I'm My Own Patient

We responded to a call a couple of blocks from the station. We always have AMR right on our heals since the our station is in the shadows of the trauma center.

Over the growl of the siren we heard from dispatch that we were responding for a fall victim. These calls are usually fairly vanilla. An old person falls, is bruised and a little battered but is fine. Every once in a while you get someone that falls and smacks their head causing a cerebral bleed. I knew an AMR crew that once responded for a "fall victim" only to find that their patient was actually a skydiver whose parachute failed to open. Splat.

We arrived on scene to find an old lady being helped by several bystanders. The 90 year old woman had been walking to the hospital, where she volunteers a couple of times a week, when the sidewalk reached up and tripped her. She managed to stop her fall with her forehead.

The entire time we were there my patient kept making jokes. She thought it was hilarious that she was going to be her own patient. It was good to have a patient that happy. She had split her head open just below the hairline above her right eye. She would probably need a couple of stitches. She was worried that she might be late for her shift. I assured her that when she showed up in our white chariot they would forgive any tardiness.

Epistaxis

I showed up at the station a little early. I was working an OT shift and hoping to get something good. The tones went off right at 0800. Welcome to station 3. The call was forgettable. Just another ill elderly person that was feeling a bit weaker than normal.

Less than 20 minutes after we arrived back at the station we found ourselves again splitting the sea of cars on their morning rush hour commute headed for another medical aid. Most of the drivers tried to wedge their cars into whatever space they could find to get out of our way.

Arriving on scene we found a 45 year old woman with a bloody nose. She said that it had been bleeding for the last 2 hours and nothing helped. She had had this happen once before about a year before and she had her left nostril cauterized. This time it was the right one. She also admitted that she had a history of hypertension but wasn't taking her medication. And what a shocker, her BP was high.

I used a nose clamp and an ice pack to try to stem the blood flow and gave my report to the AMR medic that had just come in the door. Another life saved.

Fast forward 12 hours. 2123 hours.

The tones were going off for the 13 time that day. This time we were being dispatched for another medical aid. As we responded with our lights reflecting off the exterior walls and windows of the buildings along our path dispatched advised us to stage. PD was en route to a fight outside of Home Depot. The victim had been hit with a pipe and the assailant was thought to still be in the area.

While we waited down the street the AMR crew decided to stage on the far side of the parking lot. The patient spotted the ambulance and walked right over, arriving before PD. The 45 year old male had been struck by a lead pipe right in the face. He had am avulsion that started about an inch above his left eye and traveled down at a 45 degree angle across his nose to a point about an inch below his right eye. We tried to stop the bleeding with direct pressure but that was only slowing it down a bit. Despite being drunk, which no doubt helped with the pain, the human pinata was amazingly alert and oriented.

One of the cops asked the patient if he knew who hit him. When he named his assailant the officer then asked if that wasn't the guy that the victim had stabbed in the hand the previous week. I guess these guys have a history. Maybe next time I work an OT shift at station 3 they'll have upped the ante a little. Medics love trauma.

Vacation

At my department (and I'm sure most have this ability) we can trade shifts. Instead of using up our vacation time we can have someone else work our shift. We then have to work for them on another occasion. Having someone work 2 days for me allows me to have 10 days off in a row.

I guess what I'm trying to say is, I'm on vacation!

What We Do When Not Running Calls

Firefighters work all types of different schedules. Some work every third day, for 24 hours. Some work what is called a 3's and 4's schedule. They work every other day for 5 days (3 days working) and then have 4 days off in a row. I did this for a while. Other departments work 3 days straight but then get 4 days off. I think I have it the best. I work for 48 hours then get 4 days off. The down side to my schedule is that 48 hours is a long time to be awake if you happened to get slammed with calls.

My shift officially starts at 0800.  Although the crews try to get there a little early, that way the off going crew can bail right at 0800. The oncoming crew talks with the guys getting off duty. They find out if there were any issues, rumors, good calls, stories, etc. Quite often this is done over a cup of coffee or while setting up your turnouts and other personal equipment. It really depends on how fast the guy getting off needs to get out of there.

The first order of business in the morning is to check out our equipment. We make sure that everything is there and in order. The engineer will do a complete check on the apparatus. The medic will check all of the EMS gear. The captain does......captain stuff (I think he just drinks coffee and checks eBay.....kidding). The crew then gets together, eat breakfast and talk about the day (and drink still more coffee).

Topics normally covered in the morning include any training scheduled for that day, tasks that need to be accomplished that day and most importantly....dinner.

In the morning we get in a workout. the number on cause of firefighter fatalities is heart attacks. Most departments (including mine) encourage us to work out every shift. Sometimes we have training that the department schedules in the morning hours so we have to work out later.

The morning time is when we do most of our training. Sometimes it's set up by the department and several companies will get together at one time to do it (such as an EMS class). Other times, it's just the crew getting together and working on something that they haven't done in a while. Recently my crew decided to contact one of the local towing companies to see if they had any 'spare' vehicles laying around. We ended up tearing apart a 1994 Ford Explorer for practice.

After lunch we take care of any business that's left. Sometimes we go out and do company level business inspections. Most of the time we do company level training. In the afternoon we also take care of our grocery shopping. Let me just take a moment to set something straight. We pay for our own food. It's not payed for by you, the tax paying public. So if we want to have steak and lobster, don't freak out. We're buying it with out own money.

Sometime around 4 in the afternoon we start cooking. Who cooks depends on each crew. At the double houses (one with an engine company and another company like a truck or rescue) dice are rolled to assign jobs. Dishes are usually the last to get picked. Most stations have at least one 'skate' spot where you don't have to do anything. We try to have dinner sometime around 1730.

After dinner a lot of crews watch TV. Either sports or a movie. Then, usually around 2300, everyone goes to bed. In theory, we sleep until about 0700 and then do it all over again.

Now at any point during the day we can be interrupted by the tones. Usually this happens at meal times, at a critical moment in a ball game, just after stepping into the shower or when we just fell asleep. At least that's how it seems. Sower station may only get one or two calls a day. At the busier stations the tones can go off more than a couple dozen times in 24 hours.

Eventually, your shift ends, the talk to the guys coming in to relieve you and you get to go home. One of the reasons why I love my schedule so much is that my 'weekend' is always 4 days long.

Breaking....Your Fall?

The tones go off yet again. It's been a busy day, 7 calls in 7 hours. This time we were being dispatched to the local junior high school.

When we pulled up we were greeted by a bunch of students that were as excited as little kids to see the firemen pull up in the firetruck with their lights and siren. A bunch of them said hi as I jumped out and grabbed my gear.

My patient was standing in the parking lot talking to a teacher and to his mother. His mom was worried and trying to hold it together.

The young man was holding his left arm and trying hard not to cry. Crying would only be added insult to injury. He told us that a couple of other kids had come up from behind and pushed him to the ground. He instinctively reached his hands out to break his fall and broke his arm instead.

While we talked the swelling in his arm continued to worsen. We grabbed an icepack and splinted the arm. Since getting any morphine would mean getting stuck with a needle he declined.

Poor Mother

Engine 51, respond for a possible OD, PD on scene....

We pulled up into the cul-de-sac in the upscale suburban neighborhood. There were two squad cars out front, one with its blue and red LED lights blinding all that looked at it.

Walking into the nice entry way I found two police officers, a frustrated mom and my patient, a 20 year old female that was handcuffed and laying on the tile floor. One of the officers briefly explained that they were a frequent visitor to my patient and that she has a history of drug abuse. This time she decided to fight the officers, upset that her mother had called them.

Still not happy, my patient spent her time yelling and swearing at us stopping only to vomit. She refused to admit that she was on anything at all. We knew better. Having been around the block a time or two we knew what someone stoned looked like. That and she smelled like a brewery. She was drunk and on some kind of stimulant. Probably meth. Maybe coke.

By the time that AMR showed up we had calmed the patient down. She was still throwing up but had finally reasoned that it was better to go to the hospital with the nice medics than to go with the cops.

After AMR left we found out from PD that the poor mother had been dealing with this for some time. The daughter had a boyfriend/drug supplier that was in his late 40's. He had been abusive and now there was a restraining order that wasn't doing much.

Hopefully the system won't totally fail them and the daughter can turn her life around. If not, we'll be back. Some day for something a lot more serious.

For more information on Methamphetamine visit The Anti-Meth site

The Last Thing I Heard

...Truck 105, respond for a report of a fire.....

It was the third or fourth false alarm this shift. It was getting old. I was itching for another fire (I shouldn't really be complaining because I get a lot more of them than some of the other guys on the department). After we pulled into the station went through my routine of doffing my turnouts and hooking up the plymovent to the exhaust. While doing this I informed my captain that I had reached my quota of false alarms and I would not be responding to any more without first have a structure fire. He assured me that the next on was going to be good.

About two hours later the structure tones went off again. Despite what I said earlier I was still excited to get dressed, dive into the quint and head out to a possible structure fire. As we headed out of the barn dispatch informed us that we were headed to a commercial kitchen fire with smoke and flames showing. Music to my ears. Better still, it was in my district.

My heart sank a little as I looked out my left window towards the call and didn't see any smoke. I was sure someone had extinguished it themselves. Then we turned towards it and my view was obscured.

 About a block out my captain said those magical words, smoke showing.

As we pulled into the parking lot of the banquet hall I noticed a group of people standing and watching. It would be a fun show for them, assuming they weren't the owners of the building.

The quint came to a stop and I hopped off. My boots were on the asphalt before the air breaks released the air in their system signifying that they were locked. I rounded the front of the apparatus and got my first look at the building. There were a set of double doors leading into the structure that had thick black smoke rolling out of it. There were also a couple of windows mimicking the door.

I grabbed the 1 3/4" crosslay and headed first away and then toward the door, hose paying out behind me. My captain was doing his size up of the situation and establishing IC while I masked up. Just as I finished masking up I turned to see my captain realize that I was ready and he was not.

While he masked up I decided to go on air and take a step into the enveloping black smoke. The double doors from the outside led to an anteroom. There I found a set of open double doors straight ahead which led to the hall and a set of open double doors to my right leading to the kitchen, and the fire. The smoke was down to about waist level so I bent down to look under it. I could see that the entire back half of the kitchen was aflame.

With my captain behind me I made my way into the kitchen. Just as I stepped inside I heard my engineer yell that there were propane tanks inside. The flames on the back wall were from floor to ceiling. I moved around the left of the large table in the center of the kitchen toward the seat of the fire. A few moments later the fire was out. There on the ground was a propane tank, charred black. I cooled it off and then turned it off. Moving around the other side of the table looking for hot spots I found a second propane tank which I also cooled and shut off.

Other crews had set up horizontal ventilation, giant fans at the doorway to blow out the smoke and heat. With better visibility we could now see what had happened. Someone had decided to use a pair of deep fat fryers inside. Something caught fire and it quickly spread. During overhaul we found a third propane tank. Thankfully none of them bleved. The two with direct flame impingement were open and able to off gas which probably helped.

By the time we were done with overhaul and reloading our rig there was just enough time to shower and get dinner. I'm ready for another one.

Low Sugar

I assume the tones went off. This was probably what woke me up. Or maybe it was the lights suddenly turning on. Either way, my body has the same reaction. Get up and head to the app bay. Jump into my bunker pants and hope by that time I've figured out if I can just go like that (in the case of a medical aid), toss on my turnout jacket (for a vehicle accident) or get "Scotted up" and ready to fight a fire.

This time, about 0130, it was for a medical aid. The engine company in the neighboring district was already on a call so we headed there. This meant a longer response time (my wife laughed at me when I mentioned this to her since our response time was just over 7 minutes....nothing compared to the response times of some more rural jurisdictions).

We were met at the door by the son of the patient. He led us upstairs to the master bedroom where his father lay on the floor, unconscious. He told me that his dad is a diabetic. The son had come home from work to find him laying on the floor. I inquired what his most recent blood sugar was and he had no clue. They hadn't tested it.

I grabbed the glucometer and prepped a finger for a stick. While I was applying the drop of blood to the test strip AMR showed up. The old man's blood sugar was in the low 20's. Now that the problem had been correctly determined it was time to solve it.

I started an IV in the mans right arm. He jerked slightly as I plunged in the needle. Once it was taped down the AMR medic, who had already fished out my glucose and set it up, pushed an amp of D50W. Within moments our patient was awake but confused. After about a minute you could see the internal light switch turn on. He knew what must have happened and why we were there.

We asked him if he wanted to go to the ER. He rather emphatically said no. It was the right decision. I discontinued the IV and had him sign the CYA paperwork. I talked to the son about making sure his father had something to eat before going back to sleep.

45 minutes after waking up in confusion I was back in bed, now unable to sleep. I pulled out the laptop and watched an episode of Deadwood. As I drifted off my last thought was that my alarm was going to go off way too soon.

Wrong Target

I read this at BackstepFirefighter's blog.

Two guys in Boston decided to steal something. They decided to steal a helmet....from a fire truck. I think they failed to realize that there is almost never just one firefighter and, as a general rule, are in decent shape. They are used to lugging around a lot of weight.

The truck company retrieved their property and subdued the would be thieves. The report from "witnesses" makes it sound a lot worse than what the video shows. Either way, not the greatest thing in the world for public relations. I hope that the people of Boston understand.

Patient Advocacy Even In Death

 We responded to a board and care home for a 90 year old man feeling lethargic. My first thought on hearing the nature of the call was, "Really? A 90 year old not feeling well, what are the odds?"

As we walked into the house my captain, who was really on the ball, asked the caregiver if the patient had a DNR. I love it when my captains are thinking ahead like that. The caregiver said yes and directed us to the back bedroom. As soon as we saw our patient my captain turned around and went to find the DNR. We were going to need it.

My patient was laying in a hospital bed sitting up slightly. He was guppy breathing. As my captain headed out of the room I quickly checked for a radial pulse. Not finding one I searched for a carotid pulse. He had a weak one but it was there.

As my engineer walked in the room I turned to him to explain what I had going on with the patient. I turned back and watched the old man take his last breath. Not wanting to do anything contrary to the mans wishes I loudly asked my captain if he had found the DNR. In the absence of a valid DNR we have no choice but to work up the full arrest. 

Because the staff were unorganized we had to start compressions. Thankfully, after about 30 seconds my captain found the DNR. Once it was determined that it was valid resuscitation efforts stopped. We then replaced the covers on the body and left him so that he appeared to be sleeping.

I'm glad we found that DNR.