Lessons From Arson Class

While talking with our fire marshal this week I learned a better way to start your campfires. First, get your wood. Second, buy a 99 cent bag of Lays potato chips (other chips will work too but Lays is the best). Place the bag of chips in the center of the fire pit. Now, set up your wood around the bag of chips leaving a corner of the bag exposed. Now light the bag on fire. The saturated oils in chips are quite flammable. The bag all but disintegrates and you have a roaring fire. Lays plain potato chips work best because they are thin with a high concentration of fat compared to other chips. If you do try this, please do it in a safe manner.

Squad 461

This last week we received what will end up being our new squad. The truck was donated by a fire sprinkler company in Palm Springs. Right now it looks similar to this truck, though not as clean.

We spent most of Saturday cleaning it. We removed the ladder rack and worked on the engine. We are going to get it painted and equipped mostly through donations. In a couple of months it should look something more like this. There is talk of making it a medic squad and trying to keep one medic on the engine and one on the squad. We'll see.

Second Chances, Again

At our firehouse, we volunteer for cooking. Some of us are really good cooks while others.... One of the firefighter paramedics loves to cook but has been having a string of bad luck. In his first attempt, he burned all the food. In his second attempt, he made meatloaf. It turned out raw because he misjudged the actual oven temperature (his excuse). In his third attempt, he made chili with elk. During this attempt he was "helped" by one of the firefighters who put a very liberal amount of hot sauce in the chili. It was spicy but didn't taste half bad. That night we all either had diarrhea or were vomiting or both! So this last shift he wanted to redeem himself. He made a deal where he would make his meatloaf again, but if it was not up to snuff, he would take us all out to dinner. This time the meatloaf turned out quite well. We had a great dinner with mashed potatoes and homemade biscuits. All would have been fine if he had stopped there. Unfortunately, he made a dutch apple pie as well. He forgot that in the oven and burned it. We still haven't decided if he gets to cook again. The cook (term used loosely) does have to suffer a lot of jibes from the rest of us every time he tries to cook.

We Aren't in L.A. Anymore

The call came in just after lunch for a medical aid. In fact, we were still sitting at the table. It was reported as an ill person. As we saddled up and started on our way the engineer proceeded to tell me the name of our patient, age, significant medical history, and probable chief complaint. He paints the picture that he has been here more than a couple of times and that I should get used to it. To get to our call we drive across the highway until the pavement ends. At this point we veer to the right. When the dirt road ends at a T intersection we make a right. The house is just on the left. We arrive to find our patient disoriented and sitting up in bed. Per his house mate, the patient had been seizing for the last 10 minutes. I do a quick exam while one of the firefighters gets my vitals. Just as we were setting up to do the IV the ambulance shows up. That crew had a paramedic intern (I'm so glad that I'm not on my internship anymore!) so I told her to jump in and take over. She finished her assessment and tried to start an IV, twice. Some of my firefighters were going to ask her if they could do it because she was missing some great veins. I'll chalk it up to nerves. We loaded the patient up and sent them to the hospital, back down the dirt road!

Training, Training and More Training

At 0800 on Thursday morning I was in by uniform at work awaiting the morning lineup. At about 0815 I was informed that I should get changed into my shorts and MVFD t-shirt and that I would be wearing that all day. At about 0900 the training began. We started out with bunker drills (getting dressed for a fire in full turnout gear with your SCBA). We did bunker drills for a while then we switched to hoses. In full turnouts and SCBA I had to pulled the 4" hose and attach it to a fire hydrant. We did this for a couple of hours with the 4" and 2 1/2" hose lines. I then was instructed to pull 200' of 1 3/4" line to various positions around the station. I did this over and over again. Then we drove over to the church and did a reverse hose pull. Under normal conditions the engine will stop at the hydrant and someone will jump off and grab the hose that will connect the engine to the hydrant. A reverse hose pull is where the engine is at the fire and needs to drop off everything the firefighter may need to fight the fire for the next 15 minutes. We did this training until dinner. At dinner we had steak and potatoes. It tasted great. As soon as we were done the company officer called for another drill. This time I did evolutions of all the different typed of hose pulls that I had done earlier in the day. I got pushed to my limits and then started to dry heave. I really didn't want to taste the steak again. At that point they called the drilling off and told me to relax. Later on in the shift the engineer talked with me about how hard they were pushing me. I guess he was worried that I might not understand why they were doing it. I assured him that I completely understood and would continue to give 100% without complaint.

How Big is Too Big?

I would think that people would start to realize that they may need a life style change when you start having to call 911 for relatively simple tasks such as getting off the toilet. About a month ago, my partner ran a call for an obese man stuck on the toilet. It took 8 firefighters (because that's all that would fit in the room) to remove this gentleman from the toilet. In so doing, the firefighters accidentally removed the toilet as well. Today we had a call for the same gentleman (who ways in at over 500 lbs.) because he was trying to get into his minivan. He managed to sit down in the front passenger seat but then fell backwards toward the drivers seat so that his legs were sticking out of the door. Needless to say that the minivan, however spacious, is not as big as his bathroom. It took ten of us over 20 minutes to get this guy out of his car and onto our specialized gurney. Once at the hospital he had the audacity to say that he didn't want the bariatric bed (a bed made for large people) and that he thought the beds with a 400 pound maximum weight would be good enough. Unfortunately for him, he got the double wide bed.

Orientation

Today I got to drive all the way out to the Hi-Desert Medical Center to receive the ICEMA paramedic accreditation orientation (say that three times fast). Basically it prepares a paramedic to take the accreditation test that I have already passed (I just love jumping through useless hoops). I met with the PLN (paramedic liaison nurse) and talked with her for about 90 minutes. She did give some good advice though. She encouraged me to "think outside the box." I know that sounds cheesy but what she meant is that I need to use my head as a paramedic. Unlike L.A. County, ICEMA paramedics have protocols that are guidelines. My PLN said that I should not be afraid to call the doctor and ask him for out of the ordinary (thus out of protocol) things. If it makes sense the doctor will most likely approve it. Strange to be practicing medicine in a setting where the doctors and nurses trust you.

Thieves

On Saturday afternoon we received a phone call from a concerned citizen. She told me that there was a man with a water tanker truck hooking up to the fire hydrant on the corner and stealing our water (5000 gallons at a time). She said that the man doing it had talked to her husband while he was doing it and stated that he had permission (interesting since we knew nothing about it). When he left for his construction site, the driver told them he would be back in a little bit for one more load. She called us as the man drove away. We dispatched engine 462 to investigate. Shockingly enough, the thief decided not to try to pilfer any more water when he saw a fire engine near the hydrant. Our engineer was smart enough to get a license plate number, company name, and address before he could drive off. Now the San Bernardino Sheriff's department. Unfortunately they will probably only get off with a warning.

A Day in the Life...

Thursday morning started out for me at 0630. I got up, with the other boot (probationary firefighter), before the rest of the crew. We grabbed the American Flag and raised her. We then brought in the newspaper and separated it by section on the table and started a fresh cup of coffee. At this point we ate a quick breakfast and prepared ourselves for the day. At 0900 we had morning line up. At morning line up we go over the plan for the day and talk about what needs to get done. We also decide things like who is cooking dinner and what it might be. After morning line up we went out the the apparatus bay and started our workout. We did an extensive upper body workout for about 90 minutes. At the end of this we grabbed a 50ft section of 4" hose. We then, in turn, raced two blocks down then two blocks back with the hose on our backs. At the end of this we were all hacking up our lungs, some of us for the rest of the day (no, not me). We put the hose pack back and then proceeded to have a two minute drill. A two minute drill is when the probationary firefighters get two minutes to get all of their firefighting equipment on (boots, turnout pants, turnouts jacket, gloves, SCBA which you have to turn on and check, mask, hood, and helmet). You signify that you are done by clapping. For every second that you are over the two minute mark I had to do one push up. I was 34 seconds over. After the morning workout I was only able to push out 27 push ups. The other boot, who only had to do 4 push ups, was asked to do the rest for me. It's a very good way to make you hustle and to make you closer as a team. I didn't much like having someone else doing my push ups for me but at that point I was very grateful. At this point we put all our stuff back on the engine and hit the showers. We prepared a light lunch and then took care of the station duties and studied. At around1630 we started to cook dinner (enchiladas). We ate around 1730.

At 1830 we got paged on the overhead for our next drill, a simulated fire at the recreation center at the park down the street. There are reports of one victim trapped. We run to the engine and and put on our turnouts. We then take off. In the back of the rig we finish getting ready to fight the fire by putting on the rest of our gear (our SCBA's are stored right in the backs of our seats). When we get on scene I'm instructed to "take the hydrant." I jump out of the engine and grab the 4" hose off the back. I then wrap the hose around the hydrant and the engine takes off for the building that's on fire. They stop near the building and start deploying a cross lay (a 1 3/4" hose used to fight the fire). As the engineer gets ready to receive the water from the hydrant I connect the 4" hose. He then calls for water and I open up the fire hydrant. Now I proceed (run) back to the engine for further orders. I'm told to grab the rotary saw to make a forcible entry into the building. After that both boots are told to strike a tree stump 43 times with a sledge hammer. While we are doing this we are told that there are now reports of a firefighter down. We then put on our masks and enter the building (which of course is dark). We performed rapid search for our lost comrade (represented by a couple of hose packs stuffed into turnouts with an SCBA). He is relatively easy to find since his emergency beacon is going off (a loud alarm and strobe). We find him and drag him out. We were told at this point that our rescued firefighter was not breathing. I quickly tore off my mask, hood and helmet and started rescue breathing. After 2 breaths I checked for a pulse and called for my ALS equipment. He had a pulse. At this point the drill ended. We put away everything that we had used and cleaned up our mess (the hoses leaked inside the recreation center so we had to mop it all up). At 2130 we had a call for chest pain (read the other post). At about 2300 when all was cleaned and put away, two very tired boots went to bed. Snoring ensued.

I know that I have been accepted by my brothers because on Saturday night, after a good cutter call (where we had to extricate the patient...see other post) I was taking a shower and I got initiated. They came in and first dumped a bucket of flower on me. While trying to recover from my flower bath I was doused by 5 gallons of freezing water and ice. That was cold! It also told me that I belong.

Knock at the Door

At about 1900 hours on Saturday we were cleaning up after a large dinner when we received an excited knock on the front door. The person at the door informed us that there was a nasty crash up the highway (once again I have no idea why people don't use 911). As we got into our turnouts, our fire marshal (5202 during radio traffic) ran ahead in his vehicle to provide us a scene size up. As we are rolling up the highway we hear "5202 on scene" with San Bernardino dispatch. At this point I am still skeptical about how good (or bad, depends on your perspective) this call is going to be. We then hear 5202 come over the radio again, "San Bernardino, 5202, we have a two vehicle TC (traffic collision) with one occupant needing extrication. San Bernardino, please start the state engine. Medic Engine 461 (that's us!) starting triage will advise." Now I know that it's going to be a good call. At this point we ask San Bernardino for an ETA on Mercy (Mercy Air is our local helicopter transport) and get an ETA of about 25 minutes. At this point 5202 comes back on the radio, "Medic Engine 461 from 5202, we have two patients, one immediate and one delayed. Pull up to the white pick up for extrication."

As we pull up we see that the entire front driver side of the Ford Ranger is destroyed and that our patient is sitting there with a deformed left arm dangling out the window. At this point we ask for Mercy to start for our location since we were anticipating a long extrication time. A rapid assessment shows that he is alert and oriented and inebriated. His only complaint is his left arm and swears that he can climb out of the vehicles. We convince the driver (I'm not saying how) that it is in his best interest to sit there and to let us do our thing. He states that he was wearing his seatbelt (that and his airbag saved his life) and that he did not lose consciousness. He also states that he has no medical problems, no allergies and takes no medications. After 10 minutes we had him out of the truck and strapped to the backboard. Once out of the vehicle a good secondary assessment showed that he had a left femur fracture. He wasn't going to be crawling anywhere. As I was sticking him with a 14g IV (about the size of a stir stick) the ambulance showed up. Since we already had him ready to go we canceled the helicopter and let MBA take him to the trauma center. I gave them a quick report and sent them on their way.

Afterwards we cleaned up and took a couple of pictures of the wreck. Hopefully I can get a copy and post it. The other patient signed out AMA with only some shoulder pain from the seatbelt.

Respond for Chest Pain

At about 2130 (I'm gonna make you figure out what time that is in civilian time) we got toned out for a woman with chest pain. Since we were already in our casual clothes we quickly donned our turnouts and ran over to the address. A friend of the patient met us in the driveway and told us that he had just found her this way. We went inside to find a 63 year old female laying on the ground. She had thrown up a couple of times and was also incontinent. It turns out that on Thursday, just after noon, my patient had had a stroke. At this point she was completely paralyzed on her right side. She had tried to make it to the phone from the couch but fell on the floor. She had stayed there on the floor, unable to move, until our arrival. I performed a rapid assessment and stuck her with an IV while my partner contacted our base hospital. We had to wait for about 10 minutes for our ambulance to arrive. At that point I gave my report to the paramedic intern (it was her first shift and she looked like a deer caught in the headlights). After packaging up the patient and sending her on her way with the MBA (Morongo Basin Ambulance) paramedic we went back to the station. I could get used to not having to transport my own patients.

Roll Over

Thursday morning I arrived in Morongo Valley to a snow storm! That afternoon our fire marshal received a phone call from a local citizen and was told that there was a vehicle that flipped over on the highway (why this concerned citizen didn't call 911 is a mystery). Our fire marshal then called our station to let us know that there was an accident. We rolled out to the highway and found that indeed a Ford Ranger had flipped into the ravine by the side of the road. The driver had already climbed out of the wreckage and was ok. We did a quick assessment and had the patient sign out AMA (against medical advice). At least my first call had potential.

Goodbyes and New Beginnings

Most of you that read my blog already know that I have been hired by the Morongo Valley Fire Department (MVFD) as a full time firefighter/paramedic. I work 72 hours shifts and am the only paramedic for miles around. My ambulance is over 30 minutes away and the hospitals are just as far. I'm excited to be able to work in an environment where my skills we actually be put to the test. This new job means that I had to resign my position with the La Habra Heights Fire Department and I have gone extremely part time at Gerber ambulance so as to be ale to keep my Los Angeles county paramedic accreditation. Please feel free to post any questions you may have.

ICEMA

ICEMA stands for the Inland Counties Emergency Medical Agency. ICEMA is the agency that allows me to work as a paramedic in San Bernardino County. I am currently going through their accreditation process and I am amazed at one thing. How much they expect from the paramedics. It's kind of nice really. They take the stance that we are highly trained intelligent people and are willing to let us go out into the area and prove it. We can do twice as much as an LA county medic can and we do it without having to call the hospital first. It is a refreshing (and welcome) change of pace compared to Los Angeles.

Vegas Flight

Yesterday we received a call to go and pick up a patient at Santa Monica airport. He was being flown in from Las Vegas and was going to UCLA medical center to get his aorta repaired. He had a thoracic aortic aneurysm. In plain English, the largest artery in his body, the aorta, was ballooning up and getting ready to pop just as it left his heart. As you can imagine this would have bad consequences. We were told to be at the airport at 09:45 to meet the airplane. We arrived in Santa Monica around an hour early and were lucky that we did. Just after we got in the area dispatch was informed that the people in Vegas forgot that there was a time change and informed him that the plane was on final approach. We quickly made our way out on the tarmac and searched for our plane. Once we found it we very gently loaded our patient up and made a quick escape to the hospital. Patients like this guy make me very nervous. He also had the same thing happen to his aorta a few years ago only that time it was farther away from the heart. He is one very lucky guy but I don't envy the bill he is going to get for the transport from his hometown outside of Las Vegas to UCLA.

Darwin Awards Honorable Mention

The other day we transported a man from San Pedro Peninsula Hospital (SPPH) to Little Company of Mary hospital (LCM). Our patient had been stabbed nine time earlier in the day and had lost his peripheral vision so we were taking him to LCM to get an MRI scan of his brain. After talking to our patient we discovered that he had, 20 years ago, been shot as well. He also has a younger brother that was shot 13 times and survived. I couldn't help but think that I don't want anything to do with this family.

A Trusting MD

The other day we brought in a patient in pretty severe respiratory distress to the ER. She was showing all the signs and symptoms of a patient with pneumonia and was coughing so hard that she caused a pretty bad nose bleed. After we had placed her in the bed in the ER we were finishing up our paperwork at the work station in the ER. The ER physician, without looking at the patient, asked us pointedly if she was circling (commonly called circling the drain referring to the patients deteriorating condition). She asked us if the patient needed to be intubated or if it was something that could be treated without intubation. It was nice to have a doctor trust your judgment.

Later that morning we brought in a man with low blood pressure and a slow heart rate. We were unable to establish an IV so we just quickly transported him to the hospital. The patient was not complaining of anything other than the inability to burp. I know that there may be paramedics, RNs, or doctors out there that would immediately start wondering about cardiac involvement. They would be right. When we finally did a twelve lead ECG it came back showing that the patient was having a massive heart attack. The patient spent a total of twelve minutes in the ER before being rushed to the CathLab. The doctor congratulated us on our rapid transport of the patient but we had to admit that we had missed the heart attack having been too distracted by the slow heart rate and low blood pressure. In the end the patient got exactly what he needed, a fast way to get to the hospital. It was a good call from which to learn.

Treat for the 1%

In my job we often treat the patient for the worst case (and usually least likely) scenario. Today we had a 65 year old man that called 911 because he had a splitting headache that came on all if the sudden accompanied with nausea and vomiting. The patient did have a history of hypertension (high blood pressure) and migraines and had just been released earlier in the day from the hospital due to some weakness he had a couple of days ago. The odds are that our patient was just having a bad migraine and he stated that his head hurt similar to others he had had but worse. We could have just left it at that with a great chance that that would have been the cause of the headache. The only problem is that his symptoms could also be caused by a bleeding blood vessel in the brain. The only way to tell is to give him a CT scan (or maybe an MRI, I'm not 100% positive on which one they use in this situation). So we quickly transported him to the ER and treated him as if he had the ruptured aneurysm. It can be amazing what a simple headache and a call to 911 will get you.

Practical Jokes

In the last couple of years there has been a lot of fuss about "hazing" in the fire department. People that are outside the fire service, that haven't a clue about how we act in the fire house amongst ourselves are passing judgment. I understand that some of the things that we do could seem calloused or mean but practical jokes are a vital way in which we deal with the stress of the job. A lucky few get a glimpse through a friend or loved one. Even fewer get the opportunity to be in this environment.

Here are some glimpses into the lighter side of the La Habra Heights Fire Department.

A couple of our probationary firefighters were playing dome pool while off duty. Since just playing for bragging rights is never enough they made a wager. If one of them lost a game he would have to dress up in a diaper and a pacifier with a sash that said "Happy New Year" to ring in the new year. The other would have to dress up in his station boots, boxers, and a pink apron and be vacuuming the captain's office when he arrived in the morning. Unfortunately, I didn't see the firefighter in his boxers and apron and the other firefighter lucked out because we rung in the new year on a call.

Yesterday was one of our firefighters last day. He has been hired by the OCFA (Orange County Fire Authority). Not only did he have to make us all dinner (which was excellent) but later that evening he was tackled and strapped to a backboard. We then spent 30 minutes hosing him down and covering him with the majority of the food contents in the kitchen. It was our way of saying goodbye and congratulations to one of our own. Photos to come later!