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Monday, January 30, 2012

Working Structure Fire

Calls almost always seem to come in at the most unwanted times. For example, just as you sit down to dinner, or just as you dish up a bowl of ice cream, or when your baseball team is down by 2 in the bottom of the 9th with men in coring position. This time the tones interrupted a close championship football game.

The tones alerted us that we were responding to a structure fire. Most of the time we get suited up and go find out that it was only a malfunctioning alarm or burnt popcorn. So far we weren't too amped up.

We padded out to the apparatus bay and stepped into our bunker boots and pants. After sliding on the suspenders and throwing on our jackets we jumped on the rig. Seconds later, we heard engine 58 report that they had smoke showing from station 58 and declared a "working structure fire." In my department a working structure fire gets the first alarm assignment an extra engine and BC. As soon as we turned left out of the station we could see the header too.

Engine 58 pulled up on scene about 30 seconds before us. In their size up they said they had a single story single family residence with heavy smoke and fire showing and established IC. The thick black smoke was laying down on the ground instead of climbing high in the air. There must have been an inversion layer that day. PD was there first (I will refrain from making a cop wanting to be a firefighter joke at this time) and told engine 59 that they had 2 houses on fire with occupants possible trapped in the second.

We pulled up as the captain from 59 was determining that there was only one structure involved. My captain (assuming that he would be taking IC) told me to meet the captain from engine 59 and see where he needed help. He said that his firefighter was stretching a line in between the homes in case there was a rescue and that he wanted me to take a crosslay interior. No need to tell me twice.

As my captain and the captain from 59 talked I pulled the preconnected hose line. After stretching the line to the front door I started donning my mask and my crew joined me. Once masked up I opened the bail and expelled any air that was in the hose line and I also adjusted the nozzle to a straight stream. I then stepped through the open door into the thick black smoke.

Just inside the front door was an anteroom. The smoke was thick and banked all the way to the floor. But it was also cool. Carefully moving forward a couple of feet I discovered that the environment inside the rest of the house was drastically different. The fire had self ventilated (in simple terms it had burned through the roof allowing smoke and heat to escape) and I was now able to see all the way to the back bedroom. The room looked like the entrance to hell. Everything in the entire room was on fire. At least everything that hadn't already been turned to ash. The walls were burning as were the contents of the closet. What was left of the bed (and I assume clothes) formed a mountain of flaming ash on the floor. The doorway itself had flames crawling all the way around it. It was a very cool sight.

We advanced the hose line to the door. I opened the line up and knocked a large portion of the fire down. I then stepped inside. My engineer was right behind me backing me up. From the doorway he was pointing out where the fire was in the attic space. Every time he would look at me I was looking at the ground. He would yell, "Up there!!" What he didn't know was that I was standing knee deep in red hot coals. When I would take a second to hose down the fire in the attic my feet would start burning. It was toasty. So I would turn the nozzle at my feet (and the surrounding area) and drench it, before going back to battling the flames in the attic.

It's become sort of a running joke between us. He'll randomly say "up there" and I'll respond "my feet."

Once we had knocked down the fire in that bedroom we chased it around the attic. The crew from engine 60 came in to pull ceiling for us and we had a truck company on the roof making a pincher attack.

After burning through our second SCBA cylinder my engineer and I went outside to get a new ones. This process involves us turning off our BA and someone else disconnecting our bottle. They then replace the bottle with a new one. While we were waiting we noticed the paramedics from the private ambulance company that had shown up on standby. One had long blond hair and the other dark brunette hair. As my captain joined us we remarked how we were both now feeling "ill" and needed to take a ride to the hospital. After a good laugh it was back to work.

We went back inside. now that the fire was out we ensured that it would not rekindle. We covered nearly everything in the house in class A foam. It looked as if it had snowed inside. We would not be coming back that night.

Finally all that remained was engine 58 and us. We helped them load several hundred feet of 1 3/4" attack line and another 200' of 5" supply line. The much less glamorous part of a structure fire. After that, it was time to go back and see who had won the game.

Wednesday, January 25, 2012

One Year Old, Not Breathing

"Engine 51, Medic 143, you're responding for a 1 year old unconsciousness and not breathing. PD is also en route."

In my city PD will respond to potentially critical pediatric calls and to full arrests (and any time we might need them to....ah....correct some bad behavior). As we drove down the dark residential streets dispatch informed us that PD had arrived on scene to find the patient breathing and alert. Now we could continue on in in a more conservative manner instead of like a bat out of hell.

Arriving on scene we found 3 police vehicles parked along the street. In front of the house were about 20 people, all wearing 49ers clothing (it was just minutes after the 49ers blew their Super Bowl chances). One of the officers held a small child, wrapped up in warm blankets, in his arms. Mom and dad held each other next to him. Mom was borderline hysterical.

I walked up and took a quick look at the kid. She was crying. Music to my ears. AMR had just pulled up behind us so I let them, along with my captain and engineer (who were both medics) take care of the kid. I went to the parents to find out the story.

Mom said, in between sobs, that her daughter was dancing in the kitchen when she collapsed, stopped breathing, and turned purple. Pretty much all not good things. She said that her baby didn't breath for about a minute than she started again.

Since little kids generally don't just stop breathing and collapse for no reason I probed some more. Mom said that the night before her daughter had fallen and hit her head on the couch, leaving a small goose egg. She also reported that her daughter had recently spiked a fever but they had treated that with Motrin.

After gathering all of that information I went and talked with the AMR medic. Turned out that the goose egg from "last night" was still getting larger. something about the story just didn't seem to fit right. So we didn't know if the kid had received some kind of cerebral trauma the night before and was just becoming symptomatic, if she had a febrile seizure, or had some other medical condition that was yet to be diagnosed.

Once we had the girl all ready to be transported we made sure that mom had a ride to the hospital. We let dad ride in the ambulance since he was the calm and collected parent.

Wednesday, January 18, 2012

Downhill Slide

I was tired. We had had a good structure fire earlier in the shift. I always sleep well after one of those. I woke up and noticed the lights were on. My mind went through it's short cycle of confusion, understanding, then action. I slipped on my socks and headed for the apparatus bay.

I listened to the update from dispatch trying to gauge how awake I was going to need to be for this call. If it's a call for a stubbed toe, I can go on auto-pilot. If it's a critical kid, I would need to be fully awake. We were responding for a person having a hard time breathing. I needed to be fairly awake for this one.

We walked into the back bedroom and found our patient, an 82 year old woman, laying on her bed in obvious respiratory distress. To make matters worse, she only spoke Mandarin. Fortunately her son was there to translate for me.

We sat the patient up in bed and my engineer started getting vitals. I asked and found out that my patient had started feeling a little short of breath early last night and that it had simply worsened until they had to call 911. The old woman was a diabetic with a history of high blood pressure but no breathing problems. She was a non smoker and had had no cough or recent illness. She also had no chest pain.

Just as we got the vitals AMR showed up. The patient had a BP of 110/68, a pulse of 145 and was breathing way too fast. Her pulse ox was 87%. We decided to pick her up and carry her (we didn't want to put any more strain on her) to the gurney rather than do anything else on scene. While the AMR medic and his partner placed her on an oxygen mask I grabbed our equipment. As they loaded the patient into the back of the ambulance the medic asked for a rider and our Lucas device. The patient was obviously starting a very bad downhill slide.

In the back of the bus it only took one look at the patient to know why the medic had asked for a rider. She had the look of someone circling the drain. The AMR medic grabbed his CPAP and started setting it up. I grabbed the monitor and started connecting her to it (BP cuff, pulse ox probe, electrodes and then defibrillation pads). I then rolled up her right pant leg so I would have access if I needed to do an IO.

It was about that time that we noticed she was no longer breathing. I checked for a quick pulse while the other medic grabbed a BLS airway and the BVM. Not finding a pulse I did a quick look at the monitor to see if it was something I could shock. She was in an ideoventricular PEA at a rate of about 20. Thankfully the Lucas device had been requested and we put it to good use. With the thumper going  was now free to do other things. Unfortunately I hadn't taken a seat at the patient's head when I got in the ambulance. That meant that I had to try to find everything (the AMR medic was bagging the patient) in an unfamiliar environment. It was kind of like trying to cook in a meal, with severe time restraints, in a kitchen that you've never been in before....where are the @!#$@# frying pans?!?!! Thankfully, like in a kitchen, most things were where you would intuitively look for them.

I started an IO and checked the rhythm on more time. No change. The AMR medic tried to intubate but found that the patient was a difficult tube. At that point we were about 30 seconds out from the ER.

Inside the ER I helped out the staff work on the patient for another 30 minutes. They really liked our automated chest compression device. We followed the ACLS protocol without success. The patient went from a ventricular PEA into asystole. After 30 minutes resuscitation efforts were terminated.

90 minutes after the tones went I found myself back in bed, slowly drifting back to sleep....but not before turning off my alarm.

Monday, January 16, 2012

It's 0230, What Are You Doing?

Oh that wonderful time of night where you are in a deep, deep sleep. When you're body repairs itself. I love that time of night. You know what I hate about it? Waking up right in the middle of it. It doesn't matter how short the call is, it's never quite the same as sleeping through the night.

The lights clicked on and the tones sounded. I groggily swung my body out of bed and grabbed my socks. I padded over to my turnouts and slipped them on. If I wasn't awake before, putting on cold turnouts sure did the job. At least they weren't wet!

Pulling out of the station I noticed the reflection of the lights off of the cars and houses around us. Out of courtesy we didn't use our siren. After all, just because we have to be awake doesn't mean everyone had to be awake. Also there weren't that many vehicles on the road.

Dispatch told us that we were responding for a report of the smell of smoke and that the RP didn't want to be recontacted. It was probably one of the neighbors and they didn't want to start a feud. That also told us that we were probably on a wild goose chase.

About 3 blocks out from the address we noted the smell of a skunk. I thought that that was probably going to be it. It wouldn't be the first time that we were called for a structure fire/smoke investigation/natural gas leak that turned out to be a skunk. Then we smelled it. The distinct smell of burning plastic. The RP was right, something that wasn't supposed to be burning, was.

For the next several minutes we drove around with our windows down trying to pinpoint the source of the smoke. Finally we turned a corner and noticed the haze. We were close. Once we made it to the other side of the dingy atmosphere we stopped and dismounted. We searched each house with flashlights until we found one that had brown smoke coming from behind it. Before knocking and waking up the residents we decided to check further down the street as well. We then checked to see if dispatch could do a reverse 911 call (they can call the number associated with the address as long as it's listed), but they couldn't.

Walking up to knock on the door we noticed that the smoke now looked like steam. We watched for a moment more and the steam dissipated. Either the sound of the Cummins Diesel motor, the flood lights creating a false day out front, the radios crackling with traffic or the 3 of us tromping around talking (or a combination of these things) had alerted the residents that we were there. They obviously knew that they weren't supposed to be burning trash and doused the flames.

We decided that that was enough. The fire was under control and they probably wouldn't be starting it up least that night. Time to head back to the barn and back to sleep.

Friday, January 13, 2012


As we pulled into the Lowe's parking lot we could see a couple of workers waving frantically at us (almost as if we wouldn't be able to find the store). We pulled up and my engineer hit the air break. The steps unfolded as I opened the door. After grabbing the equipment we were led to the appliance section of the store.

There we found a nearly 90 year old man sitting on a chair. The man and his son had been shopping for a new washer and dryer when, according to his son, he passed out. The son went on to say that he had helped his father to the ground. Fortunately he had seen his father's eyes glaze over and was there to catch him when he fainted.

My patient told me that he was still feeling a bit light headed. He also said that he wasn't going in an ambulance. A few weeks prior he had fainted and was transported to the hospital. He had just received a bill from the private ambulance company for the amount that his insurance did not cover. He didn't want another such bill. I assured him that I understood but I still wanted to check a few things. He readily agreed.

My patient's initial BP was low. Everything else was great. He had been seen by several specialists all trying to figure out why he was having these fainting spells but to no avail. While we checked what we could (12 lead EKG, blood sugar....) I talked to my patient.

He had served in World War II in the army. He had stormed the beaches of Normandy. We talked about basic training in 1942 and going across the Atlantic in a Liberty ship. He talked about giving up cigarettes and alcohol when he got married. We talked about his wife and his son and about his daily exercise regimen. He was full of stories and was happy to relate them to me.

10 minutes later my the WWII vet looked better. I asked him again how he felt and he said 100%. We again checked his BP and it was now 118/78.

After signing him out AMA I asked if it would be ok if I escorted him to his car. He declined. So I asked him if he would escort me to my fire engine. He laughed and agreed, saying that I was a persistent bugger.

They just don't make them like they used to.

Monday, January 9, 2012

Knights In Shining Armor

To be fair it would be more accurately described as guys in PBI and blue t-shirts but that probably depends on your point of view.

We were headed out to grab some grub. The day had gotten away from us and we no longer wanted to go shopping, cook dinner and then end up eating around 8 at night. So instead we were on our way to get something to go. Besides, it makes clean up easier too.

About two blocks down from the station we came up on a stopped station wagon in the center lane that had it's hazards on. We pulled up directly behind them and flipped on our lights as well. It was night time and we didn't want someone hitting us (although it's debatable weather or not turning on all our lights makes this more or less likely to occur).

My captain and I checked traffic and dismounted. The woman in the drivers seat said that she had run out of gas. The three year old girl in the back seat smiled at me while we talked with her mom. We decided that we would stop traffic and push her disabled vehicle into the nearby parking lot.

While my captain played crossing guard my engineer and I pushed. Just as we got her into an actual parking place her husband pulled up. The woman had called him for help. That also meant that we didn't have to worry about leaving a woman alone in a parking lot at night. As we were leaving I gave the little girl a firefighter sticker. I think we made her night.

Friday, January 6, 2012

Dazed And Confused

We were dispatched for an 88 year old man that was altered. We pulled out of the station into the damp, foggy morning and hit the growler, it's sound instantly bringing a smile to my face. Traffic pulled out of our way, some, because they were obeying the law, and others, because they were a lot smaller and less intimidating than a fire engine tearing down the street with lights and siren blazing.

We were met at the door by the wife of our patient. She said that her husband hadn't been acting right all morning. While my captain started talking to her I started talking to the husband. He knew his name and where he was but didn't know what day it was. To be fair, neither did I. He said that he was feeling 100% and that he didn't know why we were there. All of his vitals were good. His blood sugar was 154.

The Mrs. of the house told us her husbands medical history, which was lacking on thing that I thought would be on there, dementia. Finally after some more questioning the wife related a story that took place several months ago that ended with her husband in the hospital with a diagnosis of dementia.

I have no problem going out to the homes of people with dementia. It's a horrible disease. But I think the medical community as a while needs to be better at explaining the disease and it's probably progress. I got the impression on this call (and many like it) that the family members have no clue as to what to expect as dementia gets worse.

For more information on dementia click here.
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