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Thursday, July 17, 2014

Sometimes I Just Shake My Head

The call came it at oh dark thirty. OK. Really it was about 2:30 am. Right about that time when you're really enjoying being asleep.

Dispatch said that we were responding for leg pain but had the ambulance rolling code 3. Something just didn't add up.

When we arrived on scene I found my patient sitting on the stairs by the open front door. I knelt down and asked her name and what was going on. Her reply, "I can't sleep."

I asked if she was in pain thinking that we might be there for some new onset of pain. She said that she had back pain from the 2 screws and multiple operations she had had. So I followed that question up with an inquiry about any new pain to which she answered in the negative.

I then asked a couple of more questions that might possibly lead me to understand why this woman had called 911 because she couldn't sleep. No dice. She just had insomnia that night.

Fortunately for me the ambulance showed up quickly. I turned to the medic and said, "She can't sleep." That was the sum total of my pass along to the ambulance medic. I was a little frustrated. I felt like telling the insomniac that I couldn't sleep either because of her. But that wouldn't have been very professional. I still wanted to.

For the record insomnia does suck. But calling 911 after not falling asleep for a couple of hours....come on.

Saturday, June 7, 2014

Who Needs A Helmet?

Dispatch gave us an update while we were rolling. We were responding with Engine 110 for a traffic collision. Unfortunately the collision was between a vehicle and a high school student on her way to school.

Engine 110 arrived just before us. They were kneeling at the patient who was sprawled out on the street. The street was busy. It is a major artery in the city and cars get moving fast.A few feet away from the knot of firefighters there is a skateboard. Well, half of a skateboard. The other half was no where to be found.

The young woman was unconscious. The medic checked to see if she responded to painful stimulus.  She did. She contorted her body in decorticate posturing which is indicative of severe brain trauma. WE placed her in full spinal immobilization and loaded her up into the ambulance.

Since engine 110's crew only had 1 medic and we had two on my crew I road in to the hospital with the ambulance. In the back we started two IV's, placed her on the heart monitor and checked her CO2 levels. A more detailed head to toe exam was also done. There were no other injuries that were visible other than a bad goose egg on here head.

During transport the patients condition continued to worsen. She started having decerebrate posturing. Her brain was swelling and causing further injury.

At the trauma center we were met by the trauma doc and the neuro-surgeon. We gave our report and answered a couple of questions regarding the scene including probable speed of the vehicle that hit her. The surgical team whisked her away to CT for a brain scan and then I assume she went into surgery. The neurologist didn't have high hopes for a positive outcome.

She probably would have been at school the next day if she had been wearing a helmet.....correctly.

Sunday, June 1, 2014

Mayday Mayday Mayday

Two days before Christmas right after lunch the structure tones went off. The computerized voice said the words that firefighters love to hear, "structure response."

That shift I was acting as an engineer and my regular engineer was acting as captain. This happens from time to time when a captain or engineer are off duty and the position wasn't able to be filled by someone of the same rank. The department will "upgrade" qualified personnel to act out of their rank and then fill in the lower ranked vacancy.

We quickly jumped into our turnout gear and hopped in the truck. Most structure fire calls turn out to be anything but a fire. Sometimes it's a lawn mower blowing l little too much smoke. Other times it's a BBQ. When dispatch states that they have multiple callers with smoke and flames showing you know you have a working fire. We had none of that this time.

As we neared the freeway (the call was a couple of districts over) we heard another of the responding units state that they had smoke showing and then declared this a working structure fire. At my department this declaration gets a couple things started. Another engine is added to the call along with another battalion chief. In the dispatch center they also start a running clock on the fire called the fire timer. It also lets the rest of the incoming units know that it's time to put our game faces on.

As we exited the freeway the column of thick black smoke was very visible. The street that we had to take took us in front of the local mall. It was a three lane road with traffic at a near stand still trying to get a look at what was going on. Up ahead in traffic there were a couple of police cars and an ambulance all with their lights and sirens going trying to edge through traffic. No one was moving for them. It wasn't until the drivers heard the wailing sound of our growler siren combined with the air horn that people started to get a clue. All doubt about what they should do was removed when they looked in their mirrors and saw big red coming at them fast and angry. Even the cops moved out of our way.

Pulling up on scene we found ourselves right behind our battalion chief. He assigned us to shut off the utilities which we did. The BC, now IC, then assigned us to back up the interior team. At the front door there were two hose lines. One went left and up the stairs the other to the right and downstairs. Both led into darkness.

My captain instructed our hoseman to follow the line up the stairs. When our firefighter got to the top of the stairs he found that there was no room. There were already too many firefighters in the deceptively small upstairs. I never made it to the top of the stairs. It was there that I heard it.


While a house on fire qualifies as an emergency to most people to firefighters it's what we train for. That is our office. Even if we don't get to go to the "office" as often as we'd like (except maybe for my brothers in Burn). When a firefighter has an emergency a mayday is declared. A mayday means the s**t has hit the fan.

When I heard the mayday the person calling it out identified that the firefighter on the first floor hoseline was lost. For my crew it was simple. We knew where the hose was and where the firefighter was supposed to be. We boogied down the stairs toward the line.

As we got close to the front door I saw a firefighter crawl out. It was the missing fireman. He had made it out even before the RIC crew could make it inside. Within second the mayday was canceled.

Afterward it became more clear what had happened.

There had been an attic collapse in the back bedroom which caused the area around to flash over. The firefighter and captain tried to make it out of the back sliding glass door but were separated. As soon as the captain lost sight of his fireman he called a mayday. The firefighter, falling back on his training, turned and followed the hoseline out.

This call served as a chilling reminder that things can go wrong. My department and more specifically my crew have gone over the events and tried to learn how to keep that from happening to us in the future. If I never hear another mayday on one of my calls I wouldn't be disappointed.

Thursday, May 15, 2014

Going, Going......Gone

We got dispatched for a medical aid just after lunch. We were told that we were responding for a 95 year old male who was ill and unresponsive.

We arrived and were met at the front door by the family. The house was a mess. It was another hoarder house. Trails leading throughout the house. The family had slid their father/grandfather to the front door on a chair. As I walked up I asked what was going on while in my head I did a quick visual assessment of my patient. I could tell just by looking that this wasn't going to go well.

The family told me that the man had been unresponsive since the night before. His mouth was filled with crumbs because someone had decided to "feed" him while he was unconscious. He was breathing, but just barely. I reached out and checked for a radial pulse and found nothing. I did find a carotid pulse but it was slow and weak at about 45 beats a minute.

Something didn't seem right with the story so I asked again how long the patient had been down. I was told this time that their father had stopped responding to them this morning.

I little later on I asked a third time and was told that the old guy had only been unresponsive since lunch time.

I love it when stories change.

AMR showed up and started getting their gurney ready. I checked a BP (105/52) and a sugar (182). I also through the patient on the heart monitor (sinus bradycardia, no ectopy).

At this point, rather than staying on scene and pretending to be a doctor we scooped and ran. At the back of the ambulance I asked the medic if he wanted me to come along.....just in case.

He declined (you got to love young inexperienced medics that think they can handle everything by themselves).

I looked at the patient again and told the young medic that I was coming along for the ride.

As I walked around to the side of the ambulance the little voice in the back of my head told me to grab our Autopulse. I told the ambulance crew to wait for just a couple of seconds as I went to the truck to get the equipment. As I returned to the ambulance I could hear the medic remark that he hadn't seen the old man take a breath in a while.

Great. Just great.

I checked for a carotid pulse. Nothing. The old guy had coded.

I had the young medic help me get the patient onto the CPR device and told the driver to go. While en-route to the hospital the two of us would do everything we could to get the patient back. I was at the head of the patient so I took over on airway. I sank in an OPA and had good compliance with the BVM. In between breaths I flooded the IV line, grabbed the medications, put the patient on the StatPadz and checked the patients underlying heart rhythm.

The young medic attempted an IO but his drill died. He then got an IV established and administered the medications.

We rolled into the ER with the now dead patient. The ER quickly went to work continuing our resuscitation attempt. After 20 more minutes of CPR the MD finally called it.

Time of death 1406 hours.

Thursday, May 8, 2014

Water Flow Alarm

The tones went off just about 10 in the evening. There was a water flow alarm at one of the warehouses in our district.

A water flow alarm goes off when there is a water moving inside the pipes of a buildings sprinkler system. In a monitored system when the alarm sounds we also get toned out.That way if there is an actual fire we can get there in a timely manner.

This time however was like most times. Someone in the warehouse accidentally broke a pipe.

We arrived on scene and were met by one of the supervisors. She said that one of her employees had dropped a box on a pipe and cracked it. They had already contacted the alarm company who said they would be out there first thing in the morning. Meanwhile there was a lot of water spraying everywhere.

Our game plan was to shut off the water to the sprinkler system and then just to let the entire system drain. To do this we had to find the "risers." Pipes through which water is pumped up the side of the wall to the ceiling where the piped then form a grid to provide adequate coverage in case of a fire. The problem was in a building this size (about 500,000 sq ft) there are multiple risers.

Near each riser is a shut off valve. In this case they had a shut off valve on the riser itself (about 7 feet off the ground) and a PIV (Post Indicator Valve) at ground level.

While my engineer and I did some recon to find out just how many valves we were going to have to shut off my captain looked a little closer at the pipe. He noticed that the pipe had been bent upwards causing the crack. He decided to apply a little downward pressure to see if he could stem some of the flow. Nothing happened. So he decided to apply a little more pressure. He found that he could greatly reduce the amount of water leaking.

Most of you can probably see where this is heading.

My captain then decided that if a little pressure was working so well that a little more pressure would be even better. I don't think he consulted with Murphy on this one. The pipe cracked again. This time causing even more water to cascade to the floor.


While we went around turning off all of the PIV's we were followed by the assistant might manager. He kept offering little quips and asinine suggestions. At one point he muttered to my engineer that all firemen do is break s**t. He's lucky I didn't hear that one. I don't think I would have been able to stop myself from saying, "You're right. We'll leave." One of his suggestions was for us to shut  down the water main in the street. We had to remind him that he wasn't the only customer that the water company had.

Eventually we got all the valves shut off. The water flow slowed as the entire system drained. Neither the manager nor her assistant offered a thank you.

Oh well.
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