Station Visit

Just after 10 in the morning the station doorbell rang. A mother was bringing her young daughter by for a tour of the station. We started out in the apparatus bay. We showed the daughter our fire engine and opened every compartment for her. We explained the difference in firefighting equipment and jobs that we do.

The tour then took us through the rest of the station. We showed her that our station had everything a house has, a kitchen, dining room, family room, bedrooms and bathrooms, because we live at the station for 2 days at a time.

With the tour coming to a close I asked her if she had any questions. She was apparently too shy to ask any if she did. I then asked if she would like to try on some of my gear. Her eyes lit up like on Christmas morning.

She put on my turnout jacket and had a beaming smile.

While getting ready to leave the mother told me that she had brought her daughter to the station for a visit because she was afraid of firefighters. As they were leaving the tones went off. Pulling out of the station with our lights blinking and siren growling the little girl stood waving goodbye. I guess we overcame her fear.

Causualty Of War

One of the great medics and bloggers out there is being forced to close shop. Farewell Medic999! You will be missed.

Funny Disptaches

This was a dispatch for another station:

Engine 52, respond for a possible vehicle fire. The RP states they dropped a lit cigarette and then locked themselves out of the vehicle. Unknown if the vehicle has caught fire.

Stupid people provide such great entertainment.

Two Out Of Three

Engine 51, you're responding for a 65 year old female with shortness of breath.

On the way to the call my mind started to go over all of the possible causes of breathing difficulties. Even as we walked into the skilled nursing facility, differential diagnosis and treatment options ran through my head. This all changed the instant I walked into my patient's room. I was greeted by the sight of 6 staff members, and a frenzied atmosphere, doing CPR on my patient. So much for shortness of breath.

At this point training and experience took over. I ensured that good CPR was going on (not a given in skilled nursing facilities) and then asked my engineer to work on vascular access. I placed the patient on the heart monitor and noticed that she was in asystole (flat line). As the AMR medic walked in I gave a quick synopsis. She then verbalized what I was thinking, 2 rounds and out. That is to say, based on the clinical presentation, we didn't think that this patient is going to make it. We would try two rounds of medications and then, lacking any improvement with the patient's condition, terminate resuscitation efforts.

After the first round of medications there was no change in the patient. We then waited the correct amount of time, went through our H's and T's, and then administered the second round of Epinephrine and Atropine. Two minutes later I checked the monitor and was astonished to see a heart rhythm. We quickly checked for a pulse. Bingo! We checked her blood pressure and it was 139/88. I was taking a trip to the hospital. By the time that we dropped her off at the hospital the patient still had a nice perfusing blood pressure and had a pulse of 110.

---------------------------------------6 hours later---------------------------------------

Engine 51, you're responding for a 60 year old male not breathing, CPR in progress.

At least this time the dispatch let us know what we were headed into. Not that it makes a whole lot of difference. We walked into the same skilled nursing facility as earlier but this time we went to one of the rooms on the left of the entrance. We were greeted by the same frantic scene. And once again the staff was more than happy to let us in to take control. This time was similar to the last arrest. Since it worked out so well last time we decided to run things the same way. I was running the code while my engineer secured vascular access and administered the medications. This patient was also in asystole at first. When the AMR medic walked in and saw what was going on he started to go down the same thinking as we were guilty of on the previous call. I warned him that we had "saved" the last one that started out just like this one. Sure enough, one round of medications and the patient returned to a sinus rhythm. He was a little tachy at 110 but he had a good BP, 111/79. It was time for me to go to the hospital again.

While at the ER I checked on my last full arrest patient. She was still alive and waiting for a room in the ICU. The staff in the ER were a bit surprised to see us with another "save."

On both patient's a 12 lead EKG was performed after we had a return on spontaneous circulation. Neither one showed signs of an MI.

-----------------------2 hours later, right after dinner-----------------------

Engine 51, you're responding for a possible full arrest. The RP states the victim is cold and blue and refuses to start CPR.

When we arrived on scene we found a 75 year old woman laying on the floor in her kitchen. Her family had run some errands and returned to find her where she lay. Her hands were cool to the touch but her torso was still warm. And although her lips and fingertips were blue she still did not have any lividity. We also checked to see if rigor had set in. Since we found no obvious signs of death we had to work her up. Even though we knew it would be a futile attempt.

I immediately started on compressions. My captain started bagging the patient and my engineer placed the patient on the monitor and, once again, started working on vascular access. As soon as AMR showed up my captain relegated his position at the head so the AMR medic could intubate the patient. My captain would spend the rest of the time with the family starting to console them and prepare them for the bad news.

Twenty minutes or so after we arrived on scene we pronounced the patient dead. We then had the task of cleaning up quietly so as not to disturb the family. SO showed up to take control of the body. We also had to be careful what was said outside at our rigs since there was a small crowd of concerned neighbors. Our nature is to make jokes as a way of dealing with death but that wasn't the time or place.

All things considered it was a good day. Three full arrests with two saves. I have no idea if the patients that made it to the ER survived the night. I just hope, at the very least, that they lived long enough for their families to get there and say goodbye.

Maltese Cross

There is a lot of symbolism in the fire service. One of the most well known being the Maltese Cross.

In the early 11th century, in Jerusalem, the Sovereign Military Hospitaller Order of St. John of Jerusalem of Rhodes and of Malta were formed. They were better known as the Knight Hospitaller or Knights of Saint John and would eventually become the Knights of Malta. They were charged with the care and defense of the Holy Land. The knights cared for pilgrims that came to the city and also gave them armed escort when needed.

Jerusalem fell to Islamic forces in the year 1187.  During battles with the Saracen's (a term commonly used to describe all Islamic people during the Crusades) forces the Knights of Saint John faced a new weapon, fire. The Saracen's would throw glass bombs containing naphtha. Naphtha is basically lighter fluid. The Islamic warriors would then light the battlefield on fire. Hundreds of knights were burned alive. The Knights that were spared this fate risked their own lives to try and rescue those that were burning. They became, in essence, firefighters- individuals that were willing to give up their own lives in the service of those in need.

Those that risked their lives in the face of fire were recognized by fellow crusaders and awarded a badge of honor - a cross similar to the one firefighter's wear today.
 
The Knights Hospitaller, over the next few centuries, were displaced several times. Eventually they would call the island of Malta home. They lived there from 1540 to 1799 when the island of Malta was taken over by Napoleon. Because of the amount of time they spent on Malta their symbol became known as the Maltese Cross.

The Maltese Cross is a symbol of protection. It means that the firefighter who wears this cross is willing to lay down his or her life for you just as the crusaders sacrificed their lives for their fellow men so many years ago. Over the years there have been different meanings given to the points of the cross. Here is one that is common to the fire service.

Third Alarm, The Aftermath

The day after the fire we went over to the refinery to get a look at what damage was done. The operations manager met us and gave us a tour. He thanked us for saving the plant. He said that he used to work somewhere else that had a fire just like ours and it leveled the entire facility. I don't know how much of that was us and how much was luck.

 

This is what was burning. It heated up the oil to prepare it for distillation.

Another picture from the same side.

Here's the flare stack that was burning like a very angry candle!

This is from the other side of the structure from the other pictures. I love that they put fire extinguishers there after the fire.

The operations manager said that the plant would be only out of service for a couple of days. This was an old machine and it was scheduled to be replaced soon. In fact,  they already had the replacements there on site.

Third Alarm

The tones interrupted another dream that I wasn't going to remember anyway. It was 0100. Engine 51, Engine 53, Engine 62, Truck 52, Rescue 93, Battalion 6....commercial structure alarm sounding....

The address was familiar. We often get false alarms to several of the major businesses in the area and this is one of them. We donned our turnouts (mostly....there may have been one or two of us that didn't button up our jackets because it's always a false alarm) and jumped into the engine. My captain was busy looking at the map. My engineer was concentrating on driving. Just then, the other firefighter said, "Sh*t! Is that smoke over there?!! HOLY SH*T!! Those are huge F***ing flames!!" That got our attention really quick.

As we looked to the West toward the address we saw, in the night sky, a pitch black plume of smoke with flames circling through it. Our local oil refinery had caught fire. As we turned down the street my captain informed dispatch that we had a working fire and then asked for a second and third alarm assignment to be made. Basically, wake up everyone...I think we're going to need them.

While dispatch started to get the reinforcements coming we made contact with the shift supervisor at the refinery. His employees were running around in a borderline panic. When the supervisor informed us that he was missing an employee our entire focus shifted. Within a couple of minutes he was found by his friend asleep in his car. I bet he got in some trouble for that!

Once we had the life safety situation under control we slowed things down to figure out the best way to safely attack the fire. The employees were little help. They didn't know what was burning, if the fuel had been shut off or what was exposed. They did know that they had a massive (over 30 feet tall) tank of propane on the back side of the property which they thought might be close to the fire. Good to know!

The tank was about 4 times the capacity of this one.

The IC instructed our crew to head around to the back side of the facility to do some reconnaissance. We were tasked with figuring out exactly what was burning and the best way to mitigate the situation. We went down the driveway of the commercial building next door the the refinery and were able to get a good view of things. The flare stack had huge flames coming from the top and bottom of it.

 We informed the IC what we saw and that we were go to start protecting the exposures with our deck gun (we had a couple of yard hydrants with great pressure).

 The view from where I was. That's the stream from my deck gun on the left and the top of one of our lights on the engine on the lower right.

My engineer making sure I everything is going smoothly with the pump.

We also asked for engine 53 and truck 52 for additional resources. I manned the deck gun and started getting some water into the area (the refinery personnel had put into service 3 monitors that weren't really positioned in a place to do much good). I was able to hit one of the towers with the master stream and rain down water on everything. Within a couple of minutes truck 52 put up their stick and started an aerial master stream.

Truck 52 with its stick up and engine 53 in the background.

Another truck, from a neighboring agency, set up on the other side of the facility with their aerial master stream. We were then able to escort an engineer from the refinery in to shut off the fuel. The fire burnt itself out in about 20 minutes.

We were back in bed by about 0400.

Auto Ex Fail!

I saw this and laughed. I think he needs to lose a man card.

Serious CHP Accident

Please be careful while driving.

 

A Tale Of Two Diff Breathers

1932 hours. Engine 51, respond for a 60 year old female, shortness of breath. As we're pulling up to the street we see a man waving his arms hysterically. Once we get to the corner he breaks into a sprint to get to his house, a half block away. Usually when we are greeted by hysterical it's something serious.

As we walk inside the house we're we find our patient standing in the living room complaining that she can't breath. She had recently been diagnosed with lung cancer. Her vitals are all looking good with the exception of her respiratory rate which was a little high until you got the patient thinking about something else. She started talking about her back pain that she had since she now had to sleep in a recliner, What it came down to was an anxiety attack. By the time that she was loaded in the ambulance she was doing well.

0403 hours. Engine 51, respond to the corner of Central and Main for a female having shortness of breath at a gas station. Pulling up we see AMR on scene starting to treat the patient. We decide to stick around to see if they need any help.

They quickly move the patient to the back of the ambulance. There the patient becomes extremely agitated. She ended up getting sedated so that they could treat her. When AMR first arrived on scene a bystander said that the patient was having a panic attack. AMR continued to go down this route of thinking for a while. As the other medic on my crew and I stood at the back and the ambulance, we both agreed that this was something more serious than a panic attack. Finally we got some vitals:

HR- 118
RR- 36
BP- 218/104
SpO2- 98% on room air
Lung sounds- Rales in the bases on the right side
Sinus tach with frequent unifocal PVC's
12 lead unremarkable
Blood sugar- 293
Capnography- 55


The patient was complaining of shortness of breath (sudden onset) and then had severe abdominal pain and nausea. No chest pain. She had no medical history (probably because she never went to the doctor and wasn't ever diagnosed), took no medications and had no allergies.

I ended up riding in to the hospital on this one just in case. At first I was thinking a cardiac event but by the end of the call I think it was flash pulmonary edema. I think maybe the lung sounds that were reported weren't accurate. Normally I would have some better patient history but the patient was well and truly sedated.

We ended up treating the rales. Nitro and CPAP. I managed to get a line in the back of the box. We made it to the hospital without any problems.