Related Posts Plugin for WordPress, Blogger...

Tuesday, September 27, 2011

Commercial Structure Fire

I was sitting in the recliner watching some college ball waiting for my family to arrive. They were going to visit the station again. The kids love to visit and race around the fire house. I think our massive balcony is their favorite part. I check my watch and thought that they should be getting there any minute, which meant we should be getting a call. Sure enough, the structure fire tones sounded.

Photo by Nika Megino

I jumped up and ran over to the fire pole. It took me about a second to slide down the 25 foot drop to the ground floor, much faster than taking the stairs. We all quickly donned our turnout gear and jumped into the truck. I assumed that this was going to be just another false alarm and that we would be back at the station in a few minutes. Those thoughts vanished as dispatch gave us more information.

Engine 50, engine 52, engine 54, truck 51, Truck 110, engine 82, Rescue 54, battalion 11, battalion 13, commercial structure fire. We have multiple callers reporting smoke and flames showing.

That's me at the tip of the ladder. Photo by Nika Megino.

As we turned right out of the station we looked toward the address and immediately saw the dark plume of smoke. On the tactical channel my captain gave an update, "All units responding be advised truck 51 has smoke showing from the station."

We knew going into this fire that we would be going defensive right away. The building is an old abandoned Circuit City. Over 20,000 square feet that had been empty for years. In fact, we had used this building for training. We knew that the roof had dozens of holes cut by us. Also we had already had several fires (usually started by squatters) in this building. Enough so that the structural integrity of the building, especially the roof, was in question.

Engine '50' with two 2 1/2" lines going interior.

The first in engine arrived on scene and sized up the situation. There was heavy smoke and flames on the Bravo/Charley corner (For firefighters to better be able to describe a building the front is the Alpha side. You then move clockwise around the building so that the left side is the Bravo side, the rear is the Charley side and the right side is the Delta side). They also called for a second alarm giving us two more engines, a truck and another BC. It never hurts to have more manpower.

As we were pulling up Engine 50 announced that the hydrant on the corner that they had tagged was dry. Engine 52 stopped at another hydrant and started laying their LDH so that we would have a water supply. Another engine was direct to the hydrant over the wall from Engine 50. The crew from 50 laddered the wall and handed over their 5" supply line.

My view of fire attack.

While the engines worried about their water supplies and hoses we position the truck as close as we could to the burning section of the building. This was difficult because of mounds of dirt and debris all over the old parking lot. We then extended the stabilizers and raised the ladder. Our truck has a pre-plumbed water way so we didn't need to connect any hoses before getting into place. Once the ladder was up I climbed to the top. We then started flowing over 1000 gallons of water a minute onto the fire.

All the crews on the ground (looking to me like ants) were told to not go into the rear of the building while I was flowing water. I was putting more than 4 tons of the wet stuff into the building and onto the roof every minute. We didn't want anyone near that!

Anyone want to join me?

One of the crews got a report that a homeless man may have still been inside. They immediately started a search from the front. Once they were in position, with a hose line, we shut down the water tower. I then spent the rest of the operation as the eye in the sky. I was able to direct crews to hot spots and to give the IC information on the progress. I had a very unique view.

After interior efforts were stopped we again turned on the big guns. We soaked everything we could. Engine 50 also helped out with their deck gun because it's set up with the ability to use foam. By the time that we left there was over a foot of foam and water all over the roof and the interior.

The roof after the fire.

We then had to pick up the hundreds of feet of hose of varying sizes and reload them. Back at the station we washed the truck down. Four hours after the tones went off I was in the shower cleaning up.

My view of the supply lines.

And the homeless man that was reportedly inside? He was found eating a hotdog at the gas station watching everything go down.

Wednesday, September 21, 2011

Shutting Us Up

Someone did something that caused three firefighters to be speechless. That's quite a feet.

We got a call for a citizen assist the other night. Usually this means that someone fell down and the family members are unable to get them back into their chair or bed. Imagine our surprise when we were informed that we were going to help someone that didn't know how to clean up the broken wine bottle and spilled wine from under their car in the garage.

I'll wait a second while you re-read that and shake your head. Yes, you read it right.

When we arrived we were met by a woman in her late 30's. She appeared to be a well dressed business woman, and judging by the BMW in the garage, a successful one. She started by saying she only called 911 to get some advice. You see, she was afraid of the flammability of the alcohol in the wine. She said she, "didn't want to blow up in the morning."

We assured her that the small amount of alcohol would not ignite even if she were to start her car now and that by morning the alcohol would all have been evaporated.

After the call, we drove back to the station in almost total silence. The only thing said was, "I don't know what to say."

On a more positive note her 13 year old daughter squealed in delight and told anybody listening that that was the closest she'd ever been to a firefighter. We showed her the truck too. I think we made her night.

Tuesday, September 20, 2011

Oh! The Irony

So while I was at work I received a negative comment on my post 50mg Of Benadryl And Some Morphine. So I took the time to respond with a blog post instead of a lengthy comment (and I decided that getting negative comments is kinda fun). My original post was about a "frequent flyer" that just wants narcotics. She's well known to every firefighter in the area.

Fast forward about an hour after we went to bed. The tones went off and the dispatcher rattled off a familiar address. As we approach we notice that the front door is open and our favorite patient is waiting for us. She's learned not to ask for Morphine directly. This time she said that the medics before had given her a shot of Benadryl for her anxiety and another shot. She danced around the subject of MS for quite a while. In the mean time we grabbed a set of vitals (which we all well within the normal range).  She wasn't showing any of the signs of being in pain.

She then spent the next few minutes complaining about nausea. She explained that she had been vomiting all day. And that because of the vomiting she was experiencing abdominal pain. That, according to her, was the reason she needed the 'other shot.' Instead, we attacked the root of the problem. We gave her something for the nausea. She wasn't too happy that we weren't playing the game by her rules.

When AMR arrived I gave them a quick rundown on the patient. We then helped her onto the gurney and loaded her up. What was the last thing I heard her asking for as I shut the back door of the ambulance? You guessed it, a shot of Morphine.

Monday, September 19, 2011

Hate Mail

I feel like I've hit a mile stone with my blog. My first hate mail, er, comment anyways. And when I tried to answer it and explain my position a little better, I got another one. So instead of trying to explain things in the comment section I decided to do a post about it.

The original post, 50mg of Benadryl And Some Morphine, was about a drug seeker and my refusal to give them Morphine. In it, I mentioned that we have to ask a patient to rate their pain on a 1-10 scale. I think this is a waste of time because there's no real way for a health care professional to know what the patient's worst pain is. If your worst pain is a stubbed toe than a sprained finger is a   10. If you have had cholecystitis, then a sprained finger is a 2. So if the number rating is arbitrary then I have to go by my assessment to determine how much pan management is needed. 

Evidently Mr. (assumed from the typos and un-lady like language at the end of the first comment) Anonymous didn't like this. He said, 

""We always ask the patient to rate the pain. I generally don't care what they say their pain level is, their body language always tells me what I need to know. So why do we ask? I digress."

how woudl ur boss feel if they saw that? cunt

I tried to understand where they were coming from. I reread my post and tried to explain where I was coming from. I replied, 

"My Chief is a medic as well and I think he would back me up 100%. I think you may have misunderstood what I was saying. I don't care what number they assign to their pain. My 4 may be your 10. The number is a waste of time but is used for paperwork. I treat my patient instead."

He really didn't like that. Mr. Anonymous commented,

"You have a God complex. It's not up to you to "decide" what a person's pain level is. "My 4 may be your 10". You're not the one in pain so you have no clue how bad their level is. You're what's wrong with the medical field nowadays-you don't listen to the patients and make assumptions based on how YOU judge a persons body language."

So I am going to make a couple of assumptions based on these comments. First, I think Mr. Anonymous has had a bad experience with someone in the medical field that did not his pain or pain management seriously. Having been in severe pain I can imagine the anger of someone that wasn't properly treated for pain. Second, I don't think that Mr. Anonymous is in the health care field. More specifically, in the pre-hospital setting. If I'm wrong, I'm sure he'll let me know.

Mr Anonymous, you obviously think that I'm in the wrong, at least as far as patient care is concerned. Let me explain my approach to pain management. If, through a thorough assessment and examining the signs and symptoms of my patient, I determine that they are in pain, I do everything in my power to relieve that pain.

In a perfect world all I would have to do is trust a person when they say the hurt. Unfortunately, we don't live in a perfect world. I have to deal with people that lie. One of the more common misrepresentations is that of being in pain. People addicted to narcotics have been known to call 911 with the intent of getting morphine. If we as medical professionals were to just give out MS to every patient regardless of our own assessment we would not only possibly be causing more harm to our patient by feeding their addiction but we would then have every addict in the country calling 911 to get their fix. So to keep from doling out medication unnecessarily we have to judge for ourselves how much "pain" a patient appears to be in.  

How do we check someone's pain level? There are actual, physiological changes to the body when someone is in pain. There's a great paper (do you still call it a paper if it's online?) on the subject on the NursingTimes website. I'll provide a quick overview but you can find better detail in the article.

We'll start with the patient's heart rate, it goes up. As does their respiratory rate and blood pressure. There can be impaired thinking if the pain is severe enough. Oxygen saturation may be low. Nausea and vomiting often accompany intense pain. Because of the sympathetic response the patient may appear pale and sweaty. There are many other things going on with the body as it reacts to pain but those are the most obvious and easiest to assess.

So Mr. Anonymous, when I'm dealing with a 30 year old patient, with a known history of seeking narcotics, what would you have me do? Should I listen to them as they calmly tell me that they are in the worst pain of their life? Should I immediately dive for my morphine and draw it up stat? Or should I look at her vitals and perform an assessment? If her heart rate is 62, she's breathing 12 times a minute with a pulse oxygenation of 100%, their skin tone is normal in coloration, temperature and moisture, no nausea or vomiting, and their BP is normal should I ignore all the clinical data that says the patient is probably not in severe pain? I think not. 

Somehow I get the feeling that you, Mr. Anonymous, are still going to say that I need to listen to my patient. So is that true in every case? When a woman is having a heart attack but she denies it should I just trust her? No. That's why I went through schooling to become a medical professional. Contrary to what you may think we medical professionals have to do more than just listen to you. We have to look at clinical data as well. I'm sure there are some people out there in the medical field that have taken things too far the other way and they rely solely on the signs that they can observe, never listening to their patient. I am not one of those people.

Have no fear, if I respond to your home and you or a loved one are in pain, I will treat you appropriately. 

Saturday, September 17, 2011

Stop Being An....

The lights clicked on in my room for the third time that night, and it was only 0230. They were immediately followed by the familiar tones of a medical aid. We grumble and stumble out to the rig and slide into our bunker gear.

While watching the houses go by the rig as the were being pummeled by red lights dispatch said that we were responding for a fall victim. Pulling up on scene I recognized the house. We had been there before, often.

My citizen in distress was a 70 year old woman. She's obese. Shocker huh? She has had a heart attack in the past and now has CHF. She also smokes more than a structure fire. Enough that I always feel the need for a shower when I'm done with the call so that I can get the smell off of me. She has COPD, Emphysema and Asthma. She's supposed to be on home oxygen but every time we're there the cannula is tucked into the corner, unmoved, I'm sure, from the last time we were there. And she also wonders why she gets short of breath when she does the simplest of tasks. And to top everything off, she has an attitude.

We walk up to the door and find her husband waiting. She is sitting on the floor in between her recliner (the kind that stand up to help people get out) and her wheel chair. We ask if she is injured and she says no, just stuck. We help her back up into her chair. Usually this is all we do. This time they needed more help.

We then helped to move her to her portable commode. While she did her business we stepped outside. She took the opportunity to light up another cigarette. We then helped move her back into her wheelchair and then moved her once again into her recliner.

Now I don't mind "citizen assist" calls. I really don't. I don't mind helping people do things at their house that might prevent us from going back there in a few hours. I can even stand ending up smelling like stale cigarettes to help someone.

What pisses me off is when someone that needs my help, because they won't take proper care of themselves, has an attitude about it. Maybe, just maybe, you should try being nice to the people that are just there to help you.

Thursday, September 15, 2011

Calling 911?

Wednesday, September 14, 2011

A Silent Tribute

These rocks are on my way home.

They are the local graffiti rocks and anyone can paint them. Someone painted them for 9/11. This is the longest I've ever seen them without getting repainted.

Whoever did this work of art, thank you.

Sunday, September 11, 2011

9/11 Ten Years Later

10 years ago this morning I was getting ready for work. I was an aspiring firefighter but I worked for a construction supply company in Los Angeles. I had my morning routine down, shower, get dressed and watch the news for a little bit. I turned on NBC and saw that one of the twin towers was engulfed in flames. I sat, transfixed, until I saw the second plane go in. At that point I went in and woke up my wife. I went into work that morning. At work, everyone was gathered around the TV. After an hour or so the owner told us all to go home and to be with our families.

It's a difficult thing to try to put into writing how I exactly feel about that day, especially now, as a firefighter. I imagine that my feeling are similar to those of other firefighters.

In the fire service we now talk about remembering the 343 fireman that died that day. Most apparatus have either an FDNY sticker, remember 9/11 or 343 on it somewhere. Rightfully so since that was the single worst day in fire service history. But what about all the others that die? Recently a plaque was dedicated to the 55 members of the FDNY that have died due to World Trade Center related illnesses. More have died since the creation of the plaque. And what about the 937 other firefighters that have paid the ultimate price while serving the public since then?

I've decided to honor all of them in the same way. On this day I will lower the flag to half staff. I will wear a shroud on my badge. But more than anything else I will report to work and when the tones go off, I will answer the call, just as they did.

To my brothers and sisters that have gone on before me, I will carry on. To the public, when you need us, we will be there.

Saturday, September 10, 2011

Don't Sleep Naked

Seriously. No matter how attractive you may think you are at least sleep in underwear. If we're there, it's not going to be pretty.

We got a call to a business for a man having a stroke. Strokes are one of the calls where seconds count. There is only limited time to get someone have a stroke the treatment that may make the difference between permanent disability and normal life.

As we approached the business we found an old man waving us down. He pointed us toward the rear of his property. His business rents single wide trailers to construction companies to use as offices on site. He pointed us in the direction of one that had an open door on one end and said that the patient was in there. I should have suspected something bad when he didn't lead us into the trailer.

Stepping inside the trailer we found a walk way that was about 18 inches across. Lining the path was trash, boxes and miscellaneous stuff stacked all the way to the ceiling. I went in first and worked my way to the back where I found my patient. He was laying, naked, on the floor, with his head leaning to the right. He was groping around with his right arm trying to find something to grab onto. I asked him his name which he said was John. He said that he fell down on Friday night (it was now Monday morning). He was unable to move anything on the left side of his body. His facial symmetry was way off as well. Classic signs of a stroke. One that had probably struck 3 days prior.

At this point I asked my engineer to grab our carry all. It's a tarp with large loops for handles for carrying dang near anything you want, although we primarily use it to move people. My captain and I then backed out of the crawl space to get our equipment out. There was no way we were working this guy up in the trailer.

Once we had maneuvered the man onto the canvas we literally drug him out. There was no way for us to safely pick him up to carry him and avoid all the objects sticking out into the walkway. As soon as we got him to the door we picked him up and carried him to the gurney. Thankfully AMR was already waiting. I gave hem a quick rundown on the call and helped them load up the patient.

After some calls, you just need a shower.

Tuesday, September 6, 2011

Strike Team

Strike team 2870C on its way to Kern county.

Saturday, September 3, 2011

Lord Vader

If a call doesn't come in during dinner than it's bound to come in just as you sit down to eat your ice cream and watch a movie. Actually, my ice cream very rarely gets interrupted. But I do hate coming back to ice cream you can eat with a straw.

Photo by Frank Hnatek

As we walked into the home we found a an 85 year old woman laying down in bed struggling to breath. The family said that the breathing problems had started that morning and had steadily worsened. As we approached the patient the problem was easily identifiable. She had audible rales. While my engineer set her up on an oxygen mask I sat her up and got a quick pulse ox, which was 60.

While I continued questioning the family and getting my vitals my engineer then set up our CPAP. The family told us that the grandmother had had a heart attack 10 days before. While in the hospital they did an angiogram which determined that her arteries were too small for angioplasty. For some reason the family also said that my patient had not been a candidate for a CABG which meant that she still had the exact same blockages in her heart that she did 10 days ago. Not good. And to further complicate things she had developed CHF. After determining that her BP was good I gave her a spray of nitro right before put Darth Vader's mask on.

Once we got her on the CPAP her vitals started rapidly improving. Just a few short years ago the treatment for a severe CHF patient was barbaric. It involved lots of medication that did little in the short term and, depending on the severity of the patient, sticking a tube down their nose or mouth into their lungs to breath for them. At the hospital they would then have to be put on a ventilator. Sadly, a large number of those patients would never be weened off of the breathing machine.

AMR walked in just as I finished missing my IV attempt. I gave them a quick rundown with an updated set of vitals. The AMR medics must have completely ignored what I was saying because they immediately set up for a 12 lead EKG. Under normal circumstances I would have as well but because of her recent cardiac history I decided to put it on the back burner. What would it tell me? That she was having cardiac problems? No Duh. After shooting the 12 lead they decided that it wasn't clear enough so they did another one....and another one. After the 4th I stepped in and asked them what they were looking for since we already knew that she had major heart problems. About that time the lights clicked on in the heads and they got it. We loaded her up and started toward the hospital.

In the back of the bus (I went along because she was on our CPAP which isn't compatible with AMRs) I started the IV without a problem. I guess I just needed the sway of the ambulance going over speed bumps. We checked again on he O2 sats and she was up to 100%. CPAP is a God send.

At the hospital I gave my report to the doc. I then turned to the RN and gave her all the nitty gritty details. That same RN had worked up my patient 10 days earlier when she came in with the MI. While I was talking I heard the MD order one the techs to remove my CPAP. I jumped in and suggested that they have RT on standby which the all knowing doctor ignored. Within 2 minutes my patient started crumping (yes, it's a technical term). Her SpO2 went from 100% to 59% and the staff started getting excited. I just shook my head and walked out. I had done my part. Time to get into Big Red and go home.
© 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.

  © Blogger templates The Professional Template by 2008

Back to TOP