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Monday, November 28, 2011

Fire Alarm, Sort Of

Just before 11 in the morning we went shopping for dinner.We grabbed a shopping cart and headed into the store. As we turned down the first isle our radios beeped the familiar tones of someone getting a call. "District 51, engine 53, truck 51, commercial alarm sounding...." They were playing our song.

We jogged back to the truck the whole time thinking the same thing. We've been there before, often. Engine 53 will get there first. We're going to get canceled. Because of that thought process we all decided to just throw on our turnouts over our wool pants and buttoned shirts. After all, we would only be in them for 5 minutes. I jumped in the rig and sat in the jump seat.

Lights flashing and siren growling we split traffic much like a modern day Moses. The radio crackled again, "Engine 53, truck 51, we're getting reports of black smoke coming from the roof. We're upgrading this to a full alarm assignment."

At that point my first thought was regretting not getting out of my blues before donning my turnouts. I decided I better slip into my BA as well. I went through my quick checklist preparing for a fire. Turnouts were good, SCBA was on with straps tight, mask ready to go, release valve closed, axe belt on.....ready.

Engine 53 was first on scene. They reported having a commercial building with multiple occupancies with roll up doors, heavy black smoke coming from the roof. They initiated IC and let everyone else responding know that they were starting fire attack and could handle their own water supply.

Pulling around the corner we had a good view of the building. We nosed in the driveway behind engine 53. We jumped off the rig and started setting up for aerial operations. My captain chalked the front tire on our side while I set out the plate for the stabilizer. My engineer took care of his side. While he finished setting the stabilizers and getting the ladder in place I grabbed both the chainsaw and the K-12.

Once everything was set my captain headed up the aerial with the rubbish hook. Once at the tip of the aerial he pounded down hard on the roof to make sure it would hold our weight before we stood on it. He would repeat this process of sounding out the roof everywhere we went. I stepped off the ladder behind him I set down the chain saw. We were on a metal roof so the circular saw was the tool of choice.

The roof had a shallow grade and at the peak there were several vents about 6 feet long and 3 feet wide. The super heated smoke and gases were using them as a natural escape from the confines of the building. We decided to help things along. Using the rubbish hook we ripped the thin metal from around the bolts holding the vent in place. Once the the vent covering was removed we cleared the opening of any insulation allowing for a good ventilation hole. Our job done, we checked with fire attack to make sure they didn't need any more holes in the roof and then headed back to the ladder.

The fire was small. It was limited to a vehicle in the auto repair shop and a couple of racks with supplies on them. We were able to limit most of the damage to the space in which the fire started.

Thursday, November 24, 2011

Semper Fi

While blog hopping I came across this post. It was too good not to re-post.

Watch that first step.

Wednesday, November 23, 2011

Soothing Effect

I was working at one of our slower stations on an overtime shift. That morning we had the 1st and 2nd graders from the school down the street stop by for a tour. The rest of the day was spent working out, shopping, cooking and eating. There were no calls. I was looking forward to getting a good night sleep at the station as well.

I went to bed around 11 p.m.

At 1 in the morning the lights clicked on and I could hear the sound of the speakers as they turned on as well. About a half second later the tones went off signaling that we had a medical call.

We arrived at the house of a 40 year old male having trouble breathing. We were met by his wife who led us into the dining room. Her husband started having difficulty breathing about 10 minutes before. AFter talking with him for a few minutes we determined that he was having an anxiety attack. He had been having about one per year for the last several years and they always feel the same. And every time, after we show up, he calms down and is ok.

This time we canceled the ambulance and then spent another 20 or so minutes talking about his options as far as treatment. He really didn't want to take medication for it but after we explained a little more about anxiety he decided we had a point.

He was very grateful that we would spend that extra time with him, in the middle of the night.

Just as I drifted back to sleep (at least it seemed that way) the lights clicked on again....

We had 4 calls after midnight that shift. So much for a slow station and a good night sleep.

Tuesday, November 22, 2011

Yo Quiero Taco Bell

We got a call about 11 in the morning to one of our local strip malls. The call was for a woman that had fallen asleep in her car. Seriously.

My patient said that she had shown up to get something from one of the stores only to find out that it didn't open for an hour. So she took one of her Xanax and relaxed. She ended up dozing off for an our in the car that was not turned on. Eventually someone noticed her and called the cops. They came out and woke her up, then called us.

Because my patient had a rather significant medical history she wanted to go in and get checked out. The only problem was that she had a "dog." It was actually a Chihuahua. You know, the dog that is super skittish and yappie and is smaller than some rats. She didn't want to leave the dog. We finally convinced her to call a friend to come get the pooch. We also decided that the dog could wait in the back of the squad car so that we could get the anxious woman to the hospital.

One of the officers handed me a leash (did you know they carry those?). I tried to get it onto the dog without gets bit. Finally, my patient was able to slip on the leash and I picked up the dog. I held it upside down the same way I do with my cat so as not to get bit or scratched. It worked really well. Once in the back of the cop car the dog started barking at us again. It clearly didn't like its situation.

Now that we had the little terror secured we were able to get the patient onto the gurney. She later admitted to us that she took more than one of her Xanax. No wonder she fell asleep.

The last thing I saw as we cleared the scene was this small dog barking and growling in the back of the police car waiting for a family friend to come get it.

Monday, November 21, 2011

N̶a̶t̶i̶o̶n̶a̶l Local Healthcare Plan

National healthcare. A subject sure to get any group into a debate if not a flat out argument. Been there, done that. But instead of sitting around and debating the subject or worse, just waiting for the federal government to actually do something, the Alameda County board of supervisors have decided to fund a project put forward by the county's Health Care Services Agency. 

The pilot program would make use of five local fire stations to provide "federally qualified clinics" to those neighborhoods which they serve. Alex Briscoe, the director of the Health Care Services Agency asks, "What happens if we co-located a nurse practitioner from one of the community clinics with a paramedic and ran the public sector’s response to the retail clinic?

The clinics would address minor medical problems such as minor infections and immunizations helping to relieve the ever increasing pressure on local emergency departments.

In an article on the National Association of Counties website they said that "in addition to providing a limited array of on-site services, including follow-up from emergency room visits, the health portals will:
  • respond to “sub-acute” 911 calls under the county’s new Medical Priority Dispatch System (approx. 30,000 calls annually), which triages response to non-life-threatening calls 
  • provide discharge follow-up for residents in a defined area within 48 hours of discharge from emergency department care, and
  • take direct referrals from the county’s 211 call center for medical advice or consultation."

Chief Gilbert, the fire chief for the Alameda County Fire Department is quoted in the article saying,  "The fact that we can build upon that trust and meet that ever-growing need in our community that ultimately impacts the quality of life and public safety of our community is absolutely consistent with our mission and something that we're excited to be able to do."

It wouldn't be the first time that fire departments in Alameda County have been involved in preventative care. According to an article in the San Lorenzo Patch "in 2009, Alameda County became the only county in the state where paramedics were given permission to immunize residents against the H1N1 flu virus."
Recently my wife and I were having a discussion about the feasibility of a local government run health care system. I don't know if that is possible, but Briscoe seems top think so. He said, "We have to do something to reinvent the health care system. We believe we have the answer."

Friday, November 18, 2011


Tuesday, November 15, 2011

Some Time Off

For those of you that live in southern California or are planning a vacation Knotts Berry Farm is offering free admission for Police and Fire personnel plus a free admission for one other person. In addition they offer discounts for up to 6 more people.


Monday, November 14, 2011

Heart Rhythms Part 6: Blocks

A heart block is a disease in the electrical system of the heart. This is different than coronary arterial disease. The muscle tissue and vascular system is ok but the electrical impulses are not traveling in a normal fashion through the heart.

There are 3 main types of blocks, conveniently, first, second and third degree blocks. Second degree blocks are then broken down into two subtypes. We'll get to those in a minute.

First Degree Blocks 

More correctly called a first degree atrioventricular block, it is a condition in which the PR interval (the length between the beginning  P wave and the beginning of the QRS complex) is lengthened beyond 0.20 seconds.

What that means is that the electrical impulse generated in the SA node is delayed by the AV node before going on to the ventricles. Management includes identifying and correcting any possible electrolyte imbalances or withholding any offending medications.

Second Degree Blocks

A second heart block is conduction block between the atria and ventricles. A second-degree AV block is when one or more (but not all) of the atrial impulses fail to make it to the ventricles due to impaired conduction.

There are two types of second degree heart blocks, types 1 and 2. A type 2 heart block is considered to be a much more malignant block than a type 1.

Second Degree Heart Block Type 1

A second degree heart block type 1 is also known as a Mobitz 1 or a Wenckebach. 

A Wenckebach is characterized on the EKG by having an increased amount of time between the P wave and the QRS complex until a QRS complex is dropped, or missed. This is because of a diseased AV node.

The arrows point to the P waves. Not the increasing distance between the P waves and the QRS complexes.

Second Degree Heart Block Type 2

A second degree heart block type 2 is also called a Mobitz 2 block. A Mobitz 2 is characterized on the EKG by having intermittent QRS complexes dropped without a change in the PR interval. When this happens in a regular pattern the number of P waves to QRS complexes is stated as in 3:1, meaning 3 P waves for every QRS complex. 

A second degree type 2 block is caused by a a disease of the His-Purkinje System. It may also rapidly progress into a complete heart block.

Treatment may require an implanted pacemaker.

Third Degree Blocks

A third degree heart block is also known as a complete heart block. A complete heart block is a medical condition in which the electrical impulse generated in the SA node does not propagate to the ventricles. On the EKG this is characterized by having  regular P waves and regular QRS complexes but they are independent of one another. Essentially there are two separate heart rhythms on the EKG. One for the upper chambers of the heart and one for the lower ones. Usually the rate of the P waves will be higher than that of the QRS complexes. Some of the P waves will be buried behind the QRS complexes.

The most common cause is coronary ischemia. Treatment is an implanted pacemaker.

Heart Rhythms Part 1: Basic Anatomy
Heart Rhythms Part 2: Sinus Rhythms
Heart Rhythms Part 3: Junctional Rhythms
Heart Rhythms Part 4: Ventricular Rhythms
Heart Rhythms Part 5: Premature Beats
Heart Rhythms Part 6: Heart Blocks

Tuesday, November 8, 2011

Dose Of Humility

After one of our medical aids last tour I was getting some restock from our ambulance provider. As I leaned in to grab an IV catheter I cracked my dome on the ambulance. @#$%!!! So much for the smooth fireman to the rescue.

Not my actual skull

Two days later, it still hurts.

Monday, November 7, 2011

Repeat Customers

Over the last couple of shifts we've responded back to several of the patients that we saw a month ago (not always for the same problem). In the cases of a couple of the febrile kids that had seizures I'm happy to report that none of the parents were in a panic and no one tossed their kids to me. This is a major improvement.

A couple of the other calls involved people with major medical issues. You can tell that there is a sigh of relief when their local firefighters can walk in and call them by name. And that they know the history of what's going on.

On the other hand, I find that I have to be more vigilant in my assessment when I know the patient. Lest I assume something that may not be true. And while I hope that these patients won't have the need to call me again, I know it's only a matter of time.

Friday, November 4, 2011

TC Down The Street

The tones went off (insert sounds here...maybe I'll have to try that sometime). We were being dispatched for a TC just down the street from the station. We jumped into our turnouts and pulled out of the station.

As we approached the scene we could see a four door late model sedan in the middle of the side street. Along the curb was a late model mid size pickup. There was moderate damage to the front and sides of both vehicles that happens when to cars try to occupy the same space at the same time. Airbags had deployed and both occupants had self extricated.

As the air brakes set I jumped off the rig and went to see what we were dealing with. I first came upon the driver of the car. He said that other than the minor cut on his hand, he was fine. He didn't want any medical attention. I then walked over to the other driver who was talking on his cell phone.

After convincing him to hang up (repeatedly) I did a quick assessment. While my engineer held c-spine I did a neuro check to see if the patient warranted full spinal immobilization. Fortunately, he did not. While I questioned my patient I noticed that he was a bit slow in answering my questions. He would answer everything correctly but just seemed a little slow. He was also complaining of a burning sensation on his forearm. This was probably from the airbag. Once AMR showed up we loaded him on the gurney and sent him to the hospital. The poor guy was probably just shaken up from the accident.

Once he was taken care of we turned our attention to the debris field around the scene. My engineer grabbed the push broom and I grabbed the shovel. While we were tending to the patient the engine crew put absorbent down on the fluids in the roadway. Now, we cleaned everything up. While it may look like we are just being helpful it actually serves to prevent an accident later on at that same location. Once everything had been cleaned up we headed back to the barn, leaving PD to wait with the wrecks for the tow trucks.
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