As we pulled into the parking lot we were able to see several police officers surrounding our patient. Before we could even stop the rig we watched as one of the larger police officers grabbed a sweatshirt or jacket and tossed it far over his shoulder while yelling at the 30 year old male. As we approached the patient we noticed that he was being detained by PD but had yet to be handcuffed. That quickly changed as he started verbally engaging us. It was obvious that the guy was under the influence of, at the very least, alcohol. As we tried to examine the patient to determine if he needed to go to the hospital we did our best to distinguish ourselves from the cops. This usually makes it so that the patient will be cooperative with us even though they are fighting with the cops. As we tried to get vitals one of the officers said something to anger the patient. The patient was quickly placed in an arm hold and, in a not so round about way, told that he better behave or he would need to go to the hospital.
During our assessment we determined that the patient was indeed altered and that his heart rate was trucking along just a little too fast (about 140). Once AMR was on scene we filled them in on the situation. The AMR medic told the patient that he better be nice because if he wasn't she would simply knock him out, and not violently. The patient agreed and stood, without the cops permission, to get on the gurney. He was swiftly tackled back to the ground and ordered to stay there until told otherwise. After the gurney was brought out the large PD officer picked up the patient and attempted to slam him down on the gurney. Unfortunately, none of the EMS personnel were aware of the cops intentions. the gurney was not being held and it slid out from the force of the impact. The gurney stopped when it collided with the knee of another firefighter and the patient came to a stop when he smacked into the pavement. Eventually the patient was restrained to the gurney and he laughed maniacally as he was loaded into the ambulance.
It always amazes me when a guy that weighs 150 pounds refuses to be intimidated by a 230 pounds, muscular, angry cop with several other cops there to back him up. Sometimes you just got to love stupid people.
Monday, December 28, 2009
Friday, December 25, 2009
Merry Christmas
Just remember, while you're celebrating with your family, there are those that are at work today (thankfully not me this year) just in case the worst happens. Many people around my station have stopped by to say thank you and drop off a treat (even the burnt cookies). We really appreciate it. Be safe and have a merry Christmas!
Thursday, December 24, 2009
Going Above And Beyond
A few weeks ago one of the other crews at my station got a call for a victim of a fall. When they arrived on scene they found an 80 year old woman laying on the floor covered in blood. Her house looked like a scene from a horror movie with blood trails leading to the front door. Towards the rear part of her house she had fallen and hit her head on the door jam. This split her forehead open almost from ear to ear. She also broke her neck. She had crawled from where she hit her head to the phone but couldn't reach it. She finally crawled over to the front door to try and open it to get help. There was blood everywhere.
Eventually neighbor came over and found her. She called 911. The engine crew bandaged her up and placed her in a cervical collar and on a backboard. Then they sent her on her way to the hospital.
What makes my department stand out from others is what the crew did next. After the patient had been transported to the hospital they started to clean up. They used towels and mopped up the floor. They went through and cleaned every surface up to and including the jewelry that was bloody. After getting it mostly clean they used paper towels and a little bit of bleach to make sure it was all clean. Then they took the towels they had used, and a rug that had been soaked in blood and put them in the wash before the blood could dry and ruin them.
I'm proud that I work for a department that would do the extra stuff. When questioned they said that they didn't want to make their patient come home from this traumatic event just to have to clean the house and relive it.
A week later I ran a call on the same lady. She had stitches all across her forehead and had to wear a neck brace because of the cracked vertebrae. This time she was weak and unable to stand. It was a tough assessment since all she wanted to do was thank us for the last time we were there. Today she's doing fine.
Eventually neighbor came over and found her. She called 911. The engine crew bandaged her up and placed her in a cervical collar and on a backboard. Then they sent her on her way to the hospital.
What makes my department stand out from others is what the crew did next. After the patient had been transported to the hospital they started to clean up. They used towels and mopped up the floor. They went through and cleaned every surface up to and including the jewelry that was bloody. After getting it mostly clean they used paper towels and a little bit of bleach to make sure it was all clean. Then they took the towels they had used, and a rug that had been soaked in blood and put them in the wash before the blood could dry and ruin them.
I'm proud that I work for a department that would do the extra stuff. When questioned they said that they didn't want to make their patient come home from this traumatic event just to have to clean the house and relive it.
A week later I ran a call on the same lady. She had stitches all across her forehead and had to wear a neck brace because of the cracked vertebrae. This time she was weak and unable to stand. It was a tough assessment since all she wanted to do was thank us for the last time we were there. Today she's doing fine.
Wednesday, December 23, 2009
Lucid Altered Patient
We got called out just before the end of the shift. On of the things that made this call interesting is that our patient had no idea that we were coming. Our patient's son had received a call from his father at about 0730 on a Monday. His father wanted to know why he couldn't find the football game on TV. Since his father seemed confused he thought it was best to call 911.
We arrived on scene and were greeted by our patient at the door. He was a male in his late 60's and looked it. AS he sat in the chair in the front room I started to question him. He was able to answer almost all of my questions without hesitation or problems. He thought it was Tuesday morning but then said that he could be wrong and it might be Monday. I can't tell you what day of the week it is without looking at my watch first. During the questioning we noticed a full wine glass on the table.
He explained that he had poured it last night and forgotten about it. Not likely. Then my captain found several empty wine bottles in the kitchen. We asked if he had had a party recently and he said no. I asked him about his medical history to which he replied, "You name it, I got it." Not a great answer so I started to ask more pointed questions.
Do you have heart problems? No. Breathing problems? No. High blood pressure? No. History of strokes? No. Diabetes? Diet controlled. Thyroid issues? No. Anything else? No. So much for having everything.
Next I asked about his current medications to which he responded, "I take lots of meds." We were instructed to go over to the kitchen counter to retrieve the bottles of medication. He took Tylenol and Ibuprofen.
We checked his sugar which was fine. The little voice in the back of my mind kept yelling at me that there was something wrong. Something just wasn't adding up. My patient eventually said that he didn't know what was wrong but he was confused so I started a line on him and sent him to the hospital. The son arrived at the house just as we were about to leave and explained that his father has a alcohol abuse issue and that when he drinks he doesn't eat. Quite often they have to take him into the hospital because of malnutrition. I wonder if it was the alcohol/malnutrition or if he had early onset of dementia. It seemed more like the latter to me.
We arrived on scene and were greeted by our patient at the door. He was a male in his late 60's and looked it. AS he sat in the chair in the front room I started to question him. He was able to answer almost all of my questions without hesitation or problems. He thought it was Tuesday morning but then said that he could be wrong and it might be Monday. I can't tell you what day of the week it is without looking at my watch first. During the questioning we noticed a full wine glass on the table.
He explained that he had poured it last night and forgotten about it. Not likely. Then my captain found several empty wine bottles in the kitchen. We asked if he had had a party recently and he said no. I asked him about his medical history to which he replied, "You name it, I got it." Not a great answer so I started to ask more pointed questions.
Do you have heart problems? No. Breathing problems? No. High blood pressure? No. History of strokes? No. Diabetes? Diet controlled. Thyroid issues? No. Anything else? No. So much for having everything.
Next I asked about his current medications to which he responded, "I take lots of meds." We were instructed to go over to the kitchen counter to retrieve the bottles of medication. He took Tylenol and Ibuprofen.
We checked his sugar which was fine. The little voice in the back of my mind kept yelling at me that there was something wrong. Something just wasn't adding up. My patient eventually said that he didn't know what was wrong but he was confused so I started a line on him and sent him to the hospital. The son arrived at the house just as we were about to leave and explained that his father has a alcohol abuse issue and that when he drinks he doesn't eat. Quite often they have to take him into the hospital because of malnutrition. I wonder if it was the alcohol/malnutrition or if he had early onset of dementia. It seemed more like the latter to me.
Tuesday, December 22, 2009
I Pinch. I Pinch.
We were toned out for an allergic reaction to crab. As we jumped on the rig I was thinking that it had been a while since I had a good allergic reaction call. They are pretty straight forward to treat but ti's a call where we can make a big difference with medications we carry. As we were responding dispatch came through with more information. We were responding to one of our local markets for someone that had been pinched by a crab.
As we entered the store we were greeted by the manager. He escorted us to the front counter where the patient was sitting on some boxes. She had been trying to bag her own groceries when the incident occurred. The crab, while the victim was trying to bag him and take him home for dinner, saw his opportunity to strike and he took it. I can't blame him! He managed to catch the victim's left pinky in the meaty part of the flesh closest to the palm of the hand. It took a sizable chunk of flesh and flayed it open but there was no bleeding. My patient complained that the wound burned and was numb. Interesting combo. There wasn't even any bleeding to control. After a quick assessment we placed a band aid on her finger. Since her husband was right there I asked if she would like her husband to take her to the hospital to see if she needed stitches. She said no, and that she wanted an ambulance to take her. While this seems to me to be a complete waste of resources, no amount of prodding was going to get her to change her mind. When AMR showed up we gave them a quick run down on the situation. The patient walked to the ambulance and climbed in.
The entire call I couldn't get the commercial for the Honda Element out of my head that has a crab in it that wants to pinch.
As we entered the store we were greeted by the manager. He escorted us to the front counter where the patient was sitting on some boxes. She had been trying to bag her own groceries when the incident occurred. The crab, while the victim was trying to bag him and take him home for dinner, saw his opportunity to strike and he took it. I can't blame him! He managed to catch the victim's left pinky in the meaty part of the flesh closest to the palm of the hand. It took a sizable chunk of flesh and flayed it open but there was no bleeding. My patient complained that the wound burned and was numb. Interesting combo. There wasn't even any bleeding to control. After a quick assessment we placed a band aid on her finger. Since her husband was right there I asked if she would like her husband to take her to the hospital to see if she needed stitches. She said no, and that she wanted an ambulance to take her. While this seems to me to be a complete waste of resources, no amount of prodding was going to get her to change her mind. When AMR showed up we gave them a quick run down on the situation. The patient walked to the ambulance and climbed in.
The entire call I couldn't get the commercial for the Honda Element out of my head that has a crab in it that wants to pinch.
Sunday, December 20, 2009
Full Response, Structure Fire
At 0530, the tones went off, "Full response, structure fire." Such a fun phrase (at least to firefighters). Even better, it was in my district! I quickly put on my socks and shook the sleep out of my head, then headed for the apparatus bay. I quickly donned my turnouts and jumped into the seat with the SCBA. At this point I have a chance to relax, double check all my gear, and enjoy the ride.
I knew that the house in question was close so I as a little disappointed not to hear a smoke showing call from my captain. I figured it was just another false alarm.
This is what I wanted to see.
As we pulled up there was nothing showing (no fire or smoke). Just a couple of cops (really wishing they were firefighters) pointing to the house. As we dismounted we were met by the residents. I heard them explain to my captain that the fire was in the bedroom on the second floor. Before my captain could tell me I was on the way to the engine to grab a line. I pulled 200 feet of 1 3/4 line to the front door. There my captain and I masked up and called for water. As we opened the door we realized a couple of things. First, that it was partially blocked and the door wouldn't open all the way. That could be a problem if we had to make a hasty exit. Second, we noticed that the entire house was charged with smoke. Visibility was down to nothing.
My captain decided to go in first with the TIC to see if he could quickly find the fire. Once inside we could tell that the place was completely covered in trash. As we ascended the stairs we had to be very careful of our footing. My captain soon realized that the TIC wasn't working. Everything was coming up the same temperature. While we weren't able to see anything we were able to feel heat. It was warm but nothing like a good roaring structure fire. We also couldn't hear it. If you don't know, fires make a lot of noise. Next time you're near a wood fire, listen to it. Once my captain realized that the TIC wasn't going to be of much help he let me go first. I moved along the right wall of the stairs. As I got to the top of the stairs I found that there was some obstacle about the size of a small file cabinet blocking the top. I climbed over it and continued my search. I found what I thought was a closest on the right at the top of the stairs. Through the doorway straight ahead I was able to feel tile flooring, a bath tub and a sink. I kept going along the same wall (a right hand search). As I entered the bedroom I tripped on a step ladder. I ended up picking it up and tossing it across the room. It was warmer in this room but there was still no fire. I turned off my light in hopes of seeing the orange glow of the fire but nothing.
Fire crew doing vertical ventilation.
Finally a crew outside went around and busted out the window in the bedroom. The smoke poured out and fresh air came rushing in. This cleared things up and gave the fire the precious oxygen it needed to flare up. I was almost standing on top of it. I moved a couple of small book cases and asked for more hose. My captain gave me a couple more feet of hose and I extinguished the small fire. At this point my captain was low on air so we headed out to switch our bottles.
After the smoke had cleared I was amazed at what I found inside. Picture everything in the photo below spread around in the living room.
I couldn't see the floor except on the stairs where we had cleared the area. The front door was partially blocked with trash. The upstairs closet that I had found actually was open. The door from the closet was blocking the doorway to the second bedroom and had 3 feet of debris in front of it. It's no wonder it felt like a wall. The door was wedged open with garbage. We had to use several shovels and rubbish hooks just to clear the area and start on overhaul. Lots of stuff went out the second story window. I'm glad that the windows didn't crack because of the heat or else we would have had a hard time stopping it from taking the neighbors house as it went up in smoke. I found out later that my captain had moved whatever was blocking the top of the stairs. While he was doing this he slid down the stairs on his butt on all the trash. Luckily he was uninjured. The frustrating thing is that people that live like this have no idea that they are literally putting my life at risk.
I knew that the house in question was close so I as a little disappointed not to hear a smoke showing call from my captain. I figured it was just another false alarm.
This is what I wanted to see.
As we pulled up there was nothing showing (no fire or smoke). Just a couple of cops (really wishing they were firefighters) pointing to the house. As we dismounted we were met by the residents. I heard them explain to my captain that the fire was in the bedroom on the second floor. Before my captain could tell me I was on the way to the engine to grab a line. I pulled 200 feet of 1 3/4 line to the front door. There my captain and I masked up and called for water. As we opened the door we realized a couple of things. First, that it was partially blocked and the door wouldn't open all the way. That could be a problem if we had to make a hasty exit. Second, we noticed that the entire house was charged with smoke. Visibility was down to nothing.
My captain decided to go in first with the TIC to see if he could quickly find the fire. Once inside we could tell that the place was completely covered in trash. As we ascended the stairs we had to be very careful of our footing. My captain soon realized that the TIC wasn't working. Everything was coming up the same temperature. While we weren't able to see anything we were able to feel heat. It was warm but nothing like a good roaring structure fire. We also couldn't hear it. If you don't know, fires make a lot of noise. Next time you're near a wood fire, listen to it. Once my captain realized that the TIC wasn't going to be of much help he let me go first. I moved along the right wall of the stairs. As I got to the top of the stairs I found that there was some obstacle about the size of a small file cabinet blocking the top. I climbed over it and continued my search. I found what I thought was a closest on the right at the top of the stairs. Through the doorway straight ahead I was able to feel tile flooring, a bath tub and a sink. I kept going along the same wall (a right hand search). As I entered the bedroom I tripped on a step ladder. I ended up picking it up and tossing it across the room. It was warmer in this room but there was still no fire. I turned off my light in hopes of seeing the orange glow of the fire but nothing.
Fire crew doing vertical ventilation.
Finally a crew outside went around and busted out the window in the bedroom. The smoke poured out and fresh air came rushing in. This cleared things up and gave the fire the precious oxygen it needed to flare up. I was almost standing on top of it. I moved a couple of small book cases and asked for more hose. My captain gave me a couple more feet of hose and I extinguished the small fire. At this point my captain was low on air so we headed out to switch our bottles.
After the smoke had cleared I was amazed at what I found inside. Picture everything in the photo below spread around in the living room.
I couldn't see the floor except on the stairs where we had cleared the area. The front door was partially blocked with trash. The upstairs closet that I had found actually was open. The door from the closet was blocking the doorway to the second bedroom and had 3 feet of debris in front of it. It's no wonder it felt like a wall. The door was wedged open with garbage. We had to use several shovels and rubbish hooks just to clear the area and start on overhaul. Lots of stuff went out the second story window. I'm glad that the windows didn't crack because of the heat or else we would have had a hard time stopping it from taking the neighbors house as it went up in smoke. I found out later that my captain had moved whatever was blocking the top of the stairs. While he was doing this he slid down the stairs on his butt on all the trash. Luckily he was uninjured. The frustrating thing is that people that live like this have no idea that they are literally putting my life at risk.
Saturday, December 19, 2009
Job Diversity
This is a video I found about CalFire but it shows the amazing amount of job diversity within the fire service. I love this job!
Friday, December 18, 2009
Thursday, December 17, 2009
Baskin Robbins Fender (almost) Bender
So. Imagine yourself in a parking lot, say, at an ice cream shop. As you sit, waiting for someone to back out of a parking place, you notice that the person backing up isn't paying attention and that they're going to hit you. Now just think how much damage that would inflict on your 2002 Toyota Corolla. Not to mention the injuries, pain and suffering to which you would be subjected.
This is a call that we had a while ago. Two girls were in the car, both just under 20 years of age. I can understand calling the cops to get an accident report. But calling 911 for an injury accident? Really? Why not just call your lawyer directly? Thankfully, no one wanted to go to the hospital.
This is a call that we had a while ago. Two girls were in the car, both just under 20 years of age. I can understand calling the cops to get an accident report. But calling 911 for an injury accident? Really? Why not just call your lawyer directly? Thankfully, no one wanted to go to the hospital.
Wednesday, December 16, 2009
He Seemed Like He Couldn't Catch His Breath
We were toned out for a man with difficulty breathing. We arrive on scene and are greeted by the daughter of my patient. As we approached my patient I noted that he was about 70, thin build, good skins (not blue, pale...) and laying on the couch with no apparent distress. The daughter told me that her father only spoke Chinese but that she could translate. The daughter then informed us that my patient has cancer and is undergoing chemotherapy. While he was on the his way to his appointment yesterday he started feeling short of breath and ended up being seen at the ER. There he received a steroid shot and was sent home. After going through a thorough assessment AMR showed up. At this point, my patient asked if was going to the hospital...in English! At that point the assessment took a radical turn. I was able to talk to my patient directly and found out that he had no medical complaint at all. He had just been laying on the couch taking a nap when we had shown up. When I confronted his daughter she simply said, "He seemed like he couldn't catch his breath." I got the distinct impression that they were just trying to get an evening off from taking care of their sick father. The father must have understood this. He said he would go to the hospital because his family wanted him to go. Now I understand that taking care of someone as their health is deteriorating is a daunting and overwhelming task but calling 911 for a "baby sitter"...that's not right.
AMR On Scene
I enjoy working with the AMR crews for the most part. They are competent and professional bunch (which was not my experience with private sector medics in another part of the state).
We were toned out for a fall with injuries at Home Depot. As we pulled in we saw that AMR was already on scene. I know I should be happy because it means that the patient was able to get care they needed faster but what really makes me happy is that I don't have to do the paperwork. Then the AMR crew cancelled us before even getting out of the rig. It's a little strange to be the one getting cancelled. Nice though.
We were toned out for a fall with injuries at Home Depot. As we pulled in we saw that AMR was already on scene. I know I should be happy because it means that the patient was able to get care they needed faster but what really makes me happy is that I don't have to do the paperwork. Then the AMR crew cancelled us before even getting out of the rig. It's a little strange to be the one getting cancelled. Nice though.
Saturday, December 12, 2009
Daddy's Home!!
As I pull up to the house I hit the little clicker on my visor opening the garage door. After I park in the garage (a strange thing for a Californian to do) I get ready for one of the best moments of my day. As I enter the house I am almost always greeted by my two older kids screaming, "DADDA!!" They then will stop whatever they are doing and run up for a hug and a kiss. The moment usually only lasts a few seconds but I love it. Only then do I get to find my wife and give her her hug and kiss. Somewhere along the way my cat will start circling my legs and, with a twitching tail, wait for me to pet her.
The other day when I got home my daughter was a little extra excited. She told me that she had made a present for me. She hurriedly went and retrieved this:
My daughter knows that I love gum. So while she was going through her Halloween candy she discovered two pieces of bubble gum. She decided on her own that she was going to give them to me. She grabbed a sheet of paper and colored it (for wrapping paper) and then wrapped the present. It was one of the greatest gifts that I've ever received.
Thank you my Monkey (her nick name).
The other day when I got home my daughter was a little extra excited. She told me that she had made a present for me. She hurriedly went and retrieved this:
My daughter knows that I love gum. So while she was going through her Halloween candy she discovered two pieces of bubble gum. She decided on her own that she was going to give them to me. She grabbed a sheet of paper and colored it (for wrapping paper) and then wrapped the present. It was one of the greatest gifts that I've ever received.
Thank you my Monkey (her nick name).
Friday, December 11, 2009
Seizures Of A Different Kind
To me, seizures are one of the more fun types of calls to go on. For the average person out there, a seizure has to look somewhat terrifying. Your family member (or friend) loses consciousness and starts shaking all over. From an EMS point of view, they really aren't that bad. There are a couple of serious complications for which you need to watch such as the patient seizing for too long (since breathing can be affected) or trauma from the patient hitting something. The other thing that I like about seizures is that I can actually do something about it. Most patients are not actively seizing by the time we get there but the ones that are get an anti-convulsant and it almost always stops the seizure activity.
We got a call at about 0230 for a woman having a seizure.When we arrived we found our patient (a 63 year old woman) laying in bed. The entire left side of her body was contracted and shaking.As we talked to her through an interpreter we found out that she had been convulsing like this for the last 10 minutes or so. She had a brain tumor which was evidently causing the seizures. She had experienced one other seizure in her life that was about a month ago. It was the strangest thing being able to talk with my patient while she was having a seizure. Looking back on it I would have loved to question her about the experience (if she had spoken English). I gave her some medication that almost always works to stop seizures and it didn't work. By this time AMR was on scene so we loaded her up in the ambulance. The medic on the ambulance was going to give a repeat dose of the medication if the seizure hadn't stopped by the time that the started heading toward the hospital.
Something tells me that I haven't seen the last of her. Maybe next time I'll ask her more about the experience.
We got a call at about 0230 for a woman having a seizure.When we arrived we found our patient (a 63 year old woman) laying in bed. The entire left side of her body was contracted and shaking.As we talked to her through an interpreter we found out that she had been convulsing like this for the last 10 minutes or so. She had a brain tumor which was evidently causing the seizures. She had experienced one other seizure in her life that was about a month ago. It was the strangest thing being able to talk with my patient while she was having a seizure. Looking back on it I would have loved to question her about the experience (if she had spoken English). I gave her some medication that almost always works to stop seizures and it didn't work. By this time AMR was on scene so we loaded her up in the ambulance. The medic on the ambulance was going to give a repeat dose of the medication if the seizure hadn't stopped by the time that the started heading toward the hospital.
Something tells me that I haven't seen the last of her. Maybe next time I'll ask her more about the experience.
Monday, December 7, 2009
We Danced With The Devil: One Firefighter’s Cancer Chronicles
This is a great article about some of the hidden dangers that firefighters face. It's long so I'm just going to post a link. If you're a firefighter or have a loved one that is a firefighter, you need to read this.
We Danced With The Devil: One Firefighter’s Cancer Chronicles
We Danced With The Devil: One Firefighter’s Cancer Chronicles
Sunday, December 6, 2009
Stopping By Your Local Fire Station
Sometimes it's the simple things that make this job great. One of my favorite things to do is wash the fire engine. I love having a sparkling shiny rig. The other day, while washing our engine, a grandpa and grandson walked up. The grandson is ten years old and has Savant syndrome. He quickly came over to us and started rattling off questions almost faster than we could answer them. While Grandpa stopped and talked to my captain, my engineer and I showed the boy our engine. He climbed into each seat and tried all of our headsets on. He pretended to be the captain ordering up additional resources for an apartment fire. I let him wear my turnout jacket which fit like a tent. In short, the kid was in heaven. After having thoroughly inspected our equipment (and us) he told his grandpa that he was ready to go. As he was leaving he asked if he could come back and visit some other time. We told him that we are always here.
Later on, talking with my captain, I found out that this young boy was an introvert in social situations. Whenever he is in a public setting, like school, he will sit by himself, silently, off to one side. Hard to believe. The boy's grandfather said that he trust us (because we're fireman) just as much as he trusts his own family. That was the only reason he was willing to come see and talk to us.
About 15 minutes later as we were drying off the engine a mother and her 8 year old daughter rode up to the front of the station on their bicycles. The mom encouraged her daughter to ask her question. I quickly knelt down in my turnout pants to get down on her level. She asked in a very quiet voice if we had a black and white spotted dog. I had to explain to her that we didn't have a dog at this fire station. Her reaction was great. She asked why not in a way as if to say, "Why wouldn't you have a Dalmatian? That's just silly"
After trying to explain why we wouldn't have a dog at the station the mom asked if there was someone working on Christmas day. I guess it's just something that most people don't even think about. The fact that there are always firefighters waiting to come help you, even on holidays. She was surprised that there would be a crew on duty that day and decided that she was going to bake them something to say thank you. Hopefully it's good. This year, I get Christmas off.
Later on, talking with my captain, I found out that this young boy was an introvert in social situations. Whenever he is in a public setting, like school, he will sit by himself, silently, off to one side. Hard to believe. The boy's grandfather said that he trust us (because we're fireman) just as much as he trusts his own family. That was the only reason he was willing to come see and talk to us.
About 15 minutes later as we were drying off the engine a mother and her 8 year old daughter rode up to the front of the station on their bicycles. The mom encouraged her daughter to ask her question. I quickly knelt down in my turnout pants to get down on her level. She asked in a very quiet voice if we had a black and white spotted dog. I had to explain to her that we didn't have a dog at this fire station. Her reaction was great. She asked why not in a way as if to say, "Why wouldn't you have a Dalmatian? That's just silly"
After trying to explain why we wouldn't have a dog at the station the mom asked if there was someone working on Christmas day. I guess it's just something that most people don't even think about. The fact that there are always firefighters waiting to come help you, even on holidays. She was surprised that there would be a crew on duty that day and decided that she was going to bake them something to say thank you. Hopefully it's good. This year, I get Christmas off.
Friday, December 4, 2009
Honorable Mention
This story was related to me by one of the Captains at my department. It is too good not to tell. The Captain was helping to make dinner which involved slicing up some habañero peppers.
After he finished preparing dinner he went and used the bathroom. He then sat in the recliner while the chili slow cooked. After a couple of minutes he felt a burning sensation his crotch. And it started to get worse. Soon he was writhing in pain as the capsaicin soaked into a very sensitive place. With the other firefighters laughing at him he started dancing around in pain. One of the firefighters told him that soaking the affected body part in milk would help. Desperate for a cure the Captain grabbed a mug, filled it with milk, and headed for the shower. Evidently it worked, at least well enough for him to function. He then had to call the owner of the mug (it said something like worlds greatest coach) and let him know that he would probably want to throw it out.
When the story was related to me I thought the captain should have just posted a note on the board explaining what had happened and that he didn't remember which mug it was.
After he finished preparing dinner he went and used the bathroom. He then sat in the recliner while the chili slow cooked. After a couple of minutes he felt a burning sensation his crotch. And it started to get worse. Soon he was writhing in pain as the capsaicin soaked into a very sensitive place. With the other firefighters laughing at him he started dancing around in pain. One of the firefighters told him that soaking the affected body part in milk would help. Desperate for a cure the Captain grabbed a mug, filled it with milk, and headed for the shower. Evidently it worked, at least well enough for him to function. He then had to call the owner of the mug (it said something like worlds greatest coach) and let him know that he would probably want to throw it out.
When the story was related to me I thought the captain should have just posted a note on the board explaining what had happened and that he didn't remember which mug it was.
Thursday, December 3, 2009
Be Careful With Your Christmas Tree
Make sure your tree stays moist. Give it lots of water and use LED lights. If it gets dry, toss it.
Sunday, November 29, 2009
Heart Rhythms Part 1: Basic Heart Anatomy
One of the things I have been asked to do several times is my cardiac lecture. I don't mind it at all since it's a great way for me to stay proficient and up to date. I figure, by blogging it, my co-workers can have this as a reference and those not in EMS can learn a little about their own heart. This way, next time you're at your doctor's office and they hook you up to the heart monitor you can have some fun and try to figure out your own heart rhythm (OK, maybe not). Or you can just laugh at the mistakes on any one of the medical dramas currently on TV. We're going to start out with simple anatomy and progress from there. If you have any questions, please ask. This is going to be simplified.
The heart is a muscle that has four chambers. I find it easier to think of it as two separate pumps (right and left) based on it's function. There are the right atrium (upper chamber) and right ventricle (lower chamber) and the same on the other side (left atrium and ventricle). Blood comes into the heart via the superior vena cava (a big vein) and starts filling the right side of the heart while it's relaxed. Once both chambers of the right side of the heart (it's also happening on the left side simultaneously) are filled with blood, the atria are electrically stimulated and they contract. There is a one way valve separating the atria and the ventricles. The blood is forced into from the atria into the ventricles, expanding them. Muscles, when rapidly stretched, contract (Starling's Law). Just as the ventricle starts to contract, because of the stretching, it is also stimulated electrically. The ventricle then forcefully contracts ejecting the blood into the pulmonary artery (in the case of the right ventricle) which is again separated by a one way valve. Blood is then moved to the lungs where carbon dioxide is exchanged for oxygen. This is all that the right side of the heart does, receive blood from the body and pump it to the lungs. Blood returns to the heart via the pulmonary vein. It enters into the left atrium and begins to fill the left side of the heart. Once the chambers of the heart are full the process of contractions starts over. This time the blood is forced past another one way valve into the aorta, the largest of all arteries in the body. From there the blood is distributed to the rest of the body. That is the job of the left side of the heart, blood distribution to the body. The right side of the heart is smaller (the muscle tissue) because it does not require as much force to pump the blood to the lungs. Clear as mud?
Now that we understand the physical layout of the heart I'll briefly touch on the electrical system. Cardiac cells are unique in that they all have the ability to produce an electrical charge (automaticity). If they were to do this at random the heart would fail to properly contract and the result would be an absence of blood flow. So to control this there is a very organized system in place. It starts in the right atrium with the sinoatrial node (sinus node or simply SA node). The electrical impulse starts there and goes through the atria causing them to contract. It then hits the atrioventricular node (AV node) which slow down the electrical impulse for a moment before sending it down the Bundle of His to the ventricles causing the ventricles to contract. The amazing part is that if one of the sections of the electrical system fails, the other sections of the conduction system itself act as a back up. While most heart beats are started by the SA node, if it fails to work, then other parts of the heart, such as the AV node, can still do the job (although with some draw backs).
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
The heart is a muscle that has four chambers. I find it easier to think of it as two separate pumps (right and left) based on it's function. There are the right atrium (upper chamber) and right ventricle (lower chamber) and the same on the other side (left atrium and ventricle). Blood comes into the heart via the superior vena cava (a big vein) and starts filling the right side of the heart while it's relaxed. Once both chambers of the right side of the heart (it's also happening on the left side simultaneously) are filled with blood, the atria are electrically stimulated and they contract. There is a one way valve separating the atria and the ventricles. The blood is forced into from the atria into the ventricles, expanding them. Muscles, when rapidly stretched, contract (Starling's Law). Just as the ventricle starts to contract, because of the stretching, it is also stimulated electrically. The ventricle then forcefully contracts ejecting the blood into the pulmonary artery (in the case of the right ventricle) which is again separated by a one way valve. Blood is then moved to the lungs where carbon dioxide is exchanged for oxygen. This is all that the right side of the heart does, receive blood from the body and pump it to the lungs. Blood returns to the heart via the pulmonary vein. It enters into the left atrium and begins to fill the left side of the heart. Once the chambers of the heart are full the process of contractions starts over. This time the blood is forced past another one way valve into the aorta, the largest of all arteries in the body. From there the blood is distributed to the rest of the body. That is the job of the left side of the heart, blood distribution to the body. The right side of the heart is smaller (the muscle tissue) because it does not require as much force to pump the blood to the lungs. Clear as mud?
In the illustration below it shows all of the major parts of the heart and it has arrows to indicate the flow of blood. The blue blood vessels are connected to the right side of the heart (it carries less oxygenated blood headed for the lungs). The ones in red are connected to the left side of the heart and are oxygen rich.
Now that we understand the physical layout of the heart I'll briefly touch on the electrical system. Cardiac cells are unique in that they all have the ability to produce an electrical charge (automaticity). If they were to do this at random the heart would fail to properly contract and the result would be an absence of blood flow. So to control this there is a very organized system in place. It starts in the right atrium with the sinoatrial node (sinus node or simply SA node). The electrical impulse starts there and goes through the atria causing them to contract. It then hits the atrioventricular node (AV node) which slow down the electrical impulse for a moment before sending it down the Bundle of His to the ventricles causing the ventricles to contract. The amazing part is that if one of the sections of the electrical system fails, the other sections of the conduction system itself act as a back up. While most heart beats are started by the SA node, if it fails to work, then other parts of the heart, such as the AV node, can still do the job (although with some draw backs).
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
Saturday, November 28, 2009
Chest Pain AMA
Just as shift change was happening we were toned out for a medical aid. We responded for a woman with chest pain. Upon our arrival we found our patient waiting for us in the garage. As she led us inside her house she explained that about 10 minutes prior to our arrival she had been driving home from dropping her kids off at school when she started having heart palpitations.She also experienced shortness of breath. She described it as a pleuritic chest pain that only lasted about 5 minutes. She also informed us that she had a history of anxiety and had taken a Valium when she got home to calm herself down. Our patient, a 46 year old woman, had had several episodes similar to this one over the past several months. Each time she had been seen by either the ER physician or her cardiologist but they had found nothing wrong with her heart. After doing a full work up, and not finding anything, she stated that her husband was on his way home and she would prefer to let him take her to the cardiologist instead of going to the ER. We signed her out AMA and went on our way.
This is an example of a heart rhythm that we are hoping not to find. In leads II, III, and aVF there are large humps that aren't supposed to be there. This is called tombstoning (it's shaped like a tombstone and the person is quickly headed for one) and is indicative of an MI. This person would need to get to a angio-cath lab right away.
This is an example of a heart rhythm that we are hoping not to find. In leads II, III, and aVF there are large humps that aren't supposed to be there. This is called tombstoning (it's shaped like a tombstone and the person is quickly headed for one) and is indicative of an MI. This person would need to get to a angio-cath lab right away.
Thursday, November 26, 2009
Thanksgiving
One of the things that I am most grateful for this holiday season is my job. I am fortunate enough to have a job that I love, I am able to support my wife and growing family, and it's a job that most people across the country volunteer to do. Especially in these tough economic times I feel lucky to have this job.
Here are some of the statistics on firefighters nation wide. While you're enjoying your day off with your family, take a moment to remember those that are working (fire, police, EMS, hospital staff, military personnel) to make you safe.
Happy Thanksgiving.
NFPA estimates that there were approximately 1,148,850 firefighters in the U.S. in 2008. Of the total number of firefighters 321,700 or 28% were career firefighters and 827,150 (72%) were volunteer firefighters. Most of the career firefighters (74%) are in communities that protect 25,000 or more people. Most of the volunteer firefighters (94%) are in departments that protect fewer than 2,500 people. There are an estimated 30,170 fire departments in the U.S. Of these, 2,315 departments are all career, 1,790 mostly career, 4,830 are mostly volunteer and 21,235 are all volunteer. In the U.S., 13,352 or 44% of departments provide EMS service, 4,418 departments or 15% provide EMS service and advance life support, while 12,400 departments or 41% provide no EMS support.
Here are some of the statistics on firefighters nation wide. While you're enjoying your day off with your family, take a moment to remember those that are working (fire, police, EMS, hospital staff, military personnel) to make you safe.
Happy Thanksgiving.
NFPA estimates that there were approximately 1,148,850 firefighters in the U.S. in 2008. Of the total number of firefighters 321,700 or 28% were career firefighters and 827,150 (72%) were volunteer firefighters. Most of the career firefighters (74%) are in communities that protect 25,000 or more people. Most of the volunteer firefighters (94%) are in departments that protect fewer than 2,500 people. There are an estimated 30,170 fire departments in the U.S. Of these, 2,315 departments are all career, 1,790 mostly career, 4,830 are mostly volunteer and 21,235 are all volunteer. In the U.S., 13,352 or 44% of departments provide EMS service, 4,418 departments or 15% provide EMS service and advance life support, while 12,400 departments or 41% provide no EMS support.
Wednesday, November 25, 2009
Bum Fights
I find it interesting how groups of people stick together. We had just finished another call where the patient had signed out AMA. As we were pulling away the tones went off again. We immediately lit it up and headed for one of our shopping centers. AMR had been facing the other direction so we had a slight advantage but they were able to catch up and arrive just behind us. As we arrived we noticed a homeless man that was sitting in the middle of the parking lot bleeding from the nose. He had two other homeless there with him. According to the "friends" our patient had been punched in the face. We asked if they knew who did it and they clammed up. I guess they didn't want to betray another homeless person. We told them that we juat wanted to make sure that person was no longer around for our own safety. About that time PD showed up and took both "friends" aside to talk to them. Since our patient suffered trauma and was not willing to talk to us he got placed in full spinal precautions. He wasn't too happy with that but he still refused to talk to us.
Some of what we use when we place someone in full spinal precautions. They end up looking like this. It's not comfortable.
Some of what we use when we place someone in full spinal precautions. They end up looking like this. It's not comfortable.
Tuesday, November 24, 2009
Street Racing
We were toned out for a TC in front of the local high school just after 0800. As we approached the scene we were able to see a 1977 Camaro that had the entire front end destroyed. We also could see the undercarriage of a pick up truck that had flipped onto it's side and come to rest against a fire hydrant. Amazingly enough, both drivers had self extricated from the vehicle. The driver of the Camaro was a 17 year old student driving his 16th birthday present. Both drivers signed out AMA (technically the mom signed out the 17 year old). After talking with PD we found out that there had been a third vehicle and all three were street racing down a 4 lane road. When the two vehicles crashed the third kept going.
A couple of photos of what can happen while street racing.
Drive safe.
A couple of photos of what can happen while street racing.
Drive safe.
Monday, November 23, 2009
Saturday, November 21, 2009
Rampant Hypoglycemia
We were toned out for a female passed out on the sidewalk in front of one of our local grocery stores. When we arrived on scene there was a small crowd surrounding a heavy set woman in her early 50's laying on the ground shaking. Someone had grabbed their jacket and laid it down as a pillow for her. Every one of our fire apparatus is considered and ALS unit meaning that it's staffed with at least one paramedic. On my crew I'm fortunate enough to work with another medic. This can be challenging if the medics don't work well together but that's not an issue with us. We quickly grabbed s-spine and started our assessment. Witnesses said that she just kind of collapsed as she walked out of the store. After giving her some oxygen she started to come around a little bit. She was still very groggy and slow to answer our questions. We checked her sugar and it was 37. Bingo.
Lately, everybody that we run on has low blood sugar. Stub a toe, because the sugar was 42 and they were almost passing out. Short of breath...sugar 51. Fall....44. Altered....27. It's strange enough that my captain even said that either the medics he has worked with in the past were horrible and never checked sugars or there just a recent case of rampant hypoglycemia going on.
I started a line and as I began to give her some dextrose her husband came out of the store. He had been looking for her all over the inside. He told us the she did indeed have diabetes and that this happened very rarely. After she had the sugar on board she was totally coherent. She told us that she must have taken her fast acting insulin this morning instead of the slow acting and that was why her sugar was so low. We cleared c-spine and loaded her onto the gurney.
For those of you who don't know here are some of the signs and symptoms of someone with low blood sugar levels.
Lately, everybody that we run on has low blood sugar. Stub a toe, because the sugar was 42 and they were almost passing out. Short of breath...sugar 51. Fall....44. Altered....27. It's strange enough that my captain even said that either the medics he has worked with in the past were horrible and never checked sugars or there just a recent case of rampant hypoglycemia going on.
I started a line and as I began to give her some dextrose her husband came out of the store. He had been looking for her all over the inside. He told us the she did indeed have diabetes and that this happened very rarely. After she had the sugar on board she was totally coherent. She told us that she must have taken her fast acting insulin this morning instead of the slow acting and that was why her sugar was so low. We cleared c-spine and loaded her onto the gurney.
For those of you who don't know here are some of the signs and symptoms of someone with low blood sugar levels.
Monday, November 16, 2009
Frostbite at 58
Like most major metropolitan areas we have some homeless people that live in our city. We know most of them by name and they are generally happy to see us even when we drive by or if they catch us going to the store (more so than your average citizen). Side note, we were talking about this at the station and we figure it's because we are the only people that are actually nice to them and will talk to them rather than just walking away and ignoring them. I digress. We were called to one of our local shopping centers that is frequently from where the homeless call 911. We arrived and found one of our regulars in his wheelchair. When he saw us he yelled at another homeless man for calling us. Our patient said that he was worried that he may have had frostbite from a couple of nights before and that his toes really hurt. We pulled of his shoes and socks and noticed that his feet and toes were soft and pink. No chance that he had frostbite. I doubted it anyways since it hadn't been below 60 degrees in quite a while. As AMR pulled up he said that he wanted to finish his drink. Knowing him like we do we knew that he wanted to finish his beer. We told him that he knew better than that. As we helped him onto the gurney we found out that he had had a bowel movement. Oh the joys of this job. At least I didn't have to sit in the back of in ambulance with that lovely combination of smells.
Toes with severe frostbite tissue damage.
Toes with severe frostbite tissue damage.
Sunday, November 15, 2009
Structure Fire
At just after 0300 the lights turned on and the tones sounded. It was a full first alarm response for a structure fire. We quickly donned our turnouts and jumped into the engine. First, I grabbed the TIC and handed it up to my captain. I then slid into my seat mounted BA, pulled my shoulder straps tight and put on my headset. After letting my engineer know that I was ready to go I finished putting on my BA by fastening my waist strap. After that was done there was time to sit back, listen to the siren, watch the red and white lights reflect off the houses and think this is the greatest job.
We were the second unit to arrive on scene. It was a fire that had originated in the fire place but had somehow started a fire in the chimney. While the first in crew started their initial attack on the chimney from the back yard we were instructed to check for extension (to see if the fire had spread to other parts of the house, on the inside of walls, up to the attic, etc.). I grabbed an attic ladder (10 foot folding ladder that's used to make access scuttle holes). We found that the interior of the house was smokey but not that bad. Once upstairs in the bedroom that was against the chimney my captain used the TIC and determined that the there was a slight chance that it had spread up near the roof line. After checking out the attic space we determined that there was a large beam that was being heated and that was what was showing up on the TIC. We were able to determine that there was no extension into the house without tearing it apart. The chimney was not so lucky. the initial attack crew had to take most of the facade off to fully extinguish the fire.
After the fire was out my captain and I saw the owner of the house. He was approximately 50 years old and was coughing a lot and having an obviously difficult time breathing. I asked the owner if it would be OK to medically check him out. He told me that when he had first noticed the fire there was a six inch hole in the facade of the chimney through which he could see the fire. He decided to grab the garden hose and put it out himself, while wearing PJ bottoms and no shirt. When he introduced water to the fire it quickly turned to steam. When water is converted to steam it expands at more than 1700%. This forced super heated gases and smoke right out that hole and into the would be firefighter's face, causing him some respiratory problems. I placed my patient on some oxygen and did a thorough assessment. We even have a machine that will check how much carbon monoxide is in the blood stream. After about 10 minutes of oxygen my patient felt much better and was no longer hacking up a lung. I told him that he better leave the firefighting to the pros. He told me that's exactly what his wife had said. Once he signed out AMA we were cleared to go back to our station.
We arrived at that awkward time where you don't want to be up but there's not really time to go back to sleep either. I chose to lay on my bed and relax. What a great job.
We were the second unit to arrive on scene. It was a fire that had originated in the fire place but had somehow started a fire in the chimney. While the first in crew started their initial attack on the chimney from the back yard we were instructed to check for extension (to see if the fire had spread to other parts of the house, on the inside of walls, up to the attic, etc.). I grabbed an attic ladder (10 foot folding ladder that's used to make access scuttle holes). We found that the interior of the house was smokey but not that bad. Once upstairs in the bedroom that was against the chimney my captain used the TIC and determined that the there was a slight chance that it had spread up near the roof line. After checking out the attic space we determined that there was a large beam that was being heated and that was what was showing up on the TIC. We were able to determine that there was no extension into the house without tearing it apart. The chimney was not so lucky. the initial attack crew had to take most of the facade off to fully extinguish the fire.
After the fire was out my captain and I saw the owner of the house. He was approximately 50 years old and was coughing a lot and having an obviously difficult time breathing. I asked the owner if it would be OK to medically check him out. He told me that when he had first noticed the fire there was a six inch hole in the facade of the chimney through which he could see the fire. He decided to grab the garden hose and put it out himself, while wearing PJ bottoms and no shirt. When he introduced water to the fire it quickly turned to steam. When water is converted to steam it expands at more than 1700%. This forced super heated gases and smoke right out that hole and into the would be firefighter's face, causing him some respiratory problems. I placed my patient on some oxygen and did a thorough assessment. We even have a machine that will check how much carbon monoxide is in the blood stream. After about 10 minutes of oxygen my patient felt much better and was no longer hacking up a lung. I told him that he better leave the firefighting to the pros. He told me that's exactly what his wife had said. Once he signed out AMA we were cleared to go back to our station.
We arrived at that awkward time where you don't want to be up but there's not really time to go back to sleep either. I chose to lay on my bed and relax. What a great job.
Saturday, November 14, 2009
Double Whammy
We were toned out for an altered person. When we arrived on scene we were met by the patient's wife. She explained that her husband, who is 67, had been very ill and that he was in need of both liver and kidney transplants. Walking into the bedroom I found that my patient was alert enough to look at me when I entered the room but that was about all. He kept repeating in Spanish, "Me voy. Me voy." I'm going. I'm going. Where he was headed, I don't know (if he meant anywhere but the hospital.) The patient's wife informed us that he had just been released from the hospital for hyperammonemia (high ammonia levels in his blood) which left him in this exact condition.
We did a complete medical exam and could find no other reason for his altered state of consciousness. We placed him on oxygen, started an IV and sent him to the hospital. Without a transplant soon the outcome of this patient does not look to good.
We did a complete medical exam and could find no other reason for his altered state of consciousness. We placed him on oxygen, started an IV and sent him to the hospital. Without a transplant soon the outcome of this patient does not look to good.
Thursday, November 12, 2009
You're Gonna Feel Weak
The tones went off and we hopped into our bunker pants and jumped on the rig. While tearing down the street with lights and siren blazing dispatch informed us that we were responding for a 96 year old male that was feeling weak. My first thought, well DUH! Your 96 years old! What do you expect? Now deep down I know that people are calling because they are feeling something that is out of the ordinary for them but I couldn't help but think that this guy was just lucky to be feeling.
When we arrived on scene we were met by my patient's daughter. She led us to the backyard where she had left her father in the sun (because his skin color wasn't right). She gave me a decent report on his current medical problems, his past medical history, allergies and current medications. The report was good enough that I asked her if she was nurse, which she was (which slightly frightens me that a nurse would place someone that was very pale in the sun, as if it were the cure). My patient had recently (two weeks ago) undergone heart surgery and had a pacemaker/defibrillator implanted.
AMR arrived while we were getting the heart monitor on him and getting our first set of vitals. I gave a quick report just as we got a BP. 66/42. I guess that explains why you're not feeling so well and you look like you just saw a ghost. We quickly move him to the gurney and lay him flat. Once in the back of the ambulance the AMR medic started a line. After making sure that he didn't need any more help we cleared the scene.
Hopefully the guy makes 97.
When we arrived on scene we were met by my patient's daughter. She led us to the backyard where she had left her father in the sun (because his skin color wasn't right). She gave me a decent report on his current medical problems, his past medical history, allergies and current medications. The report was good enough that I asked her if she was nurse, which she was (which slightly frightens me that a nurse would place someone that was very pale in the sun, as if it were the cure). My patient had recently (two weeks ago) undergone heart surgery and had a pacemaker/defibrillator implanted.
AMR arrived while we were getting the heart monitor on him and getting our first set of vitals. I gave a quick report just as we got a BP. 66/42. I guess that explains why you're not feeling so well and you look like you just saw a ghost. We quickly move him to the gurney and lay him flat. Once in the back of the ambulance the AMR medic started a line. After making sure that he didn't need any more help we cleared the scene.
Hopefully the guy makes 97.
Tuesday, November 10, 2009
Going Up (Or Not)
One of the many things that we as firefighters have to know how to do is to respond to an emergency in an elevator. For the most part, all we are going to do as firefighters if people are stuck in an elevator is make sure everyone is ok, make sure the elevator repairman has been called and keep everyone calm. We only get to force our way in if there is an emergency ongoing inside the stuck elevator.
We have several options depending on the type of elevator. Most elevators are piston driven, meaning there is a giant piston underneath that raises and lowers the car. There's no way it's going to fall. The nice thing about this type is that we can go to the hydraulic pump and bleed off the line and slowly lower the car to the next floor. We could also open the doors to the elevator shaft on the floor above the car and use ladders to make entry through the roof hatch. (Did you know there was a roof hatch on most elevators?) We can also use our auto extrication equipment (and equipment off a heavy rescue) to make our own entry into the elevator car. The other type of elevators use cable to suspend the car. These are used in high rise buildings because of the heights involved. Along with the previously stated methods we can make a rescue from an adjoining car. This is very dangerous and left as a last resort.
Escalators are another thing with which we have to deal. If someone were to get stuck we would shut off the escalator (shut off switches are located at the top and bottom of escalators). We would then dismantle whatever we needed to to get our victim free.
I found this clip while researching elevators and escalators. I thought it worthy of sharing.
One of the "extra" things that I did learn was how to keep an elevator from stopping for other people while traveling from your floor to your desired floor. Simply press and hold the close door button and the button for the floor on which you wish to go for 5 seconds. I haven't tried it but I saw it on YouTube (which means it must be true, right?). If you have a tall building and feel like trying it out let me know how it goes. Next time I'm in one I'll try it.
We have several options depending on the type of elevator. Most elevators are piston driven, meaning there is a giant piston underneath that raises and lowers the car. There's no way it's going to fall. The nice thing about this type is that we can go to the hydraulic pump and bleed off the line and slowly lower the car to the next floor. We could also open the doors to the elevator shaft on the floor above the car and use ladders to make entry through the roof hatch. (Did you know there was a roof hatch on most elevators?) We can also use our auto extrication equipment (and equipment off a heavy rescue) to make our own entry into the elevator car. The other type of elevators use cable to suspend the car. These are used in high rise buildings because of the heights involved. Along with the previously stated methods we can make a rescue from an adjoining car. This is very dangerous and left as a last resort.
Escalators are another thing with which we have to deal. If someone were to get stuck we would shut off the escalator (shut off switches are located at the top and bottom of escalators). We would then dismantle whatever we needed to to get our victim free.
I found this clip while researching elevators and escalators. I thought it worthy of sharing.
One of the "extra" things that I did learn was how to keep an elevator from stopping for other people while traveling from your floor to your desired floor. Simply press and hold the close door button and the button for the floor on which you wish to go for 5 seconds. I haven't tried it but I saw it on YouTube (which means it must be true, right?). If you have a tall building and feel like trying it out let me know how it goes. Next time I'm in one I'll try it.
Monday, November 9, 2009
A Great Article I Found Online
Elected officials, media walk in the boots of a firefighter
Posted: 11/07/2009 05:52:58 PM PST
Updated: 11/07/2009 06:25:23 PM PST
SAN LEANDRO — Responding to emergencies. Handling traffic accidents. Helping transport victims to the hospital. Searching for and rescuing people. Yes, firefighters do more than put out fires.
Local elected officials and members of the media learned that firsthand Saturday by walking in a pair of firefighters' boots — and turncoats, helmets, masks, gloves and other heavy equipment — through Fire Ops 101. The program, put on by the Alameda County Fire Fighters Association and Alameda County Fire Department, was held at the training center on Lola Street, just off Davis Street. It was designed to place participants in controlled situations to gain a better understanding of what those riding on the big red engines do for a living, said John Torres, firefighters association president. "We want them to get in and see exactly what we do," he said.
Assemblyman Alberto Torrico, D-Fremont, called it a "sobering experience." "Everything we did showed that four firefighters are needed," he said, referring to an ongoing debate on whether a fire engine should be staffed with three or four firefighters. "It is critical they have full staffing because without it we are putting the victims and firefighters at risk."
The 10 participants were split into teams and made their way into five scenarios. This reporter was part of the "White" team, which included Torrico, Brian Dinsmore of KPIX Channel 5 and Robert Souza of the Castro Valley Forum newspaper. The group first was tasked to help safely remove a victim out of a car accident by stabilizing the vehicle and using tools like the Jaws of Life extrication device to gain access to the victim. It was an eye-opening experience for Diana Souza, a San Leandro City Council member, who like many participants had no idea that tools used to rescue people from car accidents can get outdated quickly with the constant new designs of vehicles. "Manufacturers of cars should get in touch with firefighters and others charged as first responders to these emergencies so that they can have the most up to date equipment," she said.
After removing the person trapped in the car, the team then transported the victim to the emergency medical service station. Here, firefighters provided treatment, which can include performing CPR, until an ambulance arrived and transported the victim to a hospital. About 80 percent of all calls are emergency medical service-related, officials said.
Next came a ventilation scenario. Participants climbed 100 feet on a fire engine ladder and broke through roofs using a chain saw and a large hammer. Then, as one firefighter put it, the fun came. Taking turns and aided by firefighters in front and behind, participants — equipped with oxygen tanks and masks — went into a smoke-filled building and extinguished a blaze by firing a water hose.
The last scene had the team go into another smoke-filled, pitch-black building to find and rescue a person by using thermal imaging cameras. Many participants were left with a newfound appreciation for what firefighters do daily. "We hear all these stories about fires, but you can't get a real feel until you actually put the gear on and experience what (firefighters) do," Diana Souza said. "It was a great experience and I'm definitely going to encourage all council members and other decision makers to do it."
AAA (With a Hose?)
I had just finished unwinding by reading my book in bed (a book on some of the issues in medicine) and had just turned off the light when the tones when off. My first thought, at least I wasn't asleep yet. Then we were told that we were responding for a person locked out of their vehicle. Now I don't know about you but when I have locked my keys in my car I have never thought of calling 911. I could understand it if it were hot outside and there was a kid was locked in the vehicle. Hey, even a dog. But at 2330, outside a restaurant, in mild temperatures, and it's only a guy that's locked out of his minivan. Really? Come to think of it, I've changed tires too. I used to give a friend that's a CHP officer a hard time about being AAA with a gun. I guess I'm AAA with a hose.
The funny thing is, we are good at it. We had the guys vehicle unlocked in about 3 minutes. We could be faster but that involves the owner having to replace a broken window. I really don't mind going out to do this. After all, I chose to serve the public. I just wish they wouldn't call 911. Use the non emergency number for you local fire department.
By the way, the 24 hour number to AAA is 1-800-AAA-HELP.
The funny thing is, we are good at it. We had the guys vehicle unlocked in about 3 minutes. We could be faster but that involves the owner having to replace a broken window. I really don't mind going out to do this. After all, I chose to serve the public. I just wish they wouldn't call 911. Use the non emergency number for you local fire department.
By the way, the 24 hour number to AAA is 1-800-AAA-HELP.
Thursday, November 5, 2009
You're Making Too Much
I don't care how little they are paying you, if your fire engine comes with a surf board, you're getting paid too much!
Wednesday, November 4, 2009
Repeat Customer
We were toned out for a fall with injuries to a residence that is literally 5 or six houses away from the station. It's the second time this month that we've been there. The gentleman that lives there is in his early 80's and has a long list of medical problems. He called us out today because he fell and broke his ankle (the last time we were there he had fallen and twisted the other ankle). I quickly ran through my assessment but as I did I could sense my patients frustration growing. I could almost hear his thoughts, "Why are you asking me all theses inane questions when it's obvious that I broke my ankle?" I wasn't too concerned with the broken ankle. I wanted to know why he fell. I finally got out of him that he did in fact feel dizzy before he fell. Just about that time the other firefhgter got the blood pressure, 86/52. Too low. While I started an IV to give my patient some fluids to bring up his blood pressure the other firefighter splinted the ankle with a vacusplint and placed an ice pack for the pain and swelling.
As we were loading the patient into the ambulance I told him that if he wanted to see us so bad, next time just stop by the station. We're just down the block. He laughed and said he would.
As we were loading the patient into the ambulance I told him that if he wanted to see us so bad, next time just stop by the station. We're just down the block. He laughed and said he would.
Tuesday, November 3, 2009
The Nature of Firefighters
I once saw a comic strip that depicted a little boy talking to a firefighter. The boy said, "When I grow up I want to be a firefighter." The firefighter replied, "I'm sorry, you can't do both."
So true.
So true.
Friday, October 30, 2009
"You Looked Like an Ass..."
We arrived on scene at one of the local shopping centers to find our patient ion the custody of the police. The 36 year old man had been driving erratically and was being held on suspicion of driving under the influence. After having been in custody for 20 minutes, with his hands handcuffed behind his back, and with a crowd watching from the local restaurant, this genius decided to make a break for it. I don't know where he was planning on running but he ran straight for the closed grocery store. He got about 30 feet before the cops caught up to him. Most people realize that if the fuzz is chasing you they are going to tackle you. This really sucks when your hands are not available, being cuffed, to cushion the blow of the asphalt on your face. My patient had bruising and abrasions to his face and knee. It was hard to feel bad for the guy. After checking the guy out and bandaging his wounds we sent him to the hospital. Before the patient was transported the police officer that had apprehended him told him, "You looked like an ass to the general public."
Stupid people = Job security
Stupid people = Job security
Thursday, October 29, 2009
Down at the 45 Yard Line
Every Saturday during the fall the local Jr High school football field is covered by kids of varying ages playing football. Every year we end up responding to at least one call for an injured player. It could be for a twisted ankle, a concussion or a broken bone. It's a little more interesting than your average call because it's a kid.
A couple of Saturdays back we were toned out to the Jr High for a kid with injuries. When we arrived we found our patient on the 45 yard line surrounded by various adults. As I approached there was one guy that was kneeling at my patients side that gave me adecent report on the kid. Turns out he used to be a paramedic for AMR. The 10 year old would be football star had been blindsided and felt some pain in his neck. By te time that we arrived the patient denied any pain or discomfort at all. We ended up giving him a thorough head to toe exam and found nothing. The dad was there and decided that he would take his son in to get checked out instead of going by ambulance. The kid got a nice ovation as he walked off the field.
A couple of Saturdays back we were toned out to the Jr High for a kid with injuries. When we arrived we found our patient on the 45 yard line surrounded by various adults. As I approached there was one guy that was kneeling at my patients side that gave me adecent report on the kid. Turns out he used to be a paramedic for AMR. The 10 year old would be football star had been blindsided and felt some pain in his neck. By te time that we arrived the patient denied any pain or discomfort at all. We ended up giving him a thorough head to toe exam and found nothing. The dad was there and decided that he would take his son in to get checked out instead of going by ambulance. The kid got a nice ovation as he walked off the field.
Wednesday, October 28, 2009
Dumpster Fire With Spectators
For some odd reason there are people out there that haven't figured out that if you throw away a hot item (match, cigarette...) without putting it out you can start a fire. We were toned out for a dumpster fire the other day in the parking lot of a shopping center. These are really easy to control because they are in a container and all we have to do is fill that container.
The only real concern is that if the dumpster is next to a building, it can catch the building on fire. Like this:
Luckily for the local store owners the dumpster was not up against the building. We pulled the bumper line and filled the dumpster about half full of water. While doing this, as you can imagine, we drew a crowd. Why not. I big red engine with flashing lights, smoke, flames, firefighters in turnouts, hoses...it looks interesting. After we had put everything away a couple of kids came walking by the engine with their parents. We quickly grabbed a couple of Jr Firefighter stickers (with our departments name on them) and passed them out.
No sooner had we done this than a minivan pulls up and the older sister helps 4 younger siblings out of the vehicle to come see us and get stickers too. It was more fun passing out stickers than putting out that dumpster fire.
The only real concern is that if the dumpster is next to a building, it can catch the building on fire. Like this:
Luckily for the local store owners the dumpster was not up against the building. We pulled the bumper line and filled the dumpster about half full of water. While doing this, as you can imagine, we drew a crowd. Why not. I big red engine with flashing lights, smoke, flames, firefighters in turnouts, hoses...it looks interesting. After we had put everything away a couple of kids came walking by the engine with their parents. We quickly grabbed a couple of Jr Firefighter stickers (with our departments name on them) and passed them out.
No sooner had we done this than a minivan pulls up and the older sister helps 4 younger siblings out of the vehicle to come see us and get stickers too. It was more fun passing out stickers than putting out that dumpster fire.
Tuesday, October 27, 2009
My Streak is Ruined
I have been in EMS for years and managed to avoid something until just recently.
As I walked up the driveway I was met by a middle aged woman that asked me if I was a doctor. I refrained for telling her that she needed a paramedic, not a doctor and just said no. She then informed me that she didn't need the fire department, she needed a doctor. That's why she called 911.
Turns out her neighbor, an 82 year old woman that only speaks Russian, passed out while she was at home. When she came to she threw up. She then felt better and walked over to he neighbors house to seek some help. Luckily for us the neighbor spoke Russian too. While working through the translator I was able to determine that something like this had never happened before. She also said that she had high blood pressure and was taking some over the counter Russian medication. Good luck figuring out what those are. I'm pretty good at puzzles so when the neighbor explained that she was allergic to a red fluid that you put on the skin to clean it I understood that she was talking about Iodine. She denied any medical complaint and was thinking about not going to the hospital. This was about the time that she passed out again. Her head flopped forward and to one side. I was worried about her airway so I quickly jumped in there to hold her head in a neutral position.
When she came around she blew chunks. Despite her earlier mention of this I forgot. She managed to throw up all over my left arm, my watch and into my glove. We're not just talking normal looking vomit. This stuff was stringy like snot. I went years without getting vomit on me in any way shape or form but she got me royally. Not much I could do. I continued to reassess my patient.
About this point AMR showed up. The AMR medic couldn't see my arm because it was behind the other firefighter. She took my report and then I asked if she would take care of the patient while I washed off my arm. Only then did she realize that I was dripping vomit.
As much as I don't like getting thrown up on I can't help but feel bad for my patient. How mortifying would that be throwing up on your firefighter paramedic as he is taking care of you.
As I walked up the driveway I was met by a middle aged woman that asked me if I was a doctor. I refrained for telling her that she needed a paramedic, not a doctor and just said no. She then informed me that she didn't need the fire department, she needed a doctor. That's why she called 911.
Turns out her neighbor, an 82 year old woman that only speaks Russian, passed out while she was at home. When she came to she threw up. She then felt better and walked over to he neighbors house to seek some help. Luckily for us the neighbor spoke Russian too. While working through the translator I was able to determine that something like this had never happened before. She also said that she had high blood pressure and was taking some over the counter Russian medication. Good luck figuring out what those are. I'm pretty good at puzzles so when the neighbor explained that she was allergic to a red fluid that you put on the skin to clean it I understood that she was talking about Iodine. She denied any medical complaint and was thinking about not going to the hospital. This was about the time that she passed out again. Her head flopped forward and to one side. I was worried about her airway so I quickly jumped in there to hold her head in a neutral position.
When she came around she blew chunks. Despite her earlier mention of this I forgot. She managed to throw up all over my left arm, my watch and into my glove. We're not just talking normal looking vomit. This stuff was stringy like snot. I went years without getting vomit on me in any way shape or form but she got me royally. Not much I could do. I continued to reassess my patient.
About this point AMR showed up. The AMR medic couldn't see my arm because it was behind the other firefighter. She took my report and then I asked if she would take care of the patient while I washed off my arm. Only then did she realize that I was dripping vomit.
As much as I don't like getting thrown up on I can't help but feel bad for my patient. How mortifying would that be throwing up on your firefighter paramedic as he is taking care of you.
Sunday, October 25, 2009
HOH
We were recently toned out for a person having trouble breathing. 911 was notified by the medical alarm company. This was the first time that I can remember responding to an actual emergency that had been called in by a medical alarm company. The company had all kinds of useful information like where the spare key was to the house, allergies to medications and her medical history that included COPD and HOH. Although I had never heard of HOH.
When we arrived on scene we found an 88 year old female laying flat in bed complaining of shortness of breath. She said that she awoke in this condition about 10 minutes ago. We sat her up, gave her some oxygen, and listened to her lung sounds. She was wheezing and tight so we gave her a breathing treatment. After a couple of minutes she started feeling and looking a lot better. My captain then asked her about HOH to which she responded, "What?" So he repeated himself a little louder and got a similar response. It was hard to stop from laughing when we realized HOH is Hard of Hearing. We still occasionally joke about that one.
When we arrived on scene we found an 88 year old female laying flat in bed complaining of shortness of breath. She said that she awoke in this condition about 10 minutes ago. We sat her up, gave her some oxygen, and listened to her lung sounds. She was wheezing and tight so we gave her a breathing treatment. After a couple of minutes she started feeling and looking a lot better. My captain then asked her about HOH to which she responded, "What?" So he repeated himself a little louder and got a similar response. It was hard to stop from laughing when we realized HOH is Hard of Hearing. We still occasionally joke about that one.
Our Fortunes?
One evening we were at the dinner table eating Panda Express (it was too late to cook). After we were finished the other firefighter with whom I work opened his fortune cookie and read his fortune. He laughed and then said, "I sure hope not." He then handed me his fortune. It read, "The evening will bring romance." Knowing full well that it was just us at the station I quickly agreed with him.
I then opened mine. It read, "A thrilling time is in your immediate future." It took a while for us to regain our composure.
I then opened mine. It read, "A thrilling time is in your immediate future." It took a while for us to regain our composure.
Saturday, October 24, 2009
Friday, October 23, 2009
Hunter Hits His Last Shot
First thing in the morning we were having a conversation at the table when we were toned out for a suicide. Usually, even if the person is dead, it's a suicide attempt until we get there and determine that the person is deceased. While responding we were given some additional information. Evidently PD was on scene with the victim of a self inflicted GSW. When we arrived on scene we were escorted into the bedroom where a male in his early 70's had pointed a .22 rifle at the side of his head and pulled the trigger. The interesting thing about the .22 round is that a lot of the time it possesses enough velocity to enter the cranium but not enough to exit. I did have to ask the cops to remove the weapon so that I could approach the body.
My part was really easy. I checked to see if he had a pulse or was breathing (stranger things have happened). I then hooked him up on the monitor and confirmed that he was in asystole. Only after determining death did we look around the room. The deceased was evidently a hunter because he had stuffed (taxidermied) animals everywhere in his room.
After the call was done we went back to the station and back to our conversation. We briefly remarked that this is a strange profession where your conversation can be interrupted by someone shooting themselves in the head and then the conversation continues. Just as if the conversation had been interrupted by a telephone call.
My part was really easy. I checked to see if he had a pulse or was breathing (stranger things have happened). I then hooked him up on the monitor and confirmed that he was in asystole. Only after determining death did we look around the room. The deceased was evidently a hunter because he had stuffed (taxidermied) animals everywhere in his room.
After the call was done we went back to the station and back to our conversation. We briefly remarked that this is a strange profession where your conversation can be interrupted by someone shooting themselves in the head and then the conversation continues. Just as if the conversation had been interrupted by a telephone call.
Thursday, October 22, 2009
Afterwards
We were recently toned out at 0520 for a person with heart problems. We were met by the fire of the patient at the front door. We followed her into the bedroom where she proceeded to shake her husband trying to wake him. One look and we could tell that he was dead. I quickly moved the wife out of the way and checked to see if my patient was breathing or if he had a pulse. Nothing. I then checked to see if rigor mortis or lividity had set in becuase if it has, there is nothing we can do. Not finding any "obvious signs of death" (this part always reminds me of the movie "The Princess Bride" where Miracle Max talks about someone being mostly dead or all dead) we pulled the patient onto the floor and began CPR. I jumped on compressions. For those of you that haven't had the opportunity to do chest compressions on a frail old person the first one or two compression are noisy and strange feeling. I was able to feel all of the ribs on the right side of my patient's chest and most of them on his left break. I quickly asked my Captain to check and see if there was a DNR on this patient. So with just two of us doing CPR we noticed that there was a lot of medical knowlegde between us (we're both experienced medics) that is not doing any good because wer're alone and doing CPR.
Finally the AMR crew shows up with three medics. They have a new guy so he takes the lead. We quickly move the patient to the front entry way where there is more room to work. While the other firefighter and I continue CPR the new medic puts on the defibrillation pads, turns on the heart monitor and says, "SHOCKING!" That got our attention real fast. We moved away from the patient and then looked at the FNG. Fortunately his trainer calmly informed him that there were some issues that needed to be addressed before shocking the patient. First, plug in the pads to the monitor. Second, determine if he has a shockable heart rhythm. Third, charge the defibrillator. Finally, shock the patient after you make sure that everyone else was clear. I hated being the new guy. After that we got the autopulse going, started an IO, got an airway, checked capnography and administered two rounds of meds. We also administered some sugar and sodium chloride. Everything that we did had no effect. Time of death was called at 0553.
After the code we were able to obtain some more information. The deceased had had a heart attack in April and was advised that he needed a pacemaker, but refused. He woke up that morning at 0300 not feeling well. At 0500 his wife woke up and checked on him. She said that he had a very slow pulse. 18 minutes later she called 911. We were able to wait until the coroner was contacted and it was determined that we would be allowed to remove everything that we had done (such as the IO and the airway) and to move the body back into the bed for the wife. All this was not easy to do since there was a major language barrier.
After this call I had some time to reflect upon death and my intimate relationship with it. Recently there was a death in my extended family of a 3 month old baby, an apparent case of SIDS. Given that I deal with people dying on a fairly regular basis I was surprised at how much the death and funeral of this baby affected me. It really put me into a funk for days. I thought that my ability to be emotionally detached would work in this case but I was wrong. So sitting outside the residence of my deceased patient I realized that there were some major differences (other than the fact that it was a family member and a baby) between the patients that die and my family member. After the patient died I was able to go over everything that I did with the other firefighter and critique the situation making sure that we had done everything possible to give this person a chance. It may not seem like much but having the ability to do something and then reflect that you did actually do everything you could is comforting. Talking out and critiqing the call actually helps deal with it.
As soon as we cleared the call we went back to the station, then went home. What a strange job.
Finally the AMR crew shows up with three medics. They have a new guy so he takes the lead. We quickly move the patient to the front entry way where there is more room to work. While the other firefighter and I continue CPR the new medic puts on the defibrillation pads, turns on the heart monitor and says, "SHOCKING!" That got our attention real fast. We moved away from the patient and then looked at the FNG. Fortunately his trainer calmly informed him that there were some issues that needed to be addressed before shocking the patient. First, plug in the pads to the monitor. Second, determine if he has a shockable heart rhythm. Third, charge the defibrillator. Finally, shock the patient after you make sure that everyone else was clear. I hated being the new guy. After that we got the autopulse going, started an IO, got an airway, checked capnography and administered two rounds of meds. We also administered some sugar and sodium chloride. Everything that we did had no effect. Time of death was called at 0553.
After the code we were able to obtain some more information. The deceased had had a heart attack in April and was advised that he needed a pacemaker, but refused. He woke up that morning at 0300 not feeling well. At 0500 his wife woke up and checked on him. She said that he had a very slow pulse. 18 minutes later she called 911. We were able to wait until the coroner was contacted and it was determined that we would be allowed to remove everything that we had done (such as the IO and the airway) and to move the body back into the bed for the wife. All this was not easy to do since there was a major language barrier.
After this call I had some time to reflect upon death and my intimate relationship with it. Recently there was a death in my extended family of a 3 month old baby, an apparent case of SIDS. Given that I deal with people dying on a fairly regular basis I was surprised at how much the death and funeral of this baby affected me. It really put me into a funk for days. I thought that my ability to be emotionally detached would work in this case but I was wrong. So sitting outside the residence of my deceased patient I realized that there were some major differences (other than the fact that it was a family member and a baby) between the patients that die and my family member. After the patient died I was able to go over everything that I did with the other firefighter and critique the situation making sure that we had done everything possible to give this person a chance. It may not seem like much but having the ability to do something and then reflect that you did actually do everything you could is comforting. Talking out and critiqing the call actually helps deal with it.
As soon as we cleared the call we went back to the station, then went home. What a strange job.
Wednesday, October 21, 2009
Crazy Is As Crazy Does
The other morning we were sitting around the table talking and I brought up an episode of Storm Chasers where the guys were getting pelted by baseball sized hail. I commented that they had to be crazy to chase tornadoes that way. The other firefighter replied, "Aren't you the one that runs into burning buildings?" That shut me up.
I still think the storm chasers are nuts.
I still think the storm chasers are nuts.
Monday, October 19, 2009
Losing
In the fire service there are a few cliches that are often used. These reflect, in a joking manner, what we do such as "Just living the dream" or Saving lives." While said in a non chalant way most of us do believe that we are fortunate to do what we do and can, every once in a while, save a life. The thing that is not mentioned is that sometimes we lose that fight to save lives. Most of the time when we lose that battle it's with an elderly person, quite often with pre-existing medical problems, that has lived a long life and it's simply their time to go. Or the person that has made choices in their life that unfortunatley shortened it, such as the use of some drugs. Every so often we have to deal with someone that is otherwise healthy that dies becuase of some traumatic event, a car crash, a shooting, a fall. There rarest and most difficult with which to deal are the ones involving kids.
This last week a couple of friends that work at another department had to deal with this. There was a drunk driver on the highway that crossed the double yellow line and, despite the evasive driving of the other vehicle, hit an oncoming car head on. From what I understand the vehicles struck on the front drivers side of both vehicles causing severe damage. The vehicle that was hit had in it a young family, a father, driving, mother and two daughter ages 3 and 5. The injured parties had to be extricated from the vehicle. The father sustained critical injuries and was transported to the trauma center by ambulance. The daughter was in full arrest and had some airway complications. She was transported to the closeset hospital because of the airway comprimise and then flown to the trauma center. They were able to get a pulse and a blood pressure back in the child but as they were starting to fly her out she died again. She was pronounced dead at the trauma center.
I know most of the crews that were on this accident. Things that most prople will never know are what the paramedic felt like when she had to shut the ambulance doors on that mother. Or another medic that stayed behind giving the mother a shoulder on which to cry. The medic that transported the father to the trauma center told me that they were relieved that he wasn't able to ask about the condition of his daughter. These stories almost never make it to the public.
As a paramedic you learn to be emotionally detached at what you do so that you can still function in situations like this one. The hard part can come later while dealing with your suppressed emotions. A lot of times agencies and departments will hold CISD's to help their crew through this process. In my experience crews usually deal with these situations in their own unique way on a crew level. They will talk it out with each other and possibly with a few friends in the industry that can actually understand what they are feeling sine they have been there themselves. Eventually you move on. My heart goes out to the brave men and women that serve our communities and subject themselves (and to a limited extent their families) to things that no one should have to see, then go back for more. I consider myself lucky to work along side you.
This last week a couple of friends that work at another department had to deal with this. There was a drunk driver on the highway that crossed the double yellow line and, despite the evasive driving of the other vehicle, hit an oncoming car head on. From what I understand the vehicles struck on the front drivers side of both vehicles causing severe damage. The vehicle that was hit had in it a young family, a father, driving, mother and two daughter ages 3 and 5. The injured parties had to be extricated from the vehicle. The father sustained critical injuries and was transported to the trauma center by ambulance. The daughter was in full arrest and had some airway complications. She was transported to the closeset hospital because of the airway comprimise and then flown to the trauma center. They were able to get a pulse and a blood pressure back in the child but as they were starting to fly her out she died again. She was pronounced dead at the trauma center.
I know most of the crews that were on this accident. Things that most prople will never know are what the paramedic felt like when she had to shut the ambulance doors on that mother. Or another medic that stayed behind giving the mother a shoulder on which to cry. The medic that transported the father to the trauma center told me that they were relieved that he wasn't able to ask about the condition of his daughter. These stories almost never make it to the public.
As a paramedic you learn to be emotionally detached at what you do so that you can still function in situations like this one. The hard part can come later while dealing with your suppressed emotions. A lot of times agencies and departments will hold CISD's to help their crew through this process. In my experience crews usually deal with these situations in their own unique way on a crew level. They will talk it out with each other and possibly with a few friends in the industry that can actually understand what they are feeling sine they have been there themselves. Eventually you move on. My heart goes out to the brave men and women that serve our communities and subject themselves (and to a limited extent their families) to things that no one should have to see, then go back for more. I consider myself lucky to work along side you.
Sunday, October 18, 2009
The Stupid Are Lucky
While on duty at station 1 we were toned out for a fire in the backyard of a residence at about 9pm. When we got there we found two smoldering plastic gas cans and a melted 55 gallon trash can. Once we determined that the fire was out we tried to determine what had happened. The fire had occurred in the backyard of a residence where there was a back house. The owners in the front house were the ones to see the fire, call 911 and extinguish the flames. The renters in the back house said they didn't see anything. We checked the area for an ignition source, lighters, matches, cigarettes, etc. Finding none, my captain again turned his attention back to the residents of both homes.
Finally the son of the renters spoke up. He appeared to be about 17 years old. He said that he had been in the service porch trying to pour the contents of one fuel can into the other. He was doing so without any ventilation. The fumes trailed over to the pilot light of the hot water heater and ignited. He was just able to open the door and kick both fuel cans outside. We spent a couple minutes making sure that he realized how lucky he was not to be severely burned. Hopefully he learned his lesson. If you're going to be using fuel, do so in a well ventilated area. Now he can go on and do other stupid things.
Finally the son of the renters spoke up. He appeared to be about 17 years old. He said that he had been in the service porch trying to pour the contents of one fuel can into the other. He was doing so without any ventilation. The fumes trailed over to the pilot light of the hot water heater and ignited. He was just able to open the door and kick both fuel cans outside. We spent a couple minutes making sure that he realized how lucky he was not to be severely burned. Hopefully he learned his lesson. If you're going to be using fuel, do so in a well ventilated area. Now he can go on and do other stupid things.
Saturday, October 17, 2009
Home Invasion (Changes in Perspective)
There is an assisted living facility in my district that generates a lot of calls. One type of call that we get often is the Lifealert alarm. I'm sure you remember the commercial, "Help! I've fallen and I can't get up."
I think that most EMS responders will tell you that the vast majority of these calls are false alarms. I can only think of one time when it wasn't.
We were toned out at a little after midnight to the third floor of the assisted living facility facility for a medical alarm. Once we arrived we were met by the manager (who has keys to the apartments so that we can get in without breaking things) and we walked upstairs. I knocked on the door rather forcefully and yelled "Fire Department." There was no answer. I knocked again and got the same result. At this point the manager opened the door for us. I went right as I entered the residence toward the bathroom. My engineer went straight with both of us shouting "Fire department!" The last thing I want is to scare someone and get shot. As my engineer entered the bedroom an elderly woman in bed opened her eyes and screamed. Her husband was a little slower and calmer in his reaction. After calming them down we made sure that there was no actual medical emergency (other than the heart attack we just gave that poor old woman). We then apologized and showed ourselves to the door, then bid the manager goodnight.
A few blinks later (about 3 hours) we were toned out for the victim of a home invasion robbery and assault. As we were responding we couldn't help but laugh at the irony that just a few short hours before we were the home invaders. Turns out our patient was a 48 year old Desert Storm vet that had been pistol whipped. He had been in his garage, drinking, when he heard his wife scream. He came into the house to find a man with a gun. He quickly attacked the intruder to protect his wife and 10 month old son and got beat in the head. The intruder then ran away. Our Vet was most fortunate that things didn't go further. Because he was a little altered (either from the blow to the head or the alcohol) we sent him to the hospital to get checked out.
PD had us stay on scene for the next 90 minutes just in case they found the guy that did this and things went ugly. Once they had done a thorough search of the area, including K9 units, we were released. So much for a good night sleep.
I think that most EMS responders will tell you that the vast majority of these calls are false alarms. I can only think of one time when it wasn't.
We were toned out at a little after midnight to the third floor of the assisted living facility facility for a medical alarm. Once we arrived we were met by the manager (who has keys to the apartments so that we can get in without breaking things) and we walked upstairs. I knocked on the door rather forcefully and yelled "Fire Department." There was no answer. I knocked again and got the same result. At this point the manager opened the door for us. I went right as I entered the residence toward the bathroom. My engineer went straight with both of us shouting "Fire department!" The last thing I want is to scare someone and get shot. As my engineer entered the bedroom an elderly woman in bed opened her eyes and screamed. Her husband was a little slower and calmer in his reaction. After calming them down we made sure that there was no actual medical emergency (other than the heart attack we just gave that poor old woman). We then apologized and showed ourselves to the door, then bid the manager goodnight.
A few blinks later (about 3 hours) we were toned out for the victim of a home invasion robbery and assault. As we were responding we couldn't help but laugh at the irony that just a few short hours before we were the home invaders. Turns out our patient was a 48 year old Desert Storm vet that had been pistol whipped. He had been in his garage, drinking, when he heard his wife scream. He came into the house to find a man with a gun. He quickly attacked the intruder to protect his wife and 10 month old son and got beat in the head. The intruder then ran away. Our Vet was most fortunate that things didn't go further. Because he was a little altered (either from the blow to the head or the alcohol) we sent him to the hospital to get checked out.
PD had us stay on scene for the next 90 minutes just in case they found the guy that did this and things went ugly. Once they had done a thorough search of the area, including K9 units, we were released. So much for a good night sleep.
Friday, October 16, 2009
Complicated Call
While in paramedic school you participate in scenarios. It's a way for the new paramedics to practice their assessment and critical thinking abilities and how to put all of their new skills to the test. The interesting thing about them is that the scenarios usually aren't your run of the mill calls. The instructors are usually medics and they give you calls that they went on that were different or interesting in some way. Quite often they contain some pretty severe curve balls. This call was just like one of those scenarios.
We were toned out for an 83 year old woman that had fallen. This is a fairly common call but there are a lot of ways it could go. While we were responding I started thinking of how this could play out: Slip and fall, weak and dizzy then a fall, hip fracture and fall, CVA and fall, heart attack and fall, syncopal, low blood sugar and fall, attacked by a dog and a fall...I think you get the idea.
When we arrived on scene we were met by the daughter of our patient. She said that her mother was in the bedroom trying to get back to bed after using the bathroom when she fell down. She was able to get her mother back onto the bed but that was all. When we got back to the bedroom we found our patient laying on the bed. She was looking at us when we walked in (a good sign) but didn't say anything. At this point the daughter informed us that her mother was deaf (I guess that slipped her mind). So now I was trying my best to communicate with my deaf patient (the daughter was trying to help with translating) and it wasn't going well. The daughter was saying that her mom could answer our questions but something wasn't right. Out patient kept saying that she was weak. I decided to check a blood sugar. Bingo. Her sugar came back at 31. Seems the daughter forgot to tell us that she was diabetic too. I started a line on her and gave her some D50. That seemed to perk her right up. As soon as AMR showed up we sent her on her way to the hospital. Not your typical scenario.
We were toned out for an 83 year old woman that had fallen. This is a fairly common call but there are a lot of ways it could go. While we were responding I started thinking of how this could play out: Slip and fall, weak and dizzy then a fall, hip fracture and fall, CVA and fall, heart attack and fall, syncopal, low blood sugar and fall, attacked by a dog and a fall...I think you get the idea.
When we arrived on scene we were met by the daughter of our patient. She said that her mother was in the bedroom trying to get back to bed after using the bathroom when she fell down. She was able to get her mother back onto the bed but that was all. When we got back to the bedroom we found our patient laying on the bed. She was looking at us when we walked in (a good sign) but didn't say anything. At this point the daughter informed us that her mother was deaf (I guess that slipped her mind). So now I was trying my best to communicate with my deaf patient (the daughter was trying to help with translating) and it wasn't going well. The daughter was saying that her mom could answer our questions but something wasn't right. Out patient kept saying that she was weak. I decided to check a blood sugar. Bingo. Her sugar came back at 31. Seems the daughter forgot to tell us that she was diabetic too. I started a line on her and gave her some D50. That seemed to perk her right up. As soon as AMR showed up we sent her on her way to the hospital. Not your typical scenario.
Thursday, October 15, 2009
Why We Wear What We Wear
(You like the nice alliteration in the title?) This is a news story from CBS 5 News in AZ about a firefighter getting burned. I hope he recovers quickly.
http://www.kpho.com/video/21300180/
http://www.kpho.com/video/21300180/
Sunday, October 11, 2009
Fast Food Frenzy
We were simultaneously toned out with station 1 for EMS calls at fast food restaurants. They went to Taco Bell while we headed to McDonald's (I found out later that both calls were for the same thing...funny how that happens).
We were dispatched for a man having a seizure. It's amazing to me how rarely we get to a call like this and find the patient actually having a seizure. This time was no exception. When we arrived on scene, PD already there (maybe for a late breakfast??), we found our patient laying on the bench seat of one of the tables. He was a 17 year old "kid" that was there having breakfast with his dad. The father noticed his son having a seizure so he quickly grabbed him and lay him down. Up till now I'm thinking so far so good...easy call. The dad then informs me that his son has Autism and doesn't speak. The son does however understand things fairly well. This proved to be overly optimistic. As I checked on my patient I found that he was acting normally (I had to check with the father about this). My patient was very skittish at first and didn't like us trying to check out his vitals. After talking to him for a little bit and with his dad's help we were able to check him out. He even let me prick his finger to check his blood sugar, which came back a little low (seizure activity can use up sugar stores in the blood leaving the person with low blood sugar levels). Once again with dad's help we had our patient suck down some glucose paste (no it doesn't taste as good as it sounds). The dad also informed us that this is the second time in as many weeks that his son has had siezures. His son is currently undergoing tests to try to figure out why they suddenly started. My patient has no other medical history, no allergies, and is taking no medications. When we have the AMR crew bring over the gurney to take him to the hospital my patient flips out and makes a break for it. He pushes right past me, swims past my Captain and tries to get by the other firefighter, where he was stopped. After about a minute the father was able to calm his son down. My patient would flip out at the first sign that we were trying to get him into the ambulance.
Now here's my question to my readers. What would you do to get your patient to the hospital? You have all kinds of resources, drugs, cops, ambulance, fire engine, restraints and probably some that I never thought of. What would you do, for your patient, to make sure he got the evaluation at the hospital he needs (the father completely agrees that his son needs to be seen in the ER and, for the sake of this question, is willing to go along with whatever you come up with)?
On a side note, the crew from station 1 had transient that had a seizure and was very noncooperative. Funny how many similarities there were.
We were dispatched for a man having a seizure. It's amazing to me how rarely we get to a call like this and find the patient actually having a seizure. This time was no exception. When we arrived on scene, PD already there (maybe for a late breakfast??), we found our patient laying on the bench seat of one of the tables. He was a 17 year old "kid" that was there having breakfast with his dad. The father noticed his son having a seizure so he quickly grabbed him and lay him down. Up till now I'm thinking so far so good...easy call. The dad then informs me that his son has Autism and doesn't speak. The son does however understand things fairly well. This proved to be overly optimistic. As I checked on my patient I found that he was acting normally (I had to check with the father about this). My patient was very skittish at first and didn't like us trying to check out his vitals. After talking to him for a little bit and with his dad's help we were able to check him out. He even let me prick his finger to check his blood sugar, which came back a little low (seizure activity can use up sugar stores in the blood leaving the person with low blood sugar levels). Once again with dad's help we had our patient suck down some glucose paste (no it doesn't taste as good as it sounds). The dad also informed us that this is the second time in as many weeks that his son has had siezures. His son is currently undergoing tests to try to figure out why they suddenly started. My patient has no other medical history, no allergies, and is taking no medications. When we have the AMR crew bring over the gurney to take him to the hospital my patient flips out and makes a break for it. He pushes right past me, swims past my Captain and tries to get by the other firefighter, where he was stopped. After about a minute the father was able to calm his son down. My patient would flip out at the first sign that we were trying to get him into the ambulance.
Now here's my question to my readers. What would you do to get your patient to the hospital? You have all kinds of resources, drugs, cops, ambulance, fire engine, restraints and probably some that I never thought of. What would you do, for your patient, to make sure he got the evaluation at the hospital he needs (the father completely agrees that his son needs to be seen in the ER and, for the sake of this question, is willing to go along with whatever you come up with)?
On a side note, the crew from station 1 had transient that had a seizure and was very noncooperative. Funny how many similarities there were.
Friday, October 9, 2009
I'm Not a Drunk, I'm Just Stupid
We got toned out about 8 in the evening for a teen with ALOC. When we got there we were let in the house by the parents. The 14 year old came into the front room really amped up, pacing and talking fast. He said that he was walking on the park when a white guy came up and offered him a drink of something that looked like apple juice. He then changed the story subtly and said that he was offered a "shot" of something like apple juice. The story was then altered one more time. He said he was offered a "chunk" of what he thought was apple juice. My patient then quickly added that he didn't want his parents to know because he didn't want them to think he was a drunk (my thought, "Yeah, right. It's much better that your parents think your a blithering idiot for taking "chunks" from strangers in the park."). Everything checked out on my patient except his heart rate, which was cranking along at 145 beats a minute. at one point my patient startd talking in Spanish to his parents. The other firefighter I work with flash me a knowing look. I'm fluent in Spanish so I just eaves dropped on the conversation to see if his story stayed the same. It did. After calming him down we sent him to the hospital.
Since the was the second patient with similar presentation (a little amped up with a fast heart rate but no other medical complaint) in a month we followed up. We were informed that Kaiser diagnosed him with acute alcohol ingestion and nothing else. I think either the kid had something else in his "chunk" or Kaiser didn't want to test him for anything else and went with the simplest of explanations.
Since the was the second patient with similar presentation (a little amped up with a fast heart rate but no other medical complaint) in a month we followed up. We were informed that Kaiser diagnosed him with acute alcohol ingestion and nothing else. I think either the kid had something else in his "chunk" or Kaiser didn't want to test him for anything else and went with the simplest of explanations.
Thursday, October 8, 2009
More Ambien Please
We were toned out for an auto accident with PD on scene. Upon our arrival we found an SUV in the parking lot of a strip mall. PD had the woman standing next to her vehicle. I asked what the story was and was informed that she had been driving erratically and was followed by a city employee while on the phone with 911. As my patient tried to turn into the parking lot she hit a small tree, knocking it over. My patient was clearly not operating on all cylinders so we did some checking. All her vitals were normal. Blood sugar levels were fine. Patient had no real medical complaint. She was able to answer all of our questions but very slowly. PD had grabbed her prescription medication out of her purse and handed them to me. She had filled a prescription for 30 Ambien the day before and was down to two. I wasn't sure what an overdose on Ambien would look like so I decided to call poison control. The MD on the phone said that it would just make her really out of it like having too much valium.
He also said that she did need to go to the ER. We finished up our asssessment and handed off patient care to AMR.
He also said that she did need to go to the ER. We finished up our asssessment and handed off patient care to AMR.
Monday, October 5, 2009
Twisted Ankles, Twisted Paramedics
We get toned out at about 2300 for an ankle injury. Thankfully I was not yet asleep. I'm embarrassed to admit that when we get a call like this my first response is usually to grumble that the person is calling 911 for a twisted ankle. It's hard when I know people that refuse to call 911 when they amputate a body part to think that the person with a broken ankle really needs me. Once we arrived on scene we were greeted by the husband who said that his wife had tripped and fallen down the two steps to the living room and they couldn't get her up. He was embarrassed to have to call us.
We quickly did an assessment and found that she had no other apparent injuries other than the ankle. While we worked on her ankle, the couple told us that they were watching "Nurse Jackie" and laughed that they now had to have their own encounter with emergency medicine. We joked around as we splinted her leg with a vacuum splint and put an ice pack on her ankle. I offered her some morphine but she declined. Our patient was one of the nicest patients I've ever run a call on. That's what makes the arrival of the AMR unit so bad. Some people in the EMS field are burnt out and should get out. They hate their job. the medic that showed up showed all the signs of being one of these people. So we had to load up our nice patient into the back of the ambulance with one of the grumpiest medics I've ever met. Afterward the husband made it a point to come shake all of our hands and thank us for being there.
We quickly did an assessment and found that she had no other apparent injuries other than the ankle. While we worked on her ankle, the couple told us that they were watching "Nurse Jackie" and laughed that they now had to have their own encounter with emergency medicine. We joked around as we splinted her leg with a vacuum splint and put an ice pack on her ankle. I offered her some morphine but she declined. Our patient was one of the nicest patients I've ever run a call on. That's what makes the arrival of the AMR unit so bad. Some people in the EMS field are burnt out and should get out. They hate their job. the medic that showed up showed all the signs of being one of these people. So we had to load up our nice patient into the back of the ambulance with one of the grumpiest medics I've ever met. Afterward the husband made it a point to come shake all of our hands and thank us for being there.
Tuesday, September 29, 2009
Running Firefighter
In general, firefighters are supposed to be the guys that nothing phases, and when they show up, everything is under control. Think about the times that you have seen a firefighter responding to a call. How often is he running? He may be moving quickly and with purpose but usually not running. This post is about one of the exceptions to this.
Our tones went off about 1100 in the morning. We stopped working out and jumped into our turnout pants. As we started responding we were informed that we were responding for a premature baby not breathing. At that point my pulse quickened. Not only is there now a life on the line but it's a kid, a young kid. This is both good and bad from a medical standpoint. Kids don't die (usually) unless there is something stopping them from breathing and if you can correct that problem, they bounce back. The down sides are that it's a much more stressful situation (you can have hysterical family there adding to the stress you're already feeling) and you don't run that many pediatric calls so everything may not be quite second nature.
As we pulled up to the scene my Captain said go get the kid and he'd grab the equipment. As I exited the rig I saw a woman (who turned out to be grandma) standing in the door way bordering on the hysterical. On a call you never know if dispatch got things right until you get there. Grandma being outside was not a good sign. I ran up to the house and inside I found mom holding her infant in her arms by the kitchen counter. The baby was very cyanotic, limp but breathing. The poor baby was using all of her muscles that she could to breathand she had retractions.
The mom said that she was born 3 month premature and was originally due to be born the following week. The baby had only been out of the hospital for a few days. She also said that she was burping the baby when she choked and stopped breathing. She did back blows to try and clear her airway and it worked. As I held the baby I stripped of the onesie. The baby did not look good. We placed her on some high flow oxygen and started getting some vitals. By the time that the next responding unit showed up I thought she was looking great. The paramedic walkinginto the scene thought she looked horrible until I explained how bad she was and that she was on the up swing. The AMR medic showed up next and we had to repeat the process. We quickly loaded her up and I jumped into the back of the ambulance, just in case things went south. We checked her capnography, pulse ox, and heart rhythm. Everything seemed to be checking out good. She started to really pink up (return to normal skin coloration) too. By the time that we got to the ER she was still having some respiratory distress but she was no where near the critical patient that I first saw.
Our tones went off about 1100 in the morning. We stopped working out and jumped into our turnout pants. As we started responding we were informed that we were responding for a premature baby not breathing. At that point my pulse quickened. Not only is there now a life on the line but it's a kid, a young kid. This is both good and bad from a medical standpoint. Kids don't die (usually) unless there is something stopping them from breathing and if you can correct that problem, they bounce back. The down sides are that it's a much more stressful situation (you can have hysterical family there adding to the stress you're already feeling) and you don't run that many pediatric calls so everything may not be quite second nature.
As we pulled up to the scene my Captain said go get the kid and he'd grab the equipment. As I exited the rig I saw a woman (who turned out to be grandma) standing in the door way bordering on the hysterical. On a call you never know if dispatch got things right until you get there. Grandma being outside was not a good sign. I ran up to the house and inside I found mom holding her infant in her arms by the kitchen counter. The baby was very cyanotic, limp but breathing. The poor baby was using all of her muscles that she could to breathand she had retractions.
The mom said that she was born 3 month premature and was originally due to be born the following week. The baby had only been out of the hospital for a few days. She also said that she was burping the baby when she choked and stopped breathing. She did back blows to try and clear her airway and it worked. As I held the baby I stripped of the onesie. The baby did not look good. We placed her on some high flow oxygen and started getting some vitals. By the time that the next responding unit showed up I thought she was looking great. The paramedic walkinginto the scene thought she looked horrible until I explained how bad she was and that she was on the up swing. The AMR medic showed up next and we had to repeat the process. We quickly loaded her up and I jumped into the back of the ambulance, just in case things went south. We checked her capnography, pulse ox, and heart rhythm. Everything seemed to be checking out good. She started to really pink up (return to normal skin coloration) too. By the time that we got to the ER she was still having some respiratory distress but she was no where near the critical patient that I first saw.
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