it turns out to be nothing.
As we walked in the door we were met by the daughter. She cares for her 86 year old mother who has dementia. The daughter told us that her mother would not sleep, so she couldn't sleep. So she called us because she was tired. She had told the dispatcher that her mother had chest pain.
My captain talked to the daughter about getting help. She has siblings in the area that aren't doing anything and her mother needs more care than she can provide.
In the end we had the daughter sign the mother out AMA (since the mom had no medical complaint at all). We left, this time with the name and phone number of the doctor treating the mother, and a small hope that he may be able to help stop the cycle of 911 calls.
I've been thinking a lot lately about signing people out Against Medical Advice (AMA). I've been looking at it from a literal point of view. I'm supposed to use this form when my patient, against my better judgement, decides that they don't want my services or a trip to the hospital. This does not happen very often.
I can remember one time when the parents of a 3 year old girl that had a seizure refused to go to the 2 closest hospitals. We had them sign an AMA form saying that they refused to go to the hospital that was recommended by us. On the way to the hospital of the parents choice the little girl seized 3 more times, reaching a serious condition known as status epilepticus.
I have had cardiac patients, one that was a cardiac arrest patient that was brought back to life with defibrillation, that refused to go to the ER. They signed out against my advice and best judgment.
I think that these are cases where the AMA form is perfect.
More often then not I find myself having a patient sign an AMA form because we were called out for a stubbed toe. The AMA form just doesn't seem to apply. They are doing nothing against medical advice. In fact, they are doing what I would suggest. Stop wasting our time, and don't waste the ER's time or yours. Go home. You'll live. Patient's call us for all kinds of minor things. They want a medical opinion. So we, when appropriate suggest they not go to the hospital and if they are still concerned, to make an appointment with their primary care physician. We then have them sign out AMA.
Does this make sense? Didn't I just tell them not to go?
I think it's time for the EMS profession to develop a new form for a release of liability. A WMA form. You can sign out With Medical Advice. That way, after performing a proper assessment and determining that the patient does not need an ambulance ride to the ER, the patient can release us of liability without saying that they are going against our advice.
If your area is anything like mine, most of the people that we "AMA" are actually following either our explicit advice or are following what we would do in their situation.
I found this form online that has a protocol (RAS or Release At Scene) for releasing patients that don't need to go the the ER. I love it. I want to adopt it.