FIREFIGHTER/PARAMEDIC STORIES

Working Structure Fire

noreply@blogger.com (Firefighter/Paramedic) — Mon, 30 Jan 2012 17:06:00 +0000

Calls almost always seem to come in at the most unwanted times. For example, just as you sit down to dinner, or just as you dish up a bowl of ice cream, or when your baseball team is down by 2 in the bottom of the 9th with men in coring position. This time the tones interrupted a close championship football game.

The tones alerted us that we were responding to a structure fire. Most of the time we get suited up and go find out that it was only a malfunctioning alarm or burnt popcorn. So far we weren't too amped up.

We padded out to the apparatus bay and stepped into our bunker boots and pants. After sliding on the suspenders and throwing on our jackets we jumped on the rig. Seconds later, we heard engine 58 report that they had smoke showing from station 58 and declared a "working structure fire." In my department a working structure fire gets the first alarm assignment an extra engine and BC. As soon as we turned left out of the station we could see the header too.

Engine 58 pulled up on scene about 30 seconds before us. In their size up they said they had a single story single family residence with heavy smoke and fire showing and established IC. The thick black smoke was laying down on the ground instead of climbing high in the air. There must have been an inversion layer that day. PD was there first (I will refrain from making a cop wanting to be a firefighter joke at this time) and told engine 59 that they had 2 houses on fire with occupants possible trapped in the second.

We pulled up as the captain from 59 was determining that there was only one structure involved. My captain (assuming that he would be taking IC) told me to meet the captain from engine 59 and see where he needed help. He said that his firefighter was stretching a line in between the homes in case there was a rescue and that he wanted me to take a crosslay interior. No need to tell me twice.

As my captain and the captain from 59 talked I pulled the preconnected hose line. After stretching the line to the front door I started donning my mask and my crew joined me. Once masked up I opened the bail and expelled any air that was in the hose line and I also adjusted the nozzle to a straight stream. I then stepped through the open door into the thick black smoke.

Just inside the front door was an anteroom. The smoke was thick and banked all the way to the floor. But it was also cool. Carefully moving forward a couple of feet I discovered that the environment inside the rest of the house was drastically different. The fire had self ventilated (in simple terms it had burned through the roof allowing smoke and heat to escape) and I was now able to see all the way to the back bedroom. The room looked like the entrance to hell. Everything in the entire room was on fire. At least everything that hadn't already been turned to ash. The walls were burning as were the contents of the closet. What was left of the bed (and I assume clothes) formed a mountain of flaming ash on the floor. The doorway itself had flames crawling all the way around it. It was a very cool sight.

We advanced the hose line to the door. I opened the line up and knocked a large portion of the fire down. I then stepped inside. My engineer was right behind me backing me up. From the doorway he was pointing out where the fire was in the attic space. Every time he would look at me I was looking at the ground. He would yell, "Up there!!" What he didn't know was that I was standing knee deep in red hot coals. When I would take a second to hose down the fire in the attic my feet would start burning. It was toasty. So I would turn the nozzle at my feet (and the surrounding area) and drench it, before going back to battling the flames in the attic.

It's become sort of a running joke between us. He'll randomly say "up there" and I'll respond "my feet."

Once we had knocked down the fire in that bedroom we chased it around the attic. The crew from engine 60 came in to pull ceiling for us and we had a truck company on the roof making a pincher attack.

After burning through our second SCBA cylinder my engineer and I went outside to get a new ones. This process involves us turning off our BA and someone else disconnecting our bottle. They then replace the bottle with a new one. While we were waiting we noticed the paramedics from the private ambulance company that had shown up on standby. One had long blond hair and the other dark brunette hair. As my captain joined us we remarked how we were both now feeling "ill" and needed to take a ride to the hospital. After a good laugh it was back to work.

We went back inside. now that the fire was out we ensured that it would not rekindle. We covered nearly everything in the house in class A foam. It looked as if it had snowed inside. We would not be coming back that night.

Finally all that remained was engine 58 and us. We helped them load several hundred feet of 1 3/4" attack line and another 200' of 5" supply line. The much less glamorous part of a structure fire. After that, it was time to go back and see who had won the game.

One Year Old, Not Breathing

noreply@blogger.com (Firefighter/Paramedic) — Wed, 25 Jan 2012 18:22:00 +0000

"Engine 51, Medic 143, you're responding for a 1 year old unconsciousness and not breathing. PD is also en route."

In my city PD will respond to potentially critical pediatric calls and to full arrests (and any time we might need them to....ah....correct some bad behavior). As we drove down the dark residential streets dispatch informed us that PD had arrived on scene to find the patient breathing and alert. Now we could continue on in in a more conservative manner instead of like a bat out of hell.

Arriving on scene we found 3 police vehicles parked along the street. In front of the house were about 20 people, all wearing 49ers clothing (it was just minutes after the 49ers blew their Super Bowl chances). One of the officers held a small child, wrapped up in warm blankets, in his arms. Mom and dad held each other next to him. Mom was borderline hysterical.

I walked up and took a quick look at the kid. She was crying. Music to my ears. AMR had just pulled up behind us so I let them, along with my captain and engineer (who were both medics) take care of the kid. I went to the parents to find out the story.

Mom said, in between sobs, that her daughter was dancing in the kitchen when she collapsed, stopped breathing, and turned purple. Pretty much all not good things. She said that her baby didn't breath for about a minute than she started again.

Since little kids generally don't just stop breathing and collapse for no reason I probed some more. Mom said that the night before her daughter had fallen and hit her head on the couch, leaving a small goose egg. She also reported that her daughter had recently spiked a fever but they had treated that with Motrin.

After gathering all of that information I went and talked with the AMR medic. Turned out that the goose egg from "last night" was still getting larger. something about the story just didn't seem to fit right. So we didn't know if the kid had received some kind of cerebral trauma the night before and was just becoming symptomatic, if she had a febrile seizure, or had some other medical condition that was yet to be diagnosed.

Once we had the girl all ready to be transported we made sure that mom had a ride to the hospital. We let dad ride in the ambulance since he was the calm and collected parent.

Downhill Slide

noreply@blogger.com (Firefighter/Paramedic) — Wed, 18 Jan 2012 20:58:00 +0000

I was tired. We had had a good structure fire earlier in the shift. I always sleep well after one of those. I woke up and noticed the lights were on. My mind went through it's short cycle of confusion, understanding, then action. I slipped on my socks and headed for the apparatus bay.

I listened to the update from dispatch trying to gauge how awake I was going to need to be for this call. If it's a call for a stubbed toe, I can go on auto-pilot. If it's a critical kid, I would need to be fully awake. We were responding for a person having a hard time breathing. I needed to be fairly awake for this one.

We walked into the back bedroom and found our patient, an 82 year old woman, laying on her bed in obvious respiratory distress. To make matters worse, she only spoke Mandarin. Fortunately her son was there to translate for me.

We sat the patient up in bed and my engineer started getting vitals. I asked and found out that my patient had started feeling a little short of breath early last night and that it had simply worsened until they had to call 911. The old woman was a diabetic with a history of high blood pressure but no breathing problems. She was a non smoker and had had no cough or recent illness. She also had no chest pain.

Just as we got the vitals AMR showed up. The patient had a BP of 110/68, a pulse of 145 and was breathing way too fast. Her pulse ox was 87%. We decided to pick her up and carry her (we didn't want to put any more strain on her) to the gurney rather than do anything else on scene. While the AMR medic and his partner placed her on an oxygen mask I grabbed our equipment. As they loaded the patient into the back of the ambulance the medic asked for a rider and our Lucas device. The patient was obviously starting a very bad downhill slide.

In the back of the bus it only took one look at the patient to know why the medic had asked for a rider. She had the look of someone circling the drain. The AMR medic grabbed his CPAP and started setting it up. I grabbed the monitor and started connecting her to it (BP cuff, pulse ox probe, electrodes and then defibrillation pads). I then rolled up her right pant leg so I would have access if I needed to do an IO.

It was about that time that we noticed she was no longer breathing. I checked for a quick pulse while the other medic grabbed a BLS airway and the BVM. Not finding a pulse I did a quick look at the monitor to see if it was something I could shock. She was in an ideoventricular PEA at a rate of about 20. Thankfully the Lucas device had been requested and we put it to good use. With the thumper going was now free to do other things. Unfortunately I hadn't taken a seat at the patient's head when I got in the ambulance. That meant that I had to try to find everything (the AMR medic was bagging the patient) in an unfamiliar environment. It was kind of like trying to cook in a meal, with severe time restraints, in a kitchen that you've never been in before....where are the @!#$@# frying pans?!?!! Thankfully, like in a kitchen, most things were where you would intuitively look for them.

I started an IO and checked the rhythm on more time. No change. The AMR medic tried to intubate but found that the patient was a difficult tube. At that point we were about 30 seconds out from the ER.

Inside the ER I helped out the staff work on the patient for another 30 minutes. They really liked our automated chest compression device. We followed the ACLS protocol without success. The patient went from a ventricular PEA into asystole. After 30 minutes resuscitation efforts were terminated.

90 minutes after the tones went I found myself back in bed, slowly drifting back to sleep....but not before turning off my alarm.

It's 0230, What Are You Doing?

noreply@blogger.com (Firefighter/Paramedic) — Mon, 16 Jan 2012 18:03:00 +0000

Oh that wonderful time of night where you are in a deep, deep sleep. When you're body repairs itself. I love that time of night. You know what I hate about it? Waking up right in the middle of it. It doesn't matter how short the call is, it's never quite the same as sleeping through the night.

The lights clicked on and the tones sounded. I groggily swung my body out of bed and grabbed my socks. I padded over to my turnouts and slipped them on. If I wasn't awake before, putting on cold turnouts sure did the job. At least they weren't wet!

Pulling out of the station I noticed the reflection of the lights off of the cars and houses around us. Out of courtesy we didn't use our siren. After all, just because we have to be awake doesn't mean everyone had to be awake. Also there weren't that many vehicles on the road.

Dispatch told us that we were responding for a report of the smell of smoke and that the RP didn't want to be recontacted. It was probably one of the neighbors and they didn't want to start a feud. That also told us that we were probably on a wild goose chase.

About 3 blocks out from the address we noted the smell of a skunk. I thought that that was probably going to be it. It wouldn't be the first time that we were called for a structure fire/smoke investigation/natural gas leak that turned out to be a skunk. Then we smelled it. The distinct smell of burning plastic. The RP was right, something that wasn't supposed to be burning, was.

For the next several minutes we drove around with our windows down trying to pinpoint the source of the smoke. Finally we turned a corner and noticed the haze. We were close. Once we made it to the other side of the dingy atmosphere we stopped and dismounted. We searched each house with flashlights until we found one that had brown smoke coming from behind it. Before knocking and waking up the residents we decided to check further down the street as well. We then checked to see if dispatch could do a reverse 911 call (they can call the number associated with the address as long as it's listed), but they couldn't.

Walking up to knock on the door we noticed that the smoke now looked like steam. We watched for a moment more and the steam dissipated. Either the sound of the Cummins Diesel motor, the flood lights creating a false day out front, the radios crackling with traffic or the 3 of us tromping around talking (or a combination of these things) had alerted the residents that we were there. They obviously knew that they weren't supposed to be burning trash and doused the flames.

We decided that that was enough. The fire was under control and they probably wouldn't be starting it up again....at least that night. Time to head back to the barn and back to sleep.

WWII Vet

noreply@blogger.com (Firefighter/Paramedic) — Fri, 13 Jan 2012 19:10:00 +0000

As we pulled into the Lowe's parking lot we could see a couple of workers waving frantically at us (almost as if we wouldn't be able to find the store). We pulled up and my engineer hit the air break. The steps unfolded as I opened the door. After grabbing the equipment we were led to the appliance section of the store.

There we found a nearly 90 year old man sitting on a chair. The man and his son had been shopping for a new washer and dryer when, according to his son, he passed out. The son went on to say that he had helped his father to the ground. Fortunately he had seen his father's eyes glaze over and was there to catch him when he fainted.

My patient told me that he was still feeling a bit light headed. He also said that he wasn't going in an ambulance. A few weeks prior he had fainted and was transported to the hospital. He had just received a bill from the private ambulance company for the amount that his insurance did not cover. He didn't want another such bill. I assured him that I understood but I still wanted to check a few things. He readily agreed.

My patient's initial BP was low. Everything else was great. He had been seen by several specialists all trying to figure out why he was having these fainting spells but to no avail. While we checked what we could (12 lead EKG, blood sugar....) I talked to my patient.

He had served in World War II in the army. He had stormed the beaches of Normandy. We talked about basic training in 1942 and going across the Atlantic in a Liberty ship. He talked about giving up cigarettes and alcohol when he got married. We talked about his wife and his son and about his daily exercise regimen. He was full of stories and was happy to relate them to me.

10 minutes later my the WWII vet looked better. I asked him again how he felt and he said 100%. We again checked his BP and it was now 118/78.

After signing him out AMA I asked if it would be ok if I escorted him to his car. He declined. So I asked him if he would escort me to my fire engine. He laughed and agreed, saying that I was a persistent bugger.

They just don't make them like they used to.

Knights In Shining Armor

noreply@blogger.com (Firefighter/Paramedic) — Mon, 09 Jan 2012 21:48:00 +0000

To be fair it would be more accurately described as guys in PBI and blue t-shirts but that probably depends on your point of view.

We were headed out to grab some grub. The day had gotten away from us and we no longer wanted to go shopping, cook dinner and then end up eating around 8 at night. So instead we were on our way to get something to go. Besides, it makes clean up easier too.

About two blocks down from the station we came up on a stopped station wagon in the center lane that had it's hazards on. We pulled up directly behind them and flipped on our lights as well. It was night time and we didn't want someone hitting us (although it's debatable weather or not turning on all our lights makes this more or less likely to occur).

My captain and I checked traffic and dismounted. The woman in the drivers seat said that she had run out of gas. The three year old girl in the back seat smiled at me while we talked with her mom. We decided that we would stop traffic and push her disabled vehicle into the nearby parking lot.

While my captain played crossing guard my engineer and I pushed. Just as we got her into an actual parking place her husband pulled up. The woman had called him for help. That also meant that we didn't have to worry about leaving a woman alone in a parking lot at night. As we were leaving I gave the little girl a firefighter sticker. I think we made her night.

Dazed And Confused

noreply@blogger.com (Firefighter/Paramedic) — Fri, 06 Jan 2012 20:25:00 +0000

We were dispatched for an 88 year old man that was altered. We pulled out of the station into the damp, foggy morning and hit the growler, it's sound instantly bringing a smile to my face. Traffic pulled out of our way, some, because they were obeying the law, and others, because they were a lot smaller and less intimidating than a fire engine tearing down the street with lights and siren blazing.

We were met at the door by the wife of our patient. She said that her husband hadn't been acting right all morning. While my captain started talking to her I started talking to the husband. He knew his name and where he was but didn't know what day it was. To be fair, neither did I. He said that he was feeling 100% and that he didn't know why we were there. All of his vitals were good. His blood sugar was 154.

The Mrs. of the house told us her husbands medical history, which was lacking on thing that I thought would be on there, dementia. Finally after some more questioning the wife related a story that took place several months ago that ended with her husband in the hospital with a diagnosis of dementia.

I have no problem going out to the homes of people with dementia. It's a horrible disease. But I think the medical community as a while needs to be better at explaining the disease and it's probably progress. I got the impression on this call (and many like it) that the family members have no clue as to what to expect as dementia gets worse.

For more information on dementia click here.

Stubborn Medics

noreply@blogger.com (Firefighter/Paramedic) — Tue, 27 Dec 2011 21:02:00 +0000

Most of us in health care, especially emergency medicine, know that we make the worst patients. Even though we should know better we usually don't call 911 when we should. We wait until we absolutely have to. When I developed gall stones I was in so much pain I couldn't stand upright. I couldn't drive. I couldn't think straight. But did I call 911? Nope. Too stubborn. I didn't really want to ask my parents to watch the kids or ask my wife to take me to the ER.

So we got a call around 2 in the afternoon for a fall with injuries. When we arrived on scene we found a 60 year old man laying in a recliner. His wife informed us that he had fallen in the bathroom the day before and broken his hip. He had then crawled into the living room and into the recliner instead of calling for help. When she arrived home from work she found her husband pale with pain, but he refused to let her call 911.

She then told us that her husband was one of the first paramedics in Oakland some 30 years ago. He had had his picture in the paper and everything. That instantly explained his lack of interest in calling 911. She continued to explain his reluctance by relating the story of his last hip fracture 3 years ago. The medics just manhandled him onto the gurney with no pain medication. He didn't want a repeat of the performance.

I assured my patient that things would be different this time. I don't think the salty old medic believed me. I then started a line on him. His BP was borderline low so we only started him off with 3 mg of Morphine. We then used a KED to stabilize his hips. While we moved him onto the gurney (as smoothly as possible) we gave him a fluid bolus to bring up his BP with the hopes of being able to give him some more pain medication in the back of the bus.

Next time I hope that he will be a little more willing to call us.

Merry Christmas

noreply@blogger.com (Firefighter/Paramedic) — Sun, 25 Dec 2011 19:59:00 +0000

I worked Christmas Eve. The firefighter relieving me came in a little early (thanks) allowing me to get home to the family for present opening.

Last night I was hoping for a shutout but we had a couple of calls. One guy couldn't breathe too well (fine, call us for something life threatening) and another was altered. I felt like telling them that I was out of it too at 4 in the morning. Oh well. At least they were legit calls.

Now, I think I hear a pillow calling my name.....zzzzzzzzzzzzzzz

For Those Supporting A Firefighter

noreply@blogger.com (Firefighter/Paramedic) — Thu, 22 Dec 2011 15:14:00 +0000

My wife readily associates herself with my job by calling herself a fire wife. She caught a lot of grief because of that. It's not that she doesn't have her own identity. It has more to do with the fact that my job intrudes into my our personal lives a lot more than most jobs.

Because of my chosen career my life expectancy is shorter. My risk of getting cancer is increased (more than doubled in a lot of cancers), my risk of injury/death is greater, I'm often sleep deprived, the list goes on and on.

The other day I was on Fire Engineering's website and I came across an article written for the spouses of firefighters, What Every Firefighter's Spouse Should Know.

As I read through the article I started thinking that most of this doesn't apply to me (I'm sure most firefighters feel that way). But as I thought about it more I came to the conclusion that it must apply to a lot of firefighters. And there were definitely parts that apply to me.

So for those of you that support us from the home front, and for those that would like to have a glimpse at what we put our spouses through, enjoy the article.

Real Life Saver

noreply@blogger.com (Firefighter/Paramedic) — Tue, 20 Dec 2011 16:56:00 +0000

The call came in for a choking patient. The house was just down the street from the station so it didn't take us long to get there.

We pulled up to the house and I noticed that there was no waver (someone frantically trying to get our attention). Inside, on the couch, we found a 75 year old woman. She was gently rubbing her throat. The story from family members was that she had been eating when she started choking on a piece of meat. Her daughter rushed over and did the Heimlich maneuver.

My patient said she felt as if something was still in her throat. I explained that that was a possibility, but it was more likely that the lining of her esophagus had been damaged (it's really sensitive) and that's why she felt that way. The same way you can "feel" a pill that you've swallowed without enough water.

After a thorough assessment (everything checked out great) she and her daughters decided that it would be best if they didn't go by ambulance but instead chose to take their own vehicle. We reassured them that if there were any more complications we were just a phone call away.

`Tis The Season

noreply@blogger.com (Firefighter/Paramedic) — Fri, 16 Dec 2011 15:53:00 +0000

We were dispatched for a slip and fall. Nice and generic. I've been on "slip and fall" calls ranging from a person needing a hand to get up to a person on the third story roof that had a stroke and fell, and a lot of stuff in between.

This time we pulled up to find a waver. Someone, usually a family member, that is panicked and is out in the middle of the street to wave us in. Potentially a bad sign. In front of the one story house there was a ladder. Someone had been hanging Christmas lights. My patient, a man in his early 70's, lost his balance and took the fast way to the ground.

From 5 feet up he landed on the cement driveway but not before his head came into contact with the brick wall on the side of the driveway. He was alert and oriented and had some minor bleeding from the back of his head. His family, in a near state hysteria, explained that their father had been knocked unconscious when he fell.

We grabbed c-spine and applied a neck collar. We also placed some 4x4's over the wounds on the back of his head. The trauma assessment revealed that he had a couple of skin tears on his arm as well. Other than that and his head lacerations he appeared to be in stable condition.

The guys at AMR helped up package the patient onto a backboard. The last thing I remember after loading the old man into the ambulance was one of the sons complaining that he had told his dad to let him hang the lights.

Smell Of Smoke

noreply@blogger.com (Firefighter/Paramedic) — Wed, 14 Dec 2011 21:39:00 +0000

The other day we were toned out for a possible residential structure fire. When we arrived on scene the occupants informed us that two day prior their landlord had had someone come out to work the furnace. This was the first time since then that they had turned it on.

Helmet covered in insulation after pulling ceiling.

A couple hours later they smelled smoke in the house. They did the right thing. They evacuated the house and called 911. On the way out the husband threw all the breakers killing the power to the house. When we arrived we found there to be a light smell of smoke with just a little bit of haze in the house.

Once we confirmed that there was no active fire we cancelled everyone but the engine and us. The BC decided to stick around as well. We used the thermal imager to check for hotspots throughout the house. I checked the attic in the garage and found nothing. I then went to check the attic in the house but I couldn't find the scuttle hole.

We searched the entire house (it was only a 1400 sq ft house). Every bedroom, closet, nook and cranny. There was no scuttle hole. By this time the landlord had made it to the house. He said that he had had some renovations done to the house about two years ago. He never noticed that the contractor had sealed the attic.

My battalion chief explained that we needed to check the attic to make sure there wasn't a smoldering fire and that there was no way for us to do that without a scuttle hole without making a mess. The landlord then looked at me standing there with a pike pole (and a grin). I told him that was my job to which he replied that I looked like I enjoyed my job.

The property owner decided to put his new scuttle hole in the hallway. We grabbed a salvage cover and placed it below where I would be working. I then used the pole to make a 18", mostly square hole in the ceiling. We figured that if I did it smaller than the normal 24" then it would be easier for a contractor to come in and convert the opening into a proper scuttle hole.

Once the hole was made I placed into it the attic ladder. I climbed up and was just able to squeeze in my shoulders. I looked around with the thermal imager and everything looked as it should.

Afterward we cleaned up the mess, turned on the power to the house and did a final check. Having not found anything burning we figured that the furnace was probably the culprit. We informed the residents to keep an eye on it and call us back if they needed us.

I needed to go clean my gear of all the insulation and to take a shower.

Miscommunication

noreply@blogger.com (Firefighter/Paramedic) — Tue, 13 Dec 2011 15:48:00 +0000

We were dispatched for a man feeling ill. The RP was a home health care nurse that stated her patient had a low temperature. Yeah, I was suspect too.

We walked in the house and found an old man laying in a hospital bed in the front room. It was probably the only place they had that would fit the bed without some major rearrangement of furniture. At the head of the bed stood the wife of the patient. She appeared very concerned. At his bedside, the "nurse" (I'm not sure if she is an CNA, LVN or RN).

The home health care worker, as I will refer to her, informed us that the patient had a temperature of 94º F. I quickly placed my hand on the patient's head to see how he felt. He felt like someone with a normal temperature.

The worker then informed us that his blood pressure was low, 94/52. I again touched the patient. This time I checked for a radial pulse, which I easily found. Nice and strong.

While we were getting a proper BP the worker then explained that my patient was altered (our BP was 142/82 by the way). Knowing that that phrase can mean something totally different to someone that doesn't practice emergency medicine I asked for clarification (also because he seemed to be acting normal to me). I was informed that the patient had not been responsive for the last 30 minutes of the 90 minute visit. I then asked the nurse how well she knew the patient and she said this was her first visit.

At this point I turned to the wife and talked to her. The home health "professional" was useless. His wife said that he appeared to be tired. The nurse kept interjecting that she was worried about sepsis. Every time I acknowledged her concerns but she didn't get that (there was a major language barrier).

About then AMR showed up. The CNA/LVN/RN told the AMR medic that the patient was altered. He looked to me for confirmation and didn't get it. The transporting medic was again told that the patient was altered. He looked to me again and I did a quick eye roll. He immediately got the picture. We loaded the gentleman onto the gurney and helped the guys out to the ambulance. After making sure they were all set we headed out.

Car Crash

noreply@blogger.com (Firefighter/Paramedic) — Fri, 09 Dec 2011 20:57:00 +0000

Just after dinner the tones went off. We were dispatched to the freeway with a neighboring agency for a single vehicle accident in the center divider.

Pulling up to the scene we saw several vehicles pulled over but only one appeared to have been in the accident. We nosed in Big Red behind the accident to give us a little protection as we worked. Some people are like moths to the flame with fire trucks.

We found our patient sitting and leaning up against the center divider. It was a chilly night and someone who had stopped had offered her a blanket. The victim said that she was cut off and had been forced into the median. She had been wearing her seatbelt and the airbags did deploy. There was only moderate damage to the vehicle.

The lady was initially complaining of pain to her right forearm and to the right side of her jaw. While assessing C-Spine I found that she had point tenderness around C4 and C5. As we were going through the process of placing her in full spinal precautions AMR showed up. While I finished strapping the patient to the backboard the AMR medic that was ready to strap her head down said alarmingly, "She's not breathing!"

We did a another check. She wasn't breathing, she did have a strong pulse but she wasn't responding to verbal or painful stimuli. I kept thinking, "Crap, what did I miss." While the EMT grabbed the BVM we loaded the patient onto the gurney and headed for the ambulance.

About the time that we had the BVM set up our patient started breathing again. She was also alert and oriented. The husband (who, from home, had beat the ambulance to the scene) told us that his wife had severe panic attacks and that she often passed out. I'm not sure if that was what happened here but it's something that I would have liked to know when I asked her about her medical conditions!

Before leaving I checked with the AMR crew to find out if they needed anything else. They had a paramedic intern there so they didn't feel they needed a rider.

Learning Curve

noreply@blogger.com (Firefighter/Paramedic) — Sat, 03 Dec 2011 15:04:00 +0000

You gotta love frequent flyers. Ok, maybe not. Especially at 0430. But at least one of mine (featured in blog posts here and here) is learning.

In our most recent visit to her house she didn't bother to act like she was in severe pain. She complained more about nausea. But while we were waiting for AMR to arrive she asked if she could ask the ambulance crew for some morphine. I think she's finally learning that if she's not really in a lot of pain she's not going to get treated for being in a lot of pain....at least from us. I have no idea how successful she is at getting some of the good stuff from the medics at AMR.

What Changed?

noreply@blogger.com (Firefighter/Paramedic) — Thu, 01 Dec 2011 16:37:00 +0000

I knelt down in front of my patient and gently felt for a radial pulse. "Hello, what's your name?" After introductions I asked her what was going on that day. She said that she was having "severe fatigue."

In just that short amount of time it was painfully obvious that she had some psychiatric problems. Her father said that she wasn't really able to take care of herself but wasn't bad enough that she was on a conservatorship. He had given her a cell phone in case she got lost while walking around the city but now she used it to call 911. Dad didn't seem too happy about that.

Severe fatigue, not just tired. Fair enough. Also generic enough to have all sorts of causes. My next set of questions changed my thought process. I asked how long she had been experiencing this severe fatigue. She stared at me blankly. I asked again, this time giving her the choices of minutes, hours, days, weeks, months or years (don't know why I stopped there, I should have thrown decades in as well). She thought for a minute and then said that it had been going on for months.

At this point I'm starting to see where this is going but I persist. I asked what made her call today, after months of severe fatigue? What had changed to make her call? Her answer....she had severe fatigue. That was about as far as that conversation went.

At this point I decided to backtrack a little. I asked her if she knew where she was (trying to determine if she was altered or not). She rattled off her complete address, zip code included. I then asked her what day it was. She immediately opened her cell phone, check the date and day, and repeated them back to me. I looked at my engineer and we both laughed. If she's knows enough to check her phone for the day and date I think I'll let it slide. I could tell you those things without doing the exact same thing.

Finally the ambulance showed up. We walked her over to the gurney and sent her on her way. What do you want to bet that we'll be back?

Fire Alarm, Sort Of

noreply@blogger.com (Firefighter/Paramedic) — Mon, 28 Nov 2011 15:02:00 +0000

Just before 11 in the morning we went shopping for dinner.We grabbed a shopping cart and headed into the store. As we turned down the first isle our radios beeped the familiar tones of someone getting a call. "District 51, engine 53, truck 51, commercial alarm sounding...." They were playing our song.

We jogged back to the truck the whole time thinking the same thing. We've been there before, often. Engine 53 will get there first. We're going to get canceled. Because of that thought process we all decided to just throw on our turnouts over our wool pants and buttoned shirts. After all, we would only be in them for 5 minutes. I jumped in the rig and sat in the jump seat.

Lights flashing and siren growling we split traffic much like a modern day Moses. The radio crackled again, "Engine 53, truck 51, we're getting reports of black smoke coming from the roof. We're upgrading this to a full alarm assignment."

At that point my first thought was regretting not getting out of my blues before donning my turnouts. I decided I better slip into my BA as well. I went through my quick checklist preparing for a fire. Turnouts were good, SCBA was on with straps tight, mask ready to go, release valve closed, axe belt on.....ready.

Engine 53 was first on scene. They reported having a commercial building with multiple occupancies with roll up doors, heavy black smoke coming from the roof. They initiated IC and let everyone else responding know that they were starting fire attack and could handle their own water supply.

Pulling around the corner we had a good view of the building. We nosed in the driveway behind engine 53. We jumped off the rig and started setting up for aerial operations. My captain chalked the front tire on our side while I set out the plate for the stabilizer. My engineer took care of his side. While he finished setting the stabilizers and getting the ladder in place I grabbed both the chainsaw and the K-12.

Once everything was set my captain headed up the aerial with the rubbish hook. Once at the tip of the aerial he pounded down hard on the roof to make sure it would hold our weight before we stood on it. He would repeat this process of sounding out the roof everywhere we went. I stepped off the ladder behind him I set down the chain saw. We were on a metal roof so the circular saw was the tool of choice.

The roof had a shallow grade and at the peak there were several vents about 6 feet long and 3 feet wide. The super heated smoke and gases were using them as a natural escape from the confines of the building. We decided to help things along. Using the rubbish hook we ripped the thin metal from around the bolts holding the vent in place. Once the the vent covering was removed we cleared the opening of any insulation allowing for a good ventilation hole. Our job done, we checked with fire attack to make sure they didn't need any more holes in the roof and then headed back to the ladder.

The fire was small. It was limited to a vehicle in the auto repair shop and a couple of racks with supplies on them. We were able to limit most of the damage to the space in which the fire started.

Semper Fi

noreply@blogger.com (Firefighter/Paramedic) — Thu, 24 Nov 2011 15:51:00 +0000

While blog hopping I came across this post. It was too good not to re-post.

Watch that first step.

Soothing Effect

noreply@blogger.com (Firefighter/Paramedic) — Wed, 23 Nov 2011 15:21:00 +0000

I was working at one of our slower stations on an overtime shift. That morning we had the 1st and 2nd graders from the school down the street stop by for a tour. The rest of the day was spent working out, shopping, cooking and eating. There were no calls. I was looking forward to getting a good night sleep at the station as well.

I went to bed around 11 p.m.

At 1 in the morning the lights clicked on and I could hear the sound of the speakers as they turned on as well. About a half second later the tones went off signaling that we had a medical call.

We arrived at the house of a 40 year old male having trouble breathing. We were met by his wife who led us into the dining room. Her husband started having difficulty breathing about 10 minutes before. AFter talking with him for a few minutes we determined that he was having an anxiety attack. He had been having about one per year for the last several years and they always feel the same. And every time, after we show up, he calms down and is ok.

This time we canceled the ambulance and then spent another 20 or so minutes talking about his options as far as treatment. He really didn't want to take medication for it but after we explained a little more about anxiety he decided we had a point.

He was very grateful that we would spend that extra time with him, in the middle of the night.

Just as I drifted back to sleep (at least it seemed that way) the lights clicked on again....

We had 4 calls after midnight that shift. So much for a slow station and a good night sleep.

Yo Quiero Taco Bell

noreply@blogger.com (Firefighter/Paramedic) — Tue, 22 Nov 2011 15:33:00 +0000

We got a call about 11 in the morning to one of our local strip malls. The call was for a woman that had fallen asleep in her car. Seriously.

My patient said that she had shown up to get something from one of the stores only to find out that it didn't open for an hour. So she took one of her Xanax and relaxed. She ended up dozing off for an our in the car that was not turned on. Eventually someone noticed her and called the cops. They came out and woke her up, then called us.

Because my patient had a rather significant medical history she wanted to go in and get checked out. The only problem was that she had a "dog." It was actually a Chihuahua. You know, the dog that is super skittish and yappie and is smaller than some rats. She didn't want to leave the dog. We finally convinced her to call a friend to come get the pooch. We also decided that the dog could wait in the back of the squad car so that we could get the anxious woman to the hospital.

One of the officers handed me a leash (did you know they carry those?). I tried to get it onto the dog without gets bit. Finally, my patient was able to slip on the leash and I picked up the dog. I held it upside down the same way I do with my cat so as not to get bit or scratched. It worked really well. Once in the back of the cop car the dog started barking at us again. It clearly didn't like its situation.

Now that we had the little terror secured we were able to get the patient onto the gurney. She later admitted to us that she took more than one of her Xanax. No wonder she fell asleep.

The last thing I saw as we cleared the scene was this small dog barking and growling in the back of the police car waiting for a family friend to come get it.

N̶a̶t̶i̶o̶n̶a̶l Local Healthcare Plan

noreply@blogger.com (Firefighter/Paramedic) — Mon, 21 Nov 2011 15:18:00 +0000

National healthcare. A subject sure to get any group into a debate if not a flat out argument. Been there, done that. But instead of sitting around and debating the subject or worse, just waiting for the federal government to actually do something, the Alameda County board of supervisors have decided to fund a project put forward by the county's Health Care Services Agency.

The pilot program would make use of five local fire stations to provide "federally qualified clinics" to those neighborhoods which they serve. Alex Briscoe, the director of the Health Care Services Agency asks, "What happens if we co-located a nurse practitioner from one of the community clinics with a paramedic and ran the public sector’s response to the retail clinic?”

The clinics would address minor medical problems such as minor infections and immunizations helping to relieve the ever increasing pressure on local emergency departments.

In an article on the National Association of Counties website they said that "in addition to providing a limited array of on-site services, including follow-up from emergency room visits, the health portals will:

respond to “sub-acute” 911 calls under the county’s new Medical Priority Dispatch System (approx. 30,000 calls annually), which triages response to non-life-threatening calls
provide discharge follow-up for residents in a defined area within 48 hours of discharge from emergency department care, and
take direct referrals from the county’s 211 call center for medical advice or consultation."

Chief Gilbert, the fire chief for the Alameda County Fire Department is quoted in the article saying, "The fact that we can build upon that trust and meet that ever-growing need in our community that ultimately impacts the quality of life and public safety of our community is absolutely consistent with our mission and something that we're excited to be able to do."

It wouldn't be the first time that fire departments in Alameda County have been involved in preventative care. According to an article in the San Lorenzo Patch "in 2009, Alameda County became the only county in the state where paramedics were given permission to immunize residents against the H1N1 flu virus."

Recently my wife and I were having a discussion about the feasibility of a local government run health care system. I don't know if that is possible, but Briscoe seems top think so. He said, "We have to do something to reinvent the health care system. We believe we have the answer."

Boom

noreply@blogger.com (Firefighter/Paramedic) — Fri, 18 Nov 2011 19:58:00 +0000

Some Time Off

noreply@blogger.com (Firefighter/Paramedic) — Tue, 15 Nov 2011 15:13:00 +0000

For those of you that live in southern California or are planning a vacation Knotts Berry Farm is offering free admission for Police and Fire personnel plus a free admission for one other person. In addition they offer discounts for up to 6 more people.

Enjoy.

Heart Rhythms Part 6: Blocks

noreply@blogger.com (Firefighter/Paramedic) — Mon, 14 Nov 2011 17:52:00 +0000

A heart block is a disease in the electrical system of the heart. This is different than coronary arterial disease. The muscle tissue and vascular system is ok but the electrical impulses are not traveling in a normal fashion through the heart.

There are 3 main types of blocks, conveniently, first, second and third degree blocks. Second degree blocks are then broken down into two subtypes. We'll get to those in a minute.

First Degree Blocks

More correctly called a first degree atrioventricular block, it is a condition in which the PR interval (the length between the beginning P wave and the beginning of the QRS complex) is lengthened beyond 0.20 seconds.

What that means is that the electrical impulse generated in the SA node is delayed by the AV node before going on to the ventricles. Management includes identifying and correcting any possible electrolyte imbalances or withholding any offending medications.

Second Degree Blocks

A second heart block is a conduction block between the atria and ventricles. A second-degree AV block is when one or more (but not all) of the atrial impulses fail to make it to the ventricles due to impaired conduction.

There are two types of second degree heart blocks, types 1 and 2. A type 2 heart block is considered to be a much more malignant block than a type 1.

Second Degree Heart Block Type 1

A second degree heart block type 1 is also known as a Mobitz 1 or a Wenckebach.

A Wenckebach is characterized on the EKG by having an increased amount of time between the P wave and the QRS complex until a QRS complex is dropped, or missed. This is because of a diseased AV node.

The arrows point to the P waves. Not the increasing distance between the P waves and the QRS complexes.

Second Degree Heart Block Type 2

A second degree heart block type 2 is also called a Mobitz 2 block. A Mobitz 2 is characterized on the EKG by having intermittent QRS complexes dropped without a change in the PR interval. When this happens in a regular pattern the number of P waves to QRS complexes is stated as in 3:1, meaning 3 P waves for every QRS complex.

A second degree type 2 block is caused by a a disease of the His-Purkinje System. It may also rapidly progress into a complete heart block.

Treatment may require an implanted pacemaker.

Third Degree Blocks

A third degree heart block is also known as a complete heart block. A complete heart block is a medical condition in which the electrical impulse generated in the SA node does not propagate to the ventricles. On the EKG this is characterized by having regular P waves and regular QRS complexes but they are independent of one another. Essentially there are two separate heart rhythms on the EKG. One for the upper chambers of the heart and one for the lower ones. Usually the rate of the P waves will be higher than that of the QRS complexes. Some of the P waves will be buried behind the QRS complexes.

The most common cause is coronary ischemia. Treatment is an implanted pacemaker.

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