Lung Cancer and CHF

In the middle of the afternoon we were toned out for a man having trouble breathing. When we got there we were met by his hospice nurse. She informed us that he was having rather severe breathing problems but his vitals were stable. My patient had a history of CHF and terminal lung cancer. I felt bad for the guy but there wasn't much we could do. We gave him some oxygen. Checked his lungs sounds (which were clear). His lungs were operating as best as they could as far as I could tell. All we could do is make him comfortable and get him to the hospital to get further testing done.

The Academy The Preamble

Over the upcoming weeks I am going to write about my experiences in the fire academy. I hope to give a glimpse of what I and my family went through to get where we are.

Once I was hired by my current department I was informed that I would be attending a fire academy in the area. Once I discovered this I did some research. I was unable to find out too much other than that this academy has a reputation for being rather tough.

A week before the academy started my wife and I (kids in tow) attended a family night for the academy. It was geared to let our loved ones know more or less what we were going to be going through for the next 4 months. The instructors tried to scare and intimidate the recruits (starting the mind games early). At one point the recruits were separated from their family members. The families got to watch a video from the previous academy and had a question and answer session. The recruits were marched into another room where we met our mentors. The mentors were firefighters that had graduated from the last academy and had volunteered to help us through this academy. If at any point in the academy, we needed help or had questions, they were there for us. Some of the recruits would use this resource a lot and others wouldn't.

By the end of the night my wife and I had decided that the family night was more geared towards the parents of rather young recruits still living at home. It was more or less, "make sure they get fed and have clean socks." I think my paramedic program did a better job at their family day. It was more like this...."say goodbye to the nice person that you call your loved one. For the next few months they will be tired, stressed and grumpy. Don't worry, they will return to normal after the program is over." That about sums up the academy.

Spanish Comes in Handy

We got toned out for a woman with a headache and high blood pressure at a assisted living facility. The manager met us at the front lobby and escorted us to the apartment. While we were walking the manager let us know that the tenet was Spanish speaking. As we approached the elevator the manager asked the custodian to come along to translate. I was met with some incredulous eyes by my captain and the manager when I said that wouldn't be necessary.

We were met at the door by the husband. As I approached the patient I introduced myself and asked what was going on, in Spanish. My captain was shocked at my linguistic abilities. The patient had a history of high blood pressure and had been having a severe headache since about one in the morning. I did a quick neuro check to see if she might be having a CVA. By the time that I was done AMR was on scene. We quickly loaded her up and sent to get checked out.

After that call we were toned out for another in the same facility. This time it was another Spanish speaker. This time a nice old lady had just slipped down out of her recliner and couldn't get back up. Her friends weren't able to do it either. We helped her up and then I spent a few minutes just chatting with her. Turns out she was Cuban (her accent was a dead give away). I don't get the chance to talk to many Cubans any more so it was fun. After making sure everyone was OK we cleared the call. Afterward my captain said that he didn't care if I was a lousy medic (which I'm not). The ability to speak Spanish alone made me a 14/10 in his book.

GSW

We were toned out for an EMS call just a couple of blocks from the station. At times it is difficult to understand our dispatchers so we were responding without knowing fully what we were headed into. Once we understand that this was a GSW and that PD was not there yet we shut down and staged. No sense in getting us shot. After a few minutes PD cleared the scene and we pulled up. We found a teenager sitting on the ground up against a couch. He was holding his left hand. He had been shot once by a .40 caliber weapon. He was one of the luckiest people I know getting shot. The bullet grazed the side of his head leaving about a 1 inch laceration. After that (an assumption) the bullet entered his left hand between his thumb and index finger (in the thick meaty part) and then exited out the palm. We quickly bandaged his injuries and then sent him on his way. One thing that I thought was interesting. One of the first things that he asked for was Morphine. A bit of advice. Paramedics don't like giving out narcotics to people that don't need them. And most medics that I know agree that if a patient immediately asks for Morphine the likelihood of that patient getting it drops to about zero. If you want something for the pain...let us know that you're in pain. We know what to do from there. I don't know if the transporting paramedic gave him Morphine or not but somehow I don't think so.

Virus=Very Yes...

We were toned out to a fire alarm at one of the elementary schools. When we got there we met up with the custodian (school is still out for the summer). He showed us to the alarm panel where it showed 3 trouble areas. We silenced the alarm then checked all three areas with the TIC. As we finished the alarms sounded again. Once back at the panel we silenced the alarm and noticed that there were now more than 20 trouble areas. The alarms then went off a third time. Now there were 67 trouble areas. We decided that the school needed to get the alarm company out to service the system. It reminded me of a Home Star Runner episode dealing with Strong Bad and viruses.

Line of Duty Death, Firefighter Marovich

Marovich, Thomas

Cause of Death: Fall

Age: 20

Firefighter Marovich incurred fatal injuries when falling while performing routine rappel proficiency skill training, at the Backbone Helibase in Willow Creek. He was working with the Chester Helitack Crew from the Lassen National Forest that had been assigned to the Backbone Fire in the Trinity Alps Wilderness. Firefighter Marovich was provided advance life support treatment immediately at the scene. The Base medical staff, the Humboldt County Coroner's Office, and the Humboldt County Sheriff's Office were involved in the response. The Forest Service has mobilized an accident investigation team and is working with the National Transportation Safety Board. Incident Location: Vicinity of Willow Creek (USNG: 10TDL4426)

This one is a lot closer to home. Firefighter Marovich was a fire explorer for a neighboring city.

Line of Duty Death, Firefighter Grace

Grace, Joseph T.

Cause of Death: Stress/Overexertion

Age: 47

On the evening of 7/8/09, Joseph Grace participated in a departmental drill for a "man down" drill. He had also responded to multiple incidents during the day of the 7/8/09 and over night into the early morning of 7/9/09. At approximately 0645 hours on 7/9/09, he responded to an incident prior to going off shift around 0730 hours. He reported to his second job as a paramedic and was in the process of cooking breakfast when crew members entered the kitchen and found him collapsed around 0830 hours. Care was initiated on scene and he was transported to a local care facility before being transferred to a larger medical center where he remained until his death. The nature of the fatal injury is still to be reported.

Line of Duty Death, Firefighter Grass Jr

Grass Jr., David

Cause of Death: Stress/Overexertion

Age: 34

Incident Description: Firefighter Grass was at the fire station and participating in department sponsored physical fitness training when he experienced a medical emergency. Grass was flown to St. Louis University Medical Center by air ambulance where he succumbed to an apparent brain injury. Incident Location: 165 South Fourth Street, Ste. Genevieve, MO 63670 (USNG: 15S YC 59353 07378)

Aftermath

These are photos of the aftermath of my recent structure fire.

The Honda Accord and Civic that didn't fair so well. The plywood wall in the background was set up after the fire so as to be able to secure the house.

Total roof collapse. I set up to make entry into the front door right on the other side of that wall (back a few feet from it).



The view from the dining room. There used to be a wall there separating the dining room and the garage.

The kitchen was small.

The fridge was knocked over by the deck gun.

This wall was ablaze when I entered the room. With just a small amount of water it was extinguished.

The fire had spread to the attic and had been burning there for a while but the deck gun managed to put it out.

These are Gusset plates. In order to save money they are used instead of nails to keep the structural members together. Unfortunately they fail really fast when they come in contact with flame. Modern, cheaper construction methods have made firefighting more dangerous.

This Gusset plate didn't stand a chance.

A better view of the attic.

The view toward the living room from the dining room.

The Master bedroom. All this damage was from smoke (we pulled the ceiling down to check if the fire was burning in the attic above this room).

Still in the master bedroom. A lot of the damage to this side of the house and the contents of the room could have been prevented if the tenets had shut the doors after exiting.

The second bedroom.

The third bedroom.

This is the side of the garage. The neighbors were fortunate that we got there when we did. The house next door didn't even have the pain peeling.

The view from where the first in engine was parked.

The garage collapsed as one of our captains was doing his 360 degree size up and this debris almost got him.

Vehicle Fire in a Garage

After being asleep for about 25 minutes (at 0130 because of another call) the tones went off again. We were dispatched to a structure fire. I was so tired that it took a second for my brain to kick into gear and for me to realize that I needed to hurry. I ran out to the apparatus bay and quickly donned my turnouts. Just as we cleared the bay our battalion chief arrived on scene and reported a fully involved garage and to have all units responding continue in. Hehehe. I was awake now.

The engine from station 3 was the first to arrive on scene beating us by a few seconds. We jumped out and went over to help. The engineer off the first in engine needed help hand jacking 5" hose to the hydrant. While one of the firefighters from my crew did this the other firefighter from my crew jumped on the deck gun and started to knock back the flames. I waited with my Captain for orders. The initial crew grabbed a 1 3/4" line and protected the neighbor's house from catching on fire. While all this was going on another crew had shown up and grabbed the 2 1/2" attack line and started outside attack on the garage. About this point part of the roof of the garage collapsed.

As firefighters we learn the science behind fighting fire. A lot of people may think that it's as simple as "putting wet stuff on the red stuff" but there's more to it. If it's done incorrectly we could fail to put out the fire, spread the fire, burn people inside, collapse buildings or cause a lot of water damage. The best way to put out a fire is to get up close to where you can see the "seat of the fire" and put water on it. It takes a surprisingly small amount of water to put out a fire when it can be attacked in the correct way.

While we were waiting for our orders I noticed that even though we had thousands of gallons a minute flowing into this garage all it did was keep the major flames down. The fire was still going strong in the sheltered areas where the deck gun and other hose lines could not reach from the exterior of the building. My Captain was ordered to grab his crew and to get ready for interior attack through the front door. I didn't need much encouragement from my Captain. I grabbed the 1 3/4" preconnected attack line off the rear of the engine and went for the front door. Once I was there and masked up I started attacking the fire from the outside while I waited for my crew. As soon as everyone was ready we started to make entry into the house. When the IC was informed that we were going in he had all defense operations stopped (mostly the deck gun so that it didn't put us into danger). Walking through the door I could feel enough heat to keep me in a crouch. Visibility was low but not horrible. I walked in the front door and encountered a hallway that went left and right of the entry way. To my right I could see that the fire was no longer contained to just the garage. I moved down the hallway closer to the fire and gave it some water. It went right out. We then heard the order to evacuate the building. Not what I expected to hear. We quickly, but not without reservation, backed out. From where we were we thought that we were safe. That is one of the reasons that we have an IC who stands back from the incident and watches for what develops. I'm not sure what he saw but he obviously saw something on the outside that made him not want to risk our lives inside so he had us back out for a minute. Once the scene had stabilized we went back in. In just a few minutes we had the fire inside the house under control. What was left of the two cars in the garage would take a little longer to extinguish because of our limited access to the vehicles.

After my crew was finished with interior attack we were assigned to Rehab. We hydrated up and then started helping getting SCBA bottles in a cache and swapping them out for the crews that were doing salvage and overhaul. After that we were assigned to check the air quality in the structure with a gas meter. After a fire there are many gases (carbon monoxide is the most common) that are potentially dangerous so we have to monitor them and determine when it is safe to not use our SCBA's. Once it was determined that the gases in the house were within acceptable levels all the crew took off their SCBAs.

Once everything was mopped up we started loading hose. It took about an hour to clean off our equipment and get it back onto the engine. We were cleared from the call and back at our station sometime around 0430. Just in time to get about two hours of sleep.


These were taken a few hours later. That is the garage that was engulfed. The front door that we went into is just to the left of the center of the photo.

Here you can better see the front door. You can also see the damage sustained by one of the cars by the collapsing roof.

The view from the other direction. You can see that the fence got a little charred from the heat. Over all it seemed to me that there was smoke damage in all the rooms and direct fire damage in the hallway, kitchen, family room, living room and dining room.

Line of Duty Death, Firefighter Johnson

Johnson, Robert

Cause of Death: Fall

Age: 75

Firefighter Johnson passed away from a head injury he received from a fall while retrieving SCBA from fire apparatus during a fire safety demonstration at the Pine Grove Nursery School in Mahopac. The fire department reported that the cause of the fall is unknown; Johnson went around to the far side of the apparatus to get the air-pack and, when he did not return, was discovered by other firefighters unconscious on the ground. Firefighter Johnson was treated on-scene and transported to the hospital. However, he never regained consciousness and succumbed to his injury approximately nine months later. Incident Location: Pine Grove Nursery School, 85 Myrtle Ave, Mahopac (USNG: 18T XL 03651 80101)

Line of Duty Death, Firefighter Haddix

Haddix, Dale Elliott

Cause of Death: Stress/Overexertion

Age: 70

Upon arrival with a fire crew at the scene of a vacant residential structure fire, Assistant Fire Chief Haddix engaged the pump on the department apparatus and then slumped over when he experienced a medical emergency. Assistant Chief Haddix was rendered aid on-scene by a stand-by medical crew but succumbed to his injury. The nature of the fatal injury is under investigation. The cause of the fire was intentional and charges have been filed against one 18 year old, other charges being considered. The investigation is continuing with the Vernon County Sheriff's Office and the State Fire Marshal's office. Incident Location: 175 W. Second Street, Schell City, MO (USNG: 15S VC 0179 0859)

Time of Death, 2217

I consider myself to be a good medic. I think that I have a good amount of knowledge combined with a decent amount of experience. Even with all that going I was a little nervous about running my first medical aid in almost half a year.

The call came in just before 10 at night. We were dispatched for a woman not breathing. While responding to the call we were informed that EMD had told the caller to start CPR. When we arrived on scene we hurried to the front door. After several knocks at the door without answer one of the firefighters prepared to force the door. Just then the husband opened it. He frantically told us that his wife was upstairs. When we walked in we found a woman in her late 60's on the floor. One of the firefighters quickly rolled her onto her back and checked if she was breathing (you always double check because it doesn't look too good to start CPR on a live person). He quickly determined that she was pulseless and apneic. He immediately started CPR while the other medic and I got set up to try and save this womans life. I jumped on the airway and got out a bag valve mask, the oxygen and an OPA while another firefighter put her on the monitor. She was in asystole, commonly called flat line. About this time the squad showed up for additional manpower. They set up the AutoPulse so that we could ensure adequate chest compressions. I grabbed a King tube and secured a better airway and placed her on capnography. While this was going on the other medic started an IO line and gave the first round of drugs. After a couple minutes of CPR we checked her heart rhythm again. It had not changed. By this time AMR had showed up and was assisting us with the family preparing them for the probably bad news. they explained what we were doing to try step by step. We did another round of drugs and continued CPR with no response. We finally determined that our efforts were futile and terminated resuscitative efforts at 2217 hours.

Not the best outcome but the odds were against us. The husband had no idea how long she had been down for and without quick CPR there is very little chance that we can do anything.

Line of Duty Death, Firefighter Wingard

Wingard, Ryan

Age: 28

Cause of Death: Stress/Overexertion

Firefighter Wingard was working a debris fire shortly after arriving at the site of a recently demolished house in Strattanville. After telling fellow firefighters that he was not feeling well, Wingard collapsed. CPR was initiated immediately by members at the scene and an ambulance was called for at 0409hrs. Firefighter Wingard was transported to the hospital where he passed away. Both the nature of the fatal injury and the cause of the fire are under investigation. Incident Location: 151 Washington ST, Strattanville, PA 16254 (USNG: 17T PF 4072 6264)

New Department...My First Call

July 3 was my first day "online" for my new department. It's been about 5 months since the last time that I ran a call and I could hardly wait to run some more. Wouldn't you know it, we only had one.

Mid morning we were toned out for a child locked in a vehicle. Once we were responding dispatch informed us that it was a one year old stuck in a white Chevy truck. Pulling up to the scene we saw several family member surrounding a white SUV. My Captain had me grab the Big Easy and start on getting the door open. Between me and one of the other firefighters on the shift we were able to get into the vehicle pretty quick. The mom was very grateful. We grabbed one of our teddy bears that we keep for kids (at least the ones that go through a slightly traumatizing experience) and gave it to the kid. He was happy.

Line of Duty Death, Firefighter LePage

LePage, Allan

Age: 67

Cause of Death: Struck By

Assistant Fire Chief LePage passed away from a head injury he suffered while working on a ladder truck. Investigators have not released details of the accident. Incident Location: 35 Bills RD, Kingston, RI 02881 (USNG: 19T BF 8946 9591)

TC With Fire

********WARNING********

This post may contain graphic descriptions, photos and/or commentary that may be found offensive to some readers. In writing this post I tried to balance victim privacy and respect for the family with the desire to share exactly what I experienced. I have omitted some pictures and edited my comments because of this.

At a little before three in the afternoon we were toned out. "Medic Engine 461, MBA, Medic Engine 121, respond for a TC with fire at highway 62, cross of T. Circle." As we turned out of the station onto the highway we could see the header (a column of smoke from the fire). As we approached the scene we had traffic backing up. This almost always means that we have a bad wreck. As we approached we noticed that there was one patient with what looked like significant burns. We also noted that there was an older model suburban that was totally involved with fire and that the fire had already extended into the surrounding brush. I quickly grabbed the bumper line and flaked out the hose while Grant grabbed the tools. Just as I was getting water Medic Ambulance 122 pulled up. Eric directed the paramedic to the patient sitting to the West of the accident. I started at the front right side of the suburban and worked my way around to the far side. Once there I knocked down the fire in the brush. While I was working back around the front of the vehicle to finish knocking the fire down there I heard Eric call my name and asked me to confirm that there was one fatality. It wasn't until this point, when some of the smoke cleared, that I could see that someone did not make it out of the vehicle.

Since the fire was knocked down Eric asked me to go start helping out with patient care while he and Grant finished extinguishing the fire. Just as I walked up MBA showed up. I found out that there were two patients and MBA started working on the second one. My patient had been the passenger in the Suburban and had sustained second and third degree burns to about 60% of his body. We quickly stripped him of his clothes, did a quick head to toe exam, covered him in burn sheets (to try to stop infection), placed him on a backboard and started two large bore IV's. As soon as he was packaged he was transported to the trauma center. From what I heard the other patient (the driver of the van) had sustained second and third degree burns to his left arm and chest. He also was severely hypotensive so he too was rushed to the trauma center.


This is what we saw and heard while approaching the scene.


From this angle it just looks like a bad wreck.



Here you can actually see the burns on the drivers side.

The driver had to climb out the back of his van.

I have no doubt that his seat belt and airbag saved his life.

This is the burnt out Suburban.


After rescue operation were completed we had to stay on scene and wait for the coroner (and the body recovery team). After they showed up the coroner took his photos for the investigation. We then had to disentangle the body from the vehicle. We popped the front passenger door off and grabbed the body bag. I then had to climb into the vehicle to guide the body out from the inside. To be respectful to the deceased I will not describe in detail the sights, sounds or smells that accompanied the task of body recovery. After the body was placed in the body bag we placed him in the coroners van.



Here is a short video of the auto extrication.


Grant manning the power unit.


The coroner. He was actually the head Medical Examiner for the county. He happened to be the closest coroner to our call.



The Suburban was facing the other direction when struck. I'm not sure which lane he was in or if he was on the center divider. It took a lot of force to do this.




This is where the victim lay. That is the metal frame to the front bench seat there.











Mop up.



This is the where the brush was involved. Luckily it wasn't windy that day.


This boulder was under the Suburban. It was hit hard enough to crack it straight down the middle.


Eric later would do his Burn Center rotation for his paramedic class and was able to follow up on both patients. The driver of the Van had been discharged the day before Eric was there. The other patient was still heavily sedated but was recovering well. He still has several surgeries to go through but he will live.

Fire Fatality

Crash claims life

Firefighters and the California Highway Patrol respond to a crash just west of the Yucca Grade in Morongo Valley Thursday afternoon.
Published: Thursday, January 8, 2009 7:41 PM CST

MORONGO VALLEY — One person was killed in a collision around 2:30 p.m. Thursday, Dec. 8, on Twentynine Palms Highway at Little Morongo Road in Morongo Valley. The California Highway Patrol is handling the investigation. It appeared one vehicle, possibly a Chevy Suburban, and a Verizon van were involved in a collision; both vehicles came to rest on the shoulder next to the westbound lane of the highway.The SUV caught on fire and was destroyed, and it appeared the driver was killed. The San Bernardino County Sheriff's Department confirmed the collision was fatal. The Verizon van appeared to have sustained damage from the collision and the fire.Morongo Valley firefighters responded to the scene, extinguishing the flames. Traffic was backed up as firefighters and investigators responded to the emergency, and vehicles were directed onto Little Morongo Road, where the sandy surface may have posed a problem for some drivers. The early information from the CHP online incident center indicated drivers found it difficult to see the scene because of the setting sun.For more on the collision and its aftermath, see the Saturday print edition of the Hi-Desert Star.

Line of Duty Death, Firefighter Stearns

Stearns, Brett

Age: 29

Cause of Death: Struck By

While working at Freeman Reservoir on a hazard tree abatement project with a dozen other BLM firefighters, Captain Stearns was struck and killed by a falling tree. Incident Location: USNG: 13T BF 9515 1556