101 Things the Fire Department wishes you knew



Thursday, April 30

...for the heart attack/Violator...


The caller knows what's up. She cut right to the chase. No BS, no chief complaint, Richie Rich's wife knows exactly what's wrong with her late 30s husband: Heart Attack. The Violator part, that's me.

THE EMERGENCY

A man in his late thirties is having trouble breathing.

THE ACTION

Back in the swanky part of town for the day, we're sent to the street we look at from below. The houses are actually like mansions and I always expect a servant to answer the door and walk me into a giant velvet clad room with a roaring fire.
These days it's recessed light, TV loud enough to drown out the toddlers and the matter of fact wife.
Her tone reminds me of when Mrs Happy Medic is upset I went to poker night with the Cop and the Fire Commissioner without a weeks notice.

"Hi, do you have an.." I start as we enter the living room.
"It's a heart attack." She says and leaves the room, likely hurrying back to the toddlers in one of the rooms we can't see.
I introduce myself to a clearly stressed out man lying on the couch. He's tired, stressed and speaks very softly. When prompted he describes chest pain, but shakes his head on all the important stuff. Everything is coming back normal, except the look in his eyes. He looks how I feel after a long night at Medic 99.
I'm not thinking cardiac, but can't rule it out so I'm covering the basics waiting for the ambulance Paramedic to chime in since he's the one that will have to follow whatever road I head down.
"Have you given him aspirin yet?" The wife is circling through the room, winding her way around the toys the toddlers have scattered.
"What?" I ask looking up from the monitor.
"The 911 said to give him aspirin, but we don't have any." Well wadda you know. Our call takers have better guidelines than I do.
Before I can think of a response, she's gone again and the ambulance crew has arrived. After a brief report the medic looks at me and says, "Dude needs a week off, but the closest thing we have to that is chest pain protocol."
I give him the aspirin and got the nitro out as I went into my speach about side effects.

"What does it do?" He asked softly.

I could have had a smart response, even the book answer would have done nicely, but I made the mistake of letting my mind wander for a brief moment and Dr Freud made an appearance.

"It violates the vessels...wait a minute...it dialates the vessels around your heart, but in all honesty, it does kind of violate them," I turned to the others, "Am I right?"

silence. Little s silence.

"OK, well, let us know if you feel any better or worse..."

We got him loaded and when they pulled away the enine crew let me have it. In true firehouse form I was called the "Violator" the rest of the night. Which, luckily for me, didn't last very long.

Wednesday, April 29

Trapped on the Third Floor

I was wandering through the sea of subscribers that is the FireFighter Nation awhile ago when I came across the avatar of Donald Noss. It is an image of a man standing in what looks like a burnt out kitchen, not in fire gear.
I sent a quick message, curious as to the image and got quite the interesting response.

Donald was standing in the remains of his kitchen at the Heritage House Condominiums in Rocky River, Ohio in 2006.

A late night fire raced through the building trapping many residents, including Donald and his wife, with no warning.

What followed could only be described as a perfect storm of difficulties and errors.
Donald wrote a book about his experience in the fire as well as the questions he had after the fire. Questions many firefighters never consider either when pre-planning or during a firefight.

The most amazing part of this book is that it is written from the viewpoint of someone in the panic of being trapped by fire, unsure of what to do or where to go, not some Fire Officer with 20/20 hindsight and an understanding of fire behavior.

On the third floor, they are awoken by a voice calling from the courtyard below. A police officer saw the faint glow of their TV on and is trying to help. Looking out the window they see flames climbing over 50 feet into the night sky. They hear no alarms. They hear no sirens. The officer calls on his radio for a ladder. No one is answering. They are on their own.

From Fire Faceoff-
"The policeman standing directly below us kept radioing for help to the courtyard. .He tried to reassure us that someone was coming. .He kept telling us to “stay in the window, stay in the window.” .Except for the policeman’s voice and the sharp exploding sounds the fire made as it consumed more of the roof, the courtyard was perfectly quiet. .We saw no one else.

I ran back to the kitchen again and stared at the entrance door for a few seconds trying to figure out if we had to make a run to the south end of the building no matter what I remembered Drew telling me a few years earlier.. The hallways were quiet, but I knew they had to be deadly. .Why were they so quiet? .For a second, I thought maybe everyone was already dead.. I was scared and didn’t want to run into the smoke, but the fire was huge and heading for us. .And I didn’t know if there were any flames near our front door leading down the building's long third floor hallway.. I knew they could be there but even if not, a tiny gulp of seven or eight hundred-degree smoke would be too much. .We had a long distance to run toward any exit.

The policeman on the ground tried to sound reassuring to us, but I could sense some panic building in his voice.. I didn’t know what he really knew and or was afraid to tell us. .He just kept saying, “they’re coming, they’re coming!” And then I wondered if anyone was even listening to his calls. .What was taking so long? We had to decide, right then! No second chances now. .Do we trust the policeman and the advice Drew gave me a few year's earlier?. It was getting difficult to concentrate and breathe.. Do we Stay or Run? .I kept thinking about this over and over as I ran back and forth from the kitchen to the living room window. .I never asked Linda what she thought about trying to run out of the condominium.. Time was up."



This book includes photos from both before, during and after the fire as well as dispatch transcripts all in an effort to learn why the fire spread so quickly, so quietly, killing the author's friend and neighbor, Christine McSteen after she had been told to stay in place, a rescue was coming for her.

"...contact was made with Christine McSteen in unit #309 during fire suppression in unit #308 and she was told to go to her window to be rescued. Later she was found deceased."

Through Donald's eyes and words firefighters can learn what occupants are feeling, thinking and doing when you haven't even been dispatched yet.

The most interesting part of the story, in my opinion, is that this happened 6 years prior and the problems were supposedly fixed. Firewalls in the attic, standpipes and a new alarm system. Did any of it help?

The Fire Chief says this fire was fought "by the book," but won't tell Donald what that means.

Link HERE for more details on the book. Read it and have a better appreciation for what your victims are going through while you're "getting the glory" on the nozzle.

Monday, April 27

Swine Flu Prevention Fail

What do you mean people are dying of the flu? What do you mean more people will die in car accidents?
How can I be protected from the evil swine flu?

Whatever you do, don't wear gloves and don't wash your hands with warm water and mild soap. Just wear this expensive hood and mask combo.

This photo came up on Yahoo earlier today and had me laughing.

The news tonight never mentioned washing hands with soap and water or covering your mouth when you cough.
Nothing about staying home when you're sick, wiping your nose with a tissue and cleaning door knobs and other surfaces often.

Could they have mentioned washing your pillowcase often when sick? What about avoiding the ER when not sick?

No, let's buy some cool stuff we can use to look really cool.

FAIL!

Just a little thing

A minor notice to expectant and new parents seeking help from firefighters or other emergency workers in installing your car seat.

Ahem.

Please seek this assistance PRIOR to bringing your new baby and the car seat to the firehouse.

Carrying the child on your lap in the passenger seat, I think, constitutes gross negligence. And on another note, not all emergency workers are trained in installing car seats. Unless one of them is a parent, they'll likely either read the instructions or refuse to help based on liability concerns.

Best bet is to do it when you buy it, then do it again.

Friday, April 24

Random thoughts


When trying to change a system, sometimes it's important to start over in your mind and build an ultimate system, then try to meet in the middle. With that in mind, I find the following notes in the margins of my project notes. Not sure if they're the ultimate side or the middle part. Thought I'd share.

Still hospital based! MD on staff but call ER for permissions? Why not operate under MD staff only?

Fire based FRU (fast response unit) home visits? Hour unit usage? Burnout?

Coughing considered contagious for decon? Decon air?

Redefine "patient" from medical side, not public side

I know what I can do for them not what they think they need, but they decide when to go.

Send ambulance implies transport needed, send motorcycle they get the idea.

Private ambulance for sick calls pre-scheduled

Permission to contact person's MD at all hours could get them to actually see their patients and reduce call volume

Community clinics with special units who can transport for suturing to the clinic instead of ER

Dental unit? No.

That last one is near some sloppy notes, maybe I was partially asleep. I can hear it now, "Special needs dispatch for Dentist 3!"

Pushing Miss Daisy

I have met my nemesis, the Invacare TDX5 with tarsys. Those of you who don't know what I'm talking about will soon learn where your medicare money is going and how I got a great workout yesterday.



First, the closest picture I can find of my new friend, the TDX5:



The TDX5 power chair is midwheel drive and uniquly designed to recline the rider by remote to seek comfort in various positions as a result of injury or illness. This requires the 4 stabilizing wheels shown front and back which angle outward when reclining. They're designed for stabilization, not so much for pushing. The chair shown is from a blog of a woman who uses it.
The chair I encountered was custom built at a cost of $25,650.

That is not a typo. Her invoice from the supplier (name withheld) states medicare covered the entire amount of $25,650.

The TDX5 I met had full controls for the passenger and the "pusher." this allowed anyone standing behind her to control movement and recline at the push of a button.
The foot rests were custom made to her exact dimensions as were the arm rests.

For those of you thinking I might be against chairs for those who need them, think again.
This looks like an excellent piece of technology to assist those who have pain I could never imagine.

Let's move along to when I met my lovely TDX5.
Dinner was just being served at the firehouse when the call came out to "Assist a citizen." Before we can get going the phone rings, it's dispatch. They paint the picture of a little old woman stranded at the local grocery store in her wheelchair and unable to move. We tell them all we're going to do is plug her in and maybe the store can help, but no answer.
This location is notorious for folks getting off the bus with dead wheelchair batteries. I've even pushed a man across the street to plug him in, as you'll remember.

We arrive to a familiar woman, often found shouting profanities from the floor near her bed after falling out, again. She is also known around town for the elaborate rigging of PVC pipe on her power chair which had netting, a tarp and, I'm not kidding, fog lamps for driving at night.

But she is not in her regular chair, she's got a new TDX5.

"New chair?" I ask walking over to where the charger should be attached.
"I just got it today, but the battery died. I need a push home."
"We don't push," says the officer looking to me to plug it in, but the charger is not hanging in the spot engineered for it to sit. It's a seperate unit (Maybe 4 pounds) with the wall plug and a power inverter. Why they don't just build it in, I'll never know.
"Where's your charger?" I ask looking over the amazingly outfitted chair.
"I didn't need it, the battery said 50% when I left home." It was then I noticed the large tags still attached in places.
CHARGE BATTERY FULLY PRIOR TO OPERATION

After a few minutes of trying to figure out how to charge it, the boss asked her where she lived. The other firefighters and I knew exactly where she needed to go, 3 1/2 blocks away.

The middle wheel drive TDX5 has 2 motors which allow it to turn like a tank, on a dime. We were able to release the motors so the chair could be pushed. And push we did.

Some specs on the TDX5:




Power wheelchair with mid wheel drive.
• Comes with TrueTrack technology
• SureStep Suspension
• MK5 electronics
• Center Wheel Drive and Stability Lock.
• Speed: 7.5 mph maximum
• Seat To Floor Height: Min. 16.5" @ 0 degrees tilt; Max. 21" @ 5 degrees tilt (18.5" and 19" with Tarsys respectively).
• Product Weight Capacity: User weight capacity - 400 lb. with ASBA, 350 lb. with Tarsys, 300 lb. with Tarsys and vent.
• Overall Height: 34" with 16" back height; 37" with Tarsys and 22" back height.
• Overall Width: Base: 25". Seat width to outside of joystick (16" width): 24.5". Seat width to outside of joystick (20" width): 28.5".
• Turning Radius: 22-24" depending on riggings. • Arm Height: ASBA/2GT: 9-13"-2GR/GTR: 10-16".
• Incline Capability: 9 degrees.
• Overall Length: Base (caster to trailing caster): 35".
• Product Weight: 314 lb. (with ASBA seat),388 lb. (with 2GTR Tarsys).

The chair alone weighs 400 pounds. Add in our 200 pound patient and we pushed 600 pounds 3 1/2 blocks to her apartment. All the way she told us about all the features of her new chair as we weaved through the tourists and curious onlookers. It swerves quite easily with 2 of us pushing so many minor adjustments had to be made.

When we finally arrived at her apartment we opened her door to the familiar smell of stale cigarettes and there it was, glaring like a wife might at a husband home later than expected. The old chair.
"Is it broken?" I ask, stretching my back.
"No it works fine, the salesman said I could get a new one free, so I did." she said happily, as she moved first her limp legs, then her tired body from the new dead chair to the old working one.
"So why get a new one if the old one still works?" My fellow pusher asked noting the dozens of extension cords criss crossing the room.
"This one was built just for me!"

In the end we spent over 45 minutes pushing that chair from where she was to where she needed to be. It's hard to imagine a fire engine being deployed to push a 600 pound chair with occupant home, but that's more and more what our job description requires.

I took this as a chance to learn more about the technology available to those with mobility issues and thus have come to admire the TDX5. From a distance.

The Handover Volume 3

Kim over at Emergiblog is April's host of the world's fastest growing EMS and pre-hospital blog carnival, The Handover. OK, that might be a stretch, but it sounds bitchin'.

This month's theme was "Emergency!" the television series, which played heavily in my early years as I'm sure it did for many of you.

"Pop on over" as founder Medic 999 would say and have a read, you'll be glad you did.

Squad 51, standby for response...

You Make the Call...Dumpster Fire



You are the officer of a single engine 3 person resource dispatched to a reported dumpster fire behind a local grocery store.
The store is a 1 story, type 3 and the attached buildings are similar.
From your pre-plans you know the building is sprinklered and the owners have good fire prevention practices.

As you arrive on the scene you have heavy smoke showing from behind the building and see some flames. As you turn the corner towards the rear access you find a pair of large trucks blocking your access.

Heavy fire appears to be from a large pile of refuse. One of the drivers approaches and tells you they were making deliveries to the hardware store and think the pile is mostly cardboard, but he's not sure.

As another team is stretching a line you hear the building's alarm system begin to ring.

Both engines have a water supply and another engine is now approaching from the other side.

What are your 3 primary concerns in this scenario? You Make the Call.

Thursday, April 23

...for the medical aid...


First run back in my old house this morning and I'm shaking my head already.
Some calls I get. Some reasons I understand. But at some point someone has to step up and tell these callers, "Maybe you can wait."

THE EMERGENCY

A caller states she was talking to her grandmother, got in an argument, and now grandma won't pick up the phone.

THE ACTION

Yes. 2 police cars, a fire engine and ambulance are responding to a welfare check following a phone argument. The caller told dispatch grandma had a heart attack once and that got coded as a chest pain cardiac/severe.

As we arrived the police are coming back down the stairs waving us off with angry faces.
"This is nothing guys," one officer says, "Grandma was mad and didn't want to talk anymore."

How did this call get through and coded as an emergency? We may never know. Even worse, someone out there actually thought this classified as a 911 call.
Your tax dollars at work.
Amazing. Truly amazing.

Going home

It has been said that you can't go home again.

I disagree.

Today I was sent to my first Firehouse, the one where I "grew up" in this Department. It's still here and so are a few of the guys I had lost touch with.

My morning chores were easier when my mind raced with memories from seeing the familiar pictures on the wall, familiar names on the lockers and that good old big dinner table.

All my troubles fell away. I was reminded when we would go out on warm evenings and check for road closures and fire hazards in the night club district. I remembered when we frequented the local coffee shop when the new girl got hired. Playing cards late into the night and declaring a winner when the bells rang.

This is where my probationary boss retired. 32 years in the Department and a smile on his face every morning.

So here I am for the day, smile bigger than usual seeing the old engine barely fit into the house.

And my young daughter's face in a picture on the wall, thanking the crew for taking up a collection when she was born.

It's going to be a good day. I'm home.

...for the active seizure...


Firegeezer recently posted THIS story about a Nationalized hospital who called 911 for a man just outside their doors.
It reminded me of a run we had a few years back INSIDE a private hospital here in the states.

THE EMERGENCY

Caller states a man is having a seizure in an office.

THE ACTION

The address looks familiar on the screen and as we approach we see why. We've been dispatched to the hospital. The engine and fire ambulance crew (They don't transport, but staff a dual medic unit, don't get me started) are milling about in the lobby trying to find out where to go. We finally make contact with security who leads us up to their office where they say a man is having a seizure.
All the while we're hearing "Code orange, third floor. Code Orange, third floor." I ask security what that means and they say it's the hospital's code for a medical emergency within the hospital.

Hmmm...where are they?

We've all been in the ER when a code blue is struck somewhere else, the attending and a couple of nurses grab a predetermined kit and go.

On the third floor we meet our "patient." He was caught by security wandering near the pharmacy storage rooms in a secure area of the hospital and has been detained awaiting police arrival. When he was searched they found numerous narcotics and the man then said, "I 'm having a seizure" and fell to the ground.
It was on this call that I learned a little about "maintaining self image."

Ever seen people on TV pick up an arm, drop it and say, "He's dead!"? What are they doing? Nothing. The trick there is to drop the hand over the person's face. If the hand falls and hits them in the face, they're likely out cold. When the hand magically falls away from the face on repeated attempts, the person is consciously keeping their hand from hitting them. They are awake.
Unconscious people are not able to hold their eyes shut.
Another one, and back me up or call me on this one fellow care givers: Never have I had an unconscious person cross their ankles and leave them there.

So here is our new buddy, ankles crossed, eyes held shut and the hand amazingly missing his face every time when my partner leans down and whispers in his ear. One eye just barely popped open, saw me and went shut again.

We were taking him down to the ER on the cot when we finally met up with the 'Code orange' team. They were furious they had not been alerted of the event sooner. They learned of our situation from the engine driver who luckily went in to flirt with the staff. Turns out that only the 'code blue' alerts are heard in the ER. Makes perfect sense, right?

The physician got the quick report and took a look at him.
"Did you do his feet like that?" No, he had them like that on the floor as well, crossed.

When security told them what the guy was caught for, they almost turned red.

I followed them to the ER where they did everything by the book. The big, painful book.
IV access was obtained 14g in the AC.
Gag reflex was confirmed by yankauer tip insertion.
Rectal temp was taken to ensure accuracy of reading.
Body was exposed to examine for trauma secondary to seizure activity.

It was when his pants were coming off that he reaced down to keep them on. Suddenly aware of his situation.

"What did you whisper when you were down there?" I asked after we had left.
"I simply said, 'Your fly is open.' and he wasn't expecting that. Every man instinctivly wants to check."

I still use that line and it still works.

Monday, April 20

...for the diabetic...


We're racing to back up a BLS engine who reports PD has a man experiencing a diabetic emergency. Under their guidelines, combined with the officer's, E.T. will also be needing transport.

THE EMERGENCY

PD has made a traffic stop and found a patient in distress. A BLS unit has requested an ALS response.

THE ACTION

Ever been watching some kids play, something happens and you say, "Oh they just don't know any better."
That phrase came to mind on this run.
*Disclaimer. I have the highest respect for anyone who chooses willingly to help others. I do not see my self as above other caregivers, just specially trained to handle certain situations that others are not. When my skills are needed, I use them, but I understand that a good Paramedic must first be a good EMT. And good EMTs I like.

This crew had their hearts in the right place. Much like the team of civilians forcibly restraining a man so the AED can analyze him, they're trying and they get credit for that.

Our patient was stopped by police after rolling through a stop sign and has told the officer the odor on his breath is because of a diabetic condition and could in no way be alcohol or liquor. Following his guidelines he activated a code 2 response for an eval more or less to get the "Nope, he's good to go to jail" clearance.

The first engine on scene is BLS and the EMT assigned to it either misunderstood the chief complaint or never covered diabetes in EMT school. The patient is munching on a bag of Reese's Pieces candies and in our system only Paramedics can take a blood sample for a glucose level. They have assumed that eating the candies is a sign of a diabetic emergency because, really, who eats those things like...candy?
So the call goes out for an ALS backup.

As I approach the car where the patient is still sitting, he's pulling the NRB aside to munch on the candies. Before asking for a report I reach over and grab the candies and place them atop the car.
"No snacking." I tell him as I ask the EMT for a report.
The snap of the stethoscope as he forcibly placed it over his neck was almost comical as he began to fumble through a report much the same way the doctors at the clinics do when they call us.
All the while the patient is alert, oriented and nervous. Three things diabetic emergencies seldom are.
I clear them from the scene and kneel down to speak to my patient.
"Hi there, what seems to be the trouble?"
"I have a blood sugar problem, that's why my breath smells, it's not alcohol." He says with not a slur, but with concentrated effort to avoid a slur, which is quite more obvious. All I could think of was E.T. eating those candies and am now waiting for my patient to say his name is L-E-AAA-T. He never did.

"Oh you have diabetes. OK, Is that Type A or type B diabetes?" I ask, baiting the hook.

For those of you not on the job, there are two types of diabetes, Type I - Insulin dependant and Type II - Controlled by diet and exercise. Any diabetic knows exactly what type and treatment regiment they are on. Back to the show.

"Oh, Type A and it's bad." He responds, biting the line and I'm not letting him go. I do enjoy catching the intoxicated in half truths and watching them get frustrated to the point of telling the truth. I find it helps truly assess their level of consciousness and teaches them that we know what we're doing.

"So Type A, huh?" I look to my officer who slows down the ambulance to code 2. "What's with the candies? Trying to fool the breathalyzer?"
"Noooooo," escapes his lips, "My sugar is low so I need the candies."
"I thought the odor on the breath was from Diabetic Ketoacidosis, a high blood sugar, which means you're only making it worse with the candies, but you already know that being a Type A Diabetic, right?" I tell him as I'm confirming the vitals given by the BLS crew. Then a normal blood sugar reading beeps below me and I show it around the crew like a card trick.

Altered folks tend to look at you confused or stare past you, clues that the brain and the eyes are not communicating, but this guy is looking around the car. He's trying real hard to come up with an answer. At least 30 seconds pass.

"I've got a bad bowel and need to get to my doctor's office." Couldn't have been more out of left field.
"What?" I say slowly placing the stethoscope around my neck.
"You heard me, bad bowel, what do you know about that?" He left out 'Mr Smartypants.'
"I know that's not a reason not to take field sobriety tests or any other exam the police deem necessary." I stood, thinking I had him, but you know my clientele, they know the law.
"I want to goto the hospital."

I let out a long sigh and eyed the candies on the hood of the car. As the ambulance arrived I gave my report and the Medic did his best to talk sense to the driver as we were sent back in service.

As I walked away I heard the EMT from the ambulance say, "Are you going to finish these or should we leave a trail so you can get back to your car in a few hours?"

I stopped in the middle of the street I was laughing so hard.

Sunday, April 19

Sunday Fun - Caption this photo

I came across this photo awhile back and have been trying to work it into a post somehow. So I'm taking the easy way out and why not? It is Sunday.

So take a moment and tell me what the caption should be for this flickr photo:










For those of you not on the job, this may seem silly. Our airpacks are designed to give us 25-45 minutes of breathing air, but the harder we work, the more we breathe so it is important to understand how long a bottle will last. By exerting ourselves and emptying a bottle we can learn to better control our breathing as well as getting used to moving in our bulky gear. Not to mention the initial panic of being out of air.

Friday, April 17

You Make the Call...Stop the blog?


You are a Firefighter Paramedic in a metro service with a rather dry sense of humor. Frustrated and angry with the status quo you chose to start a blog. Not a blog to change things, but a blog to vent your frustrations and blow off some steam.

You have been trying to make a change to your system, but no one up the ranks will listen to new ideas.

Then a person you have known for a little while comes forward with an opportunity to help you advance your concepts in a way that will make the higher-ups take notice and prove the ideas could work.

The Only drawback is that you must reveal your identity and association with your blog, possibly ending your cheap therapy.

Although anyone with basic internet skills knows whereabouts you are, the details could bring consequences should the brass not appreciate your tone in some posts.

Keep quiet and keep posting or go for broke and get things changed? You make the call.

Thursday, April 16

...for the STEMI...


OK, that wasn't the exact dispatch, but we're getting there. Recently I've been sent to the "Broken hip/fall" and the "Abdominal Pain food poisoning" which are amazing deductions from a caller with no training, a call taker with minimal training and a computer system that doesn't have those options. Someone had to go out of their way and change the dispatch criteria. But I digress...

I'm not a big fan of EMS fads myself, but STEMI at least usually gets the Doctor's attention when you arrive at hospital. I haven't seen a difference in treatment yet, nor in time to lab, but boy do they start falling over each other when you say STEMI. The title got your attention, didn't it?

THE EMERGENCY

A man's family has called stating he has chest pains.

THE ACTION

Stop me if you've heard this one. Mid 50's man has an argument with the wife, then goes out to do some yard work. Comes back in a few minutes later pale, diaphoretic and holding his hand to his chest.
We've all had this one. His limb leads are clean. I,II,III have no changes so naturally we're looking at ASA, nitro, MS if needed, O2 and a lights and sirens return with an early radio call. I don't care if his fairy god mother appears and tells me it's not cardiac, this guy's having the big one.

What sticks out on this run for me was the home remedies that were attempted before we arrived. He speaks no English so the 12 year old is telling us of the elaborate treatments that were attempted. The circular bruises on his chest and abdomen are from a suctioncup type remedy called Fire Cupping that uses pressure to move deep tissues. It did not move his infarct. At least not in the direction they were hoping for. (photo from flickr search for fire cupping, not of patient)

They rubbed enough tiger balm ointment on his chest to send one of the firefighters searching for a window to open in the tiny living room. I caught a whiff of it as we were LEAVING the station there was so much. Wiping that stuff off is just bad, it gets on your gloves, then you touch the bags, you get the picture.

It was downstairs in the ambulance as we got the IV going and more nitro, we ran the 12 lead which showed the infarct right where we thought it was, anterior moving septal. And still no changes in leads I,II,III or our treatment.

As we arrived at the ER, 12 lead traces in hand, the staff was scrambling like never before. Active chest pain calls are always priority, but now that we call them STEMIs everyone runs around like that scene from the movie Airplane.

I hand the 12 leads to the Doctor who takes a cursory look and sets them down. She turns to a nurse and says, "Get a 12-lead on him as soon as possible please."

I picked it back up and handed it to her saying, "For comparrison. That's why we're doing this whole 12 lead in the field thing, right? To help you?"

"That's a bad trace and your electrodes could be better placed." Funny, the computer in the machine seemed to like it. I decided to refresh my skills by watching the technician remove my...hey wait...he's using my electrodes. The Doc takes the print out, which looks eerily familiar and tells the desk nurse to call the lab and tell them they're on their way.

Whole time was maybe 3-4 minutes and no one likes this Doc anyway, but what is the point of printing out those anterior leads if they are to be ignored?

Some Docs don't even ask for it, just take our word. Once we were even met in the parking lot by the lab team and went straight into the lab to transfer. That was weird.

But what made this event less stressful and more hilarious was when the Doctor finally got around to looking at her patient, just before they moved him.
The suctioncup remedy which left the ring bruises on his chest now showed giant bruises all over his torso wherever they moved the cups. She stopped in her tracks, reached out for my arm and asked if we had beat him.

"Not this one, I don't think." I said, looking at the ceiling.
"No we beat the old lady and the kid, not him." My partner said, walking back to the rig.

Monday, April 13

New Mutual Aid Company


Welcome, Paramedic SuperMonkey, to the Mutual Aid Board.

I've been following Medix311 for a little while, great 12-lead post arrest stuff, but had to add them on when this post quoted a patient describing a whip lash injury...


"So whiplash from a week ago, huh? What happened? Was it a car accident?" Just a curious, conversational, innocent question. "No... I fell asleep in my recliner and pulled something." Now trust me, given my overall impression of the patient, this was a WTF? Seriously? You called for this?

So welcome "X" and thanks for some great posts. And congrats on 10,000 hits!

...for the cardiac eval...


A local street fair is closing up shop and the weather is getting cold. That was when a 19 year old presents to the event medical staff with quite the unique chief complaint.

THE EMERGENCY

A 19 year old male reports chest pain.

THE ACTION

We knew the area would be busy, but the event folks have their act together and get us quickly in where we need to be. On the way a supervisor is telling me not to laugh when the man relays his chief complaint. He's also telling me because of the way it was reported, he had to activate us.
What was the complaint?

"I drank, like, 2 of those 5 hour energy shots and now I feel jittery." As he says it he rubs his chest. I looked to the event supervisor who held his arms up as if to say, "See, I told you so."

Our friend has a variety of stories he hasn't put much thought into, the same stories we hear day in and day out.
"I'm here with some friends, but they left me here."
"My brother lives just over there but he kicked me out."
"I can't call anyone, my phone is dead."

And he went on and on.

The check out checks out, but he insist on "Getting checked out." I find myself giving the ambulance crew the same story I got from the event supervisor and I had to smile.

As he climbed in he asked the golden question. "How much will this cost me?"
Before I could answer, the EMT on the ambulance looks him up and down and says, "Well, somewhere between $1200 and $2800 depending on tests."

"But I don't have any money."

And the doors closed and he drove away, still with 8 hours of energy to go.

Sunday, April 12

Sunday Fun - Company Logos

Every department has companies that earn a reputation or have a nickname or neat mascot.

Some companies adopt a cute cartoon character:


Others may go for a dark image to express their bad assedness:


And even others have "unique" slogans like Los Angeles County Fire's "Track Attack"

...for their wildland unit.

But your Happy Medic would like to see some more accurate station logos put out there.

What about that station on the outskirts that seems to have members who are a little bigger than the rest of the department? You know the crew, they can make a standing rib roast knowing they'll be in quarters to watch it cook. How about this for their logo:


And then there's that station where the Engine and the Truck race to each fire simply to hound the other for being second in. The guys never trade with the other crew, choosing to keep the truck "pure." These folks need a hug. Or maybe just a new logo will calm them down.



Do you have an unusual company mascot or logo? Shoot me an email at thehappymedic@gmail.com with a link, I'd love to see it.

Please do not send any logos containing the following phrases or images:
Fight what you fear
double deuce
fightin' (insert number here)
Little Irish guy boxing
A dragon and you're in Chinatown
These have been worn into the ground

Saturday, April 11

Times they do a change



Times they do a change.




When I was 1st introduced to the fire service I was in the 4th grade as our class had a field trip to the fire station. It was a short walk across the street from the school in a tract home that was fitted with a large garage to house the fire engine. Except for the garage and the flagpole out front it blended in well. I'd like to say how I remembered the fire engine and equipment, but my major memory was of the ice cream sandwiches they gave us at the end of the tour. My second encounter was quite different, about a year later a friend and I were flicking matches into the dry grass area in a local park. We would stomp the fire out, laugh and move to another area and repeat. We were tough dudes. Of course when we turned around on the trail to return one of our stomped out fires was ripping pretty good. We ran over and tried to stomp the edges with no luck. I took off my fairly new jacket, soaked it in the creek and beat the fire edges with it. By now the smoke cloud that formed caused a crowd to stand and watch. They of course were in our line of escape. We stayed till the fire crew arrived and put out the fire (probably about 2 1/2 acres) then faced the music of the officer (B.C.) Who loaded us in his pickup truck and delivered us home to our parents. Not a real happy experience along with being grounded the rest of the summer. Guess it could count as my first brush fire:)


Fast forward >>>>>>13 years when my brother calls needing a ride to the local office for the states forestry service to pick up an application. I take him there and the lady asks if I would like an application too. Bottom line I test and receive a job offer due to my high score with veteran points (my brother didn't make the cut off). So right off the street I report to my first assignment at a local airport station (the county where I worked contracted for local fire service with the forestry). Huge crash rigs, loud claxtons ringing, gamewell alarms, 24 hour alarm watch duty and about 18 firefighters on duty working 84 hours a week. I had hit the mother lode...$533.00 a month! It was a pay loss for me from my last job but I was burned out in a low manager position and was ready for a change.


I got to see many changes in the fire service through various employers. Most change came about in the line of safety (usually brought on by some unfortunate tragedy) and a lot were fought for by our employee group and eventually our union. The educational requirements jumped tremendously as new areas of responsibility were piled on the fire service. First came specialty fires (oil, aircraft, propane, industrial, wildland etc.) then ambulance service (as EMT's), then paramedics, then auto extrication, then came fire inspections of business, public education programs, dive teams, hazardous materials teams, swift water rescue, urban search and rescue and terrorism response. Just to mention a few.


Each specialty was multi-layered ranging from first responder rating to specialist. Each layer had minimum certitications and on going education to keep current. It was always a challange to become better equipted with knowledge, new tools and experience.


I saw the changes in requirements to be able to get a firefighter job both increase (education wise) then decrease (agility wise). The traditional method of progressing through the ranks put to the side of the road as promotional exams allowed those good at tests to leap frog over rank structure. It was always my theory that a manager should be able to perform each job of those they supervise. In an emergency that knowledge could save crews lives.


Also the public view of a firefighter evolved as many tragedies were faced, so many in such a short period of time. From earthquakes, hurricanes, riots, floods, major wildland fires destroying neighborhoods, terrorist attacks, the Oklahoma bombing, mass shootings and more, the firefighters held hero status for doing the job they were paid and signed up to do. I saw times when citizens begged us to let them buy us lunch or restaurants invited us for free meals (all as a thank you for a job well done) It didn't matter that I may not have had anything to do with that particular incident, the out pouring was amazing. This hero image has attracted many who unfortunately appear to be more interested in the image of the uniform they wear then the job.



But the large majority appear to be in it for the long haul, making the best of a persons worst day and providing the best care and comfort for the situation or doing the best job you can with your knowledge, tools, team and experience. So a tip of my hat to you, and you will know who you are in spite of your denial to others.

Friday, April 10

An article you need to read


Firehouse Magazine contributor Daniel Byrne has a great article in the April issue that just came into HM HQ.

In it he tackles the issue of college educated recruits and how the mission of the Fire Service has changed to the point that advanced learning can actually be a plus instead of a hindrance.

I've heard many a time that "college boys" had no place in the firehouse and that they could never learn "with all that stupid crap in their heads."
I never told them I was a college boy. When it sneaks out that Happy has a bachelor's in EMS, they cock their heads and say things about how funny it would be if I was telling the truth.

But there it is on the wall here at home, framed next to the wife's degree, Medical School tassel proudly hanging form the corner. Wow did those Pre-Med folks hate having us next to them at graduation. We weren't real Medical Students while attending and then weren't real firefighters when we got out.

Byrne's article is available on the Firehouse.com website for registered members, which I am not, and I hesitate to reproduce it here for obvious reasons but I would like to add in one quote that made me smile.

"If you think your college-educated rookie, who has a proven ability to learn and comprehend difficult concepts, cannot grasp the basics of our job, then the problem may in fact be yours."

Find a copy or subscribe, this article alone is worth it.

You Make the Call...Search and Rescue


For this week's You Make the Call, I'm opening up a scenario that seems to be a topic of much discussion in the Fire/Rescue world: search priority.

So let's take a scenario similar to one I think most jurisdictions have, the multi-story residential.

  • You are dispatched as part of a first alarm assignment to a report of a fire in a building. A police cruiser has spotted fire in the top floor of a three story house just after 3 AM.
  • Weather is fair, little wind and neighbors are just emerging from their homes as you arrive. No one is standing in front of the house on fire.
  • Water supply is conveniently directly in front of the house and the street is clear enough to allow truck placement when they arrive.
  • You are the second engine to arrive on scene and are instructed by the Chief, who is now arriving on scene, to conduct a primary search.
  • On a quick 360 you note fire is extending from the third floor and that the rear of the house has a fire escape from the second floor, non-deployed, indicating possibly a multi-unit building. You also count 4 gas meters.



Where do you start and where do you go? You make the call.

The image is from the Springfield, Massachusetts Fire Department who responded to this fire on February 1st of this year. I found this image to be the best quality for my purposes here and in no way am making a comment on firefighting activities carried out in the photo or on the scene. This photo was taken by Dennis G. Leger and came up on a search result for "3 story fire."

Thursday, April 9

They don't make them like they used to.


"Engine 51 10-4, KMG 365." The Captain spoke with authority.

It was another world. 1 generation removed from myself.

Like many a kid I waited and waited through all the ads for washing powder and the medic alert tags until the claxon would strike at the beginning of an Emergency! episode. After the opening set up we'd see mighty 51 roll out the doors on a clear sunny California morning off to another amazing rescue, not realizing that the Fire Service portrayed in the show was already dead. The career I longed to follow my father into was already changed before I got in.

Roll call was first thing in the morning, dress caps and ties lined up for the Captain to read the morning's news. He had an office just off the apparatus floor where he planned the day's events, training, cooking and whatever else needed to be done.

The men diligently went about their morning duties, raised the flag, held discussions about equipment and learned from one another.

On emergency scenes they were well practiced professionals carrying out any task given them by the Officers safely and with pace. They never questioned the reasons or intentions of their superiors because their superiors had moved up through the ranks because of their abilities.

They don't make them like they used to.

We are in the middle of the biggest shift of power the Fire Service has ever seen.

I jokingly referred to the hiring of younger and younger firefighters as "The changing of the guard." The vets who filled the ranks of the growing departments of the 60s and 70s are leaving, and fast.

No longer are dining room table talks about large fires or tactics, but about certifications, degrees and disability pensions.
Morning training is reduced to making members comply to uniform regulations, tuck in their shirts, polish their boots and clean their gear.
Appreciation for their equipment takes a back seat to the TV and the internet, which seem to be on more and more and the drill book out less and less.
Officers are chosen by their scores on a test, then reshuffled based on how their outward appearance reflects that of the community. Hard to tell the race or gender of a fire officer in full PPE in a smoke filled hallway, but you sure can tell their ability level.
A passion to provide a quality service falls as personnel are required to do more with less and lose sight of their primary responsibilities.

Where did the crew of Engine 51 go? Yes they were a dramatization of reality, but what was it based on? It was based on men like James O Page and others who offered technical advice and surely added the aspects of the Department they wanted shown. The professionalism, the dedication, the pride.

I learned later these were all hold overs from the para-military structure that so many today reject.

I recall watching a young firefighter complain that he was reprimanded for not wearing his proper uniform to an accident scene. It was a hard argument to make in shorts and a polo shirt. He looked more like a delivery driver than a firefighter and it was listening to his rant that I realized he is the one new recruits will be looking towards in 15 years for advice and guidance. I shuddered.

Was it my rose colored glasses of youth that saw these things?

No, I learned when watching the show on DVD while my eldest was a baby. The hairstyles were different, the equipment educational, but the outward glow of professionalism was unmistakable.

Watching that show again takes me back to the world of my youth, when every fire had a rescue, every story a moral and every shift was another chance to spend time with friends.

To this day I have the squad claxon as the sound on my computer when a wootoff at woot.com is underway. When a new item is for sale it will tap out those familiar three tones "Beep, beep, beep, Squad 51 standby for response."
And when my daughter, 3, says, "We've got a job!" it's in response to that claxon sounding, just like I remember it all those years ago.

"Medic 99, clear."

Wednesday, April 8

...for the overdose...


The baby boomers are getting restless. Some of the older ones have re-examined thier lifestyles and are making changes for the better. More exercise, better diet, quit drinking. But what happens when your body won't fall asleep?

THE EMERGENCY

A man has called stating he may have an anxiety attack.

THE ACTION

It's after midnight and our new friend meets us at the door in his pajamas and a robe. He shuffles into the house and has a thick Irish accent as he describes the emergency. He's afraid he may not fall asleep.

For over 50 years he was a heavy drinker, so much so that he often passed out at night instead of falling alseep.
Since visiting the doctor a few weeks ago and quitting drinking, he now has trouble falling asleep. Tonight his sleeping medications are not working and he would like a shot (medicine, not booze) of some kind to help him sleep.

"Have you tried watching baseball?" I asked him and he laughed.
"I've tried everything my friends. Warm milk, pills, a bath even, but noothin' (the accent) is makin' me the wee bits of tired."
"Well, I can sing you to sleep. That's about as far as we can go unless you want a ride to the hospital."
"Oh no, no hospital for me. I was just hoping for a shot or a new pill or soomthin'."

He escorted us to the door and apologized for calling so late.
"Had I known I'd be so much trouble earlier, I'd a had a shot or two (not medicine)."

Amen.

Tuesday, April 7

Code 3 hospice referrals

With my project to change the way EMS is delivered in my system plugging right along, I keep collecting specific cases of EMS abuse and misuse.

Along with those cases I'm also starting to find some that fall under the "You don't need us, but have no other options" category.

Just such a patient:

Terminal CA patient, wants to stay at home for the duration of her painful days. Her sister wants help around the house, lifting and bathing and such. No problem there, getting hospice involved after a quick call to her primary care makes sense.

Except today is Sunday and the answering service will only transfer the call if it's an emergency. When the sister says, OK it's an emergency, please connect me to the doctor, the answering service instructs her to call 911 and hangs up. No joke.

We arrive to a woman who simply wants to stay home but her caretaker needs help. The caretaker, her sister remember, also says she needs some time to get the house in better order to take better care of her.
In touch with our supervisor I'm instructed that the only option is to transport her and hope the attending physician can get through to her primary and arrange the hospice intake. So she's loaded up and I'm trying all my best bad jokes to get her to smile and luckily she does.

Had I had the authority through channels to get a hospice intake scheduled, not only would this woman be able to stay in her home, but we could have had an ambulance back in service.

And the best part of this call was the way the dispatch center coded it. 26D1- Fall, unconscious, difficulty breathing. In the narrative I can see the answers to the questions: The pateint is alert (awake), the patient denies any injuries, the patient is not clammy/changing colors/having difficulty breathing. The problem is: Pt has soiled self, needs help into bed.

Again, no joke. Lights and sirens for the hospice referral. Changes are coming.

Monday, April 6

'New' airway technique


Just in case I invented this technique, I'm calling it the Happy Inverted Trendelenburg Leveling Airway Stabilization Technique or HIT LAST. Hence the late Dr Trendelenburg inverted here.

We are always taught to deal with supine patients, but how many of them present differently? Most often when we find them we manipulate them into our treatment position. But that isn't always best.

We responded to a female who had not been seen for days and was found prone on the bedroom floor, emesis of varying type and time drying on the floor near her face, which was slightly turned to one side, likely saving her life.

She is unconscious, responding to loud verbal and pain only with mumbles clogged with emesis. The textbook says to roll her over and manage her airway. I figured since her body has been dealing with this for sometime, I'll trust it has an idea how to solve it. As she's breathing I can hear the stridor and the aspirated emesis is still pouring out slowly. Some may argue it was spilling from the esophogus, but I have to assume at this point it is coming out of the airway.
Her O2 sat is in the 80's and her pressure is in the 60s, but I'm still hesitant to roll her over and create a natural blockage for all that junk to roll right back down into her lungs.

Then I got an idea.

All we had were a bunch of police officers at the scene who broke down the door for the well being check, so I put them to work. We ruled out trauma, so the unfamiliar movements we were about to perform could be handled by unfamiliar hands.

I fired up my suction with my airway kit open and ready. I instructed the legs to be lifted slightly first, just about a foot off the ground. When they were set, I had the next two officers, positioned at her waist, lift her mid section about 8 inches off the ground. When the wave came, I was ready. We gathered close to 200 cc of emesis from that movement and the stridor cleared. Since gravity was doing all the work, I was able to get fluid a supine patient would have choked on. She coughed a few times, understandable, then her sats started to climb after replacing the O2 we had on during set up.

Now supine and onto a board for removal and her lung sounds were far better. Not perfect, but better than the globs of fluid I heard earlier. Not even rhales, ronchi or bubbles, but sludge like. Like when your foot sinks deep into a mud puddle. Now I hear ronchi.

Code 3 to the ER she's satting 99% on high flow, color is improving and she's opening her eyes from time to time while taking 10 good solid breaths per minute.

At the ER, after RSI meds were administered,(gag intact pre-hospital) the Doc's have that fancy slide scope, the one with the camera on the blade. They see all sorts of chunky goodness my mighty suction couldn't clear that she was breathing around. Stuff so old it didn't wiggle when she breathed. Her pressure was over 100 and a nice narrow complex rhythm was beating along as they intubated and "stabilized" her.

When I described my actions to the Docs, they smiled and said, "Yeah, that works alright."

It's not an A list intervention, but in this case I think allowing the junk a natural escape assisted with suction was the way to go. Many may argue that immediate full supine access and intubation would have been the way to go, but she still had a gag reflex in place and I have no access to alternate intubation methods. Yet.

So the HIT LAST is born. Keep it in mind the next time you hear that voice in your head say, "Oh crap, this airway sucks."

You Make the Call...Trauma Diversion...What Happened


This was the situation on Friday.

As I was looking at the radio, expecting to see a big, "Just Kidding," readout, my driver says, "We're here!"

I quickly told him not to enter the parking lot, but stop just short of it, in the bus stop. No way the City bus stop could be considered "Hospital Campus" under EMTALA, right?

I keyed the mic again, "Doc, this is Medic 99, can you please confirm I have an altered mental status trauma criteria patient and you are asking me to divert away from your trauma center?"

Without a perceptable delay I hear back, "What's your ETA 99?"
"Doc, we're at the property line. If you're diverting, I need confirmation for the recording and need to get moving."
"Copy that 99, you are diverted due to trauma saturation, sorry and good luck."

I tell the driver to hurry along to Saint Closest and call them up on the radio. Instead of asking for a report I hear them say, "We copied your patient information 99, we'll be ready for you."

Someone was paying attention, thank goodness, and was being proactive.

When we hit the doors of the ER the nurse let out an audible sigh. "We were wondering where he went."
"Excuse me?" I asked, confused.
"He wandered off maybe an hour ago after we made him wait for a ride to detox. He was in a fight yesterday, got beat up in a parking lot. Looks like he went back for seconds."

Talk about Deja Vu.

If you said get a clear diversion order and get moving, you made the right call.

...for the abdominal pain...


3:41 AM and your tummy hurts. You're 23, it happens. And when you call from a street corner, it usually means your usual residence is no longer available or no longer anywhere close to you. Oh and no, you can't take my picture.

THE EMERGENCY

23 year old male caller states he is experiencing abdominal pain.

THE ACTION

We're sent no lights and sirens for the clearly appropriately coded call. As we arrived at the street corner a bit before 4 AM we see 2 men, one of them on a cell phone, the other waving good bye to the first one.

I roll down the window and this is what transpires:

Happy Medic "Did you report a medical emergency?"
Weird Guy "Yes, my stomach is about to explode."
HM "Can you repeat that please?"
WG "My stomach feels like it's going to explode" he's speaking very quickly and looking up nad down the street as he talks to avoid eye contact. "I have a heart condition, I've had like a lot of heart attacks so I'd like to goto Saint Farthest if they're accepting ambulances."
Bingo, he knows the lingo. Which means he's been with us more than once before.
HM "Where did your friend go?"
WG "Oh that's my roommate, we came up here to party because our house counselor said we should go out and dance."
HM "Dance? Now I'm confused. Does your stomach hurt or are you just stuck here with no ride?"
WG "What is your name and badge number? Why are you not wearing a name tag?"
HM "This is called a sweatshirt, I wear it when I'm cold. My badge is on my uniform shirt next to my bed at the fire station."
Out comes the camera.
HM "You do not have my permission to take my picture or capture video of me."
WG "Haven't you heard of the first amendment? the photographer's first amendment? It says I can take your picture whenever I want and you can't stop me."
HM's partner giggles.
HM "Have you ever heard of HIPPA?"
WG "That privacy law, yes have you?"
HM "I might be wrong but I think you need written permission to videotape a patient encounter. Do you have written permission to be taping this?"
WG "I'm so going to sue you and your department and your city, I'm suing you all I have an attorney you know."
HM "Do you think your attorney can come and give you a ride, it seems as though your abdominal pain has passed.
WG "Can you take me to the hospital or let me charge my phone?"
HM now notices in the reflection of the ambulance mirror, the camera menu on the screen. He may not actually be taking video. I put the ambulance in gear.
WG "Can you at least tell me where a pay phone is? My phone is dead."
The first honest thing all night.
HM "Go back a few blocks to the gas station, they have a pay phone."
WG "Thank you, that's all I wanted. You should be nicer to people."
HM "Be safe and please don't use 911 as your personal taxi service. Have a wonderful day."

And we drove away. We had a call not a few blocks away less than an hour later and hoped it would be him so when he saw us coming again he'd run away.
Now I'll be scouring YouTube looking for the angry Paramedics who wouldn't let a poor man charge his cellphone in the ambulance at 3:41 AM.

Sunday, April 5

Sunday Fun - Welcome Ambulance Attendants

Last week I welcomed the firefighters from around the world, this week a special welcome to all the EMT's, Paramediciners and ambulance drivers (Yes some folks are just that) who may be stopping in to say hello. Welcome!



Welcome Paramedics


American Ambulances are largely volunteer or privately operated, larger cities may have ambulance service rolled into the Fire Department. Narragansett, Rhode Island is served by this common style.



欢迎 救护车

Different regions of China run different systems, but in Hong Kong they run a fast response car and a transport unit. China also has a variety of different emergency numbers, not just a standard one. 119 will get you a fire response while 120 sends the ambulance.



Verwelkom Paramediciner

Suffering a broken leg in Roskilde, Denmark
will get you this sharp looking rig staffed with Paramediciners. Also available is an Ambulancelæge which is an ambulance staffed with an anesthesiologist and a paramedic. A nice option to have in my opinion.


καλωσορίζω ΑΣΘΕΝΟΦΟΡΟ

The Greeks run an interresting tiered system called EKAB2, which operates a number of differently equiped units depending on the nature of the call, from technicians to 2 dual MD units.




Magen David Adom (red shield of David in Hebrew) has introduced an armored ambulance to respond in dangerous areas of Israel. Just the fact that they need this makes me double think scene safety.

Saturday, April 4

A Letter in the File of Richard Poplawski


Motorcop passes along this story of another multiple murder carried out by a wing nut lunatic kid (23) who believes in some kind of "Gun ban coming" as a result of the new President.
What a coward.

He's only giving those who wish to ban aggressive weapons a reason to do so. If you support the Constitution and all the amendments within it you must come out against this murdering coward and all those like him.

Those of you who respect firearms and the underlying culture must support gun rights by removing those from your organizations who are not stable.

I personally do not agree with Mr. Poplawski's aparent views on gun rights, but when the last President suspended Habeus Corpus, I didn't murder anybody.
When my guy lost 2 elections, I didn't take anyone hostage and kill them and 13 of their friends.

In the coming weeks I hope Mr Poplawski is given a fair and speedy trial, as all Americans are entitled to. Too bad he made this decision in a death penalty state.
Had he waited until Utah he could have faced his beloved guns in the firing squad.

This letter goes in your file Mr Poplowski and may your God show you the mercy you extended to the fallen officers, you murdering coward.

...for the gas leak...


The elderly can be fun. Other times they can be confusing. Sometimes they get lazy, just like the rest of us.

THE EMERGENCY

1 AM and an elderly woman is reporting a gas leak in her basement.

THE ACTION

We arrive lights and sirens and she's not waving us down so much as waving us DOWN, as in "Stop all the ruckus!"
We step down and to her address in full PPE, when she tells us we won't be needing our slickers for this job. Into the basement, which is clean compared to other almost nona-genarians, to not a hint of a smell of gas.

The 50 year old furnace, duct work covered in asbestos, is sitting next to a brand new water heater in the middle of the interior wall.
"I turned on the thermostat and nothing happened. The utility company put me on hold for 20 minutes and said it would take at least an hour for them to send someone. Can you imagine?"
Before I had time to think of something with a double meaning, the near retirement officer reaches over, turns the shutoff for the gas to the 'off' position and tells her, "Not a problem anymore."

"Can't you fix it for me?" She asks as he's walking back out into the cold night.
"No ma'am, you called us to mitigate a hazard and we've done just that. You'll have to wait another 55 minutes for the utility company to come by and fix the problem."

She just looked at us walking away. I kind of felt bad for her having to wait a whole hour to see if her furnace still works or, worse, needs to be replaced. Tearing out all that asbestos insulation is going to be a big expense.

Back at the house the boss made sure we understood his actions. "If we tell her it looks fine and it isn't we go down. $100 bucks says she's got a sue happy kid that would just love to jump on us for something like that. I did the only thing that is solid for us, remove the gas, no emergency."

I hadn't thought that far into the future and like to think people are better than that but, no...no we're not.

Friday, April 3

Memories of the first 200


Since this project began a little less than a year ago as emsfun blog, I've annoyed you with 200 posts about my life and career. My original intention was to simply scream into this empty room as therapy, but then people started to stop by and listen so I started to wander into their rooms and listen to them scream. And now it's an obsession.

On the way we've had over 12,000 hits between the 2 sites and since separating from emsfun and flying solo as the Happy Medic, we'll be passing 10,000 any hour now.

I wanted to share some memories that stand out in my career as a firefighter, memories I'm sure we all share in a different way. Since I can't yet tell you who I really am (That day is approaching, I assure you) I'll tell you what made me who I am.

  • I remember walking into the apparatus room at my first Fire Explorers meeting the day before my 16th birthday. It was ladder drill night and I watched in amazement as my peers were doing the things that until that moment I thought only guys like my dad could do. The next week dad took me to the supply depot so I could get my turnouts, helmet and gloves. Happy Birthday to me.

  • As an explorer, riding along with an ALS engine, I saw my first recusitation effort. The firemen worked seamlessly with the ambulance crew and I thought everything went well. When we arrived at the hospital to retrieve our medic I learned the man had died. The firefighter walked me in to the room where they had recently ceased efforts and I remember standing there wondering why none of the things we did worked. That was the first of many lifeless bodies I would encounter. Right then I realized that sometimes you can run everything right but the patient just doesn't cooperate.

  • My first night in the fire station as a paid firefighter was supposed to be quiet. In a rural part of a rural state there were 3 of us. One EMT, one Paramedic and me, the firefighter. I was driving the 1974 10 speed double clutch 1000 gallon tender. A call came out for a major MVA on the highway. I sprang out of bed and ran to the tender, started it up and was away in a flash. That old tender moved so slow that the ambulance crew passed me on the freeway and I eventually just turned the lights and siren off. By the time I arrived they had packaged and transported.

  • First day with my shiny new Paramedic license and the morning brings my first recusitation as lead. After 30 minutes of CPR (old 15-2 CPR) and all our meds I was on the phone to the hospital for permission to stop. As the Doctor was reading me the time of death I heard behind me, "He's back! We got him back! I have pulses!" The Doctor said, "You have what?" I responded we would see him in 20 minutes, we were transporting. I still have that rhythm strip in my little folder in the desk. He lived; walked out a few weeks later. That's the run I think about when things seem to be going bad.

  • After taking multiple entrance exams around the country I was back sulking at my old job, assuming I had missed the list at my first choice. The wife and I had been checking the answering machine at home every 30 minutes for weeks hoping for word that I got the job. Nothing. One quiet day at Engine 5 the phone rang. My probie (Now their Chief of EMS, why didn't I stay?) answered the phone and said it was for me. When I said hello I was met by a strange scratchy voice as if someone was holding the phone up...to...an answering machine. "You have been selected for our next academy class, please call me back when you get a chance if you still want the job." I hung up, called my boss and called off sick. How could I be expected to work at a time like that?

Two years after that phone call I was standing in a busy County ER triage line with a patient I had transported twice that same day, one of our regulars. I was whistling a tune when the nurse asked, "Why are you so happy?" And the Happy Medic was born.

Stay safe out there,

HM

You Make the Call...Trauma Diversion


I'm dispatched to a gas station in a sketchy part of town for a man down.
We arrive to find a man lying supine on the ground, bloodied, with multiple traumatic injuries to his chest, face and neck. He is responding to loud verbal with slurs and swears.

This man has taken a serious beating and clearly lost.

We get him exposed and onto a board with collar. Airway is clear and all vital signs are checking out. There is a heavy odor of alcohol on his breath and clothing. Bleeding is controlled and IV access is established enroute to the trauma center.

All night on the radio we've been hearing multiple trauma transports and expect a full house when we arrive.

After giving my radio report, instead of hearing the usual, "Copy that, we'll see you in 5 minutes" I get a response from the Medical Director who is on staff.
He asks, "Do you think you can divert to another hospital? This patient sounds stable."

The patient is indeed stable, but meets trauma center criteria. This is the only trauma center in the region.

Before I can respond my driver informs me we're almost arriving.

What do I do? You make the call.

Thursday, April 2

...for the man down...


I lay down all the time and no one sends a code 3 dispatch my way. With talk of dispatch centers adding incoming text messages to their arsenal of information gathering (Oh Gods NO!) these calls still come in and require a dispatch. What was better than the 911 abuse was that this man came with his own pre-hospital tracking system.

THE EMERGENCY

An out of area cell phone reports a man sitting in a parking lot against a wall, crying.

THE ACTION

We've all been there, right? Maybe your best girl left you or you had your iPod stolen and you break down and cry.
Well, this caller thinks you need an ambulance.

We arrive as the engine crew is standing in a half circle around our new friend, who's shirt is unbuttoned. No big surprise there, I often unbutton my shirt to cry, it usually makes people leave me alone.

As I approach to take a report I see electrodes on the patient but no cardiac monitor nearby. Hmmm...I think to myself, we didn't take that long to get here that he got a trace and put the monitor away. This needs further investigation.

"Gentlemen, and citizen, good evening, I'll be your Paramedic," and I lost my train of thought looking at the electrodes.

Written on the right shoulder electrode's white foam circle is yesterday's date and a unit number, Medic 88. On another is today's date and some scribbled initials and a familiar acronym for Saint Closest.

What was written on the third, you ask?

Nothing. And we left it that way. I've heard of this practice before and didn't like it much, but he demanded an evaluation by a physician and, darn it, it's against the law to tell him no.

At Saint Farthest I showed the triage nurse the electrode and she laughed telling me he must have pulled the old ones off because she did the same thing 3 days ago.

Har Har. This is just silly. Maybe if we were given the training and authority to assess and refuse this man an ambulance, he'll stop calling us for a ride across town.

Wednesday, April 1

Happy Medic's Identity

The time has come, fair readers, to let you know who I truly am. Mainly because I got pinched last night and the truth is on the way out and I wanted you to hear it here first.

I am not a firefighter or a paramedic, I don't work in a big city or drive a fancy "medic van." I'm a delivery driver in West Paducah, Kentucky and live in the parking lot of the local fire station. When they go on calls, I look through their dispatch logs and just make stuff up.

Last night I was out having a few too many and let loose that I was the Happy Medic. Some rival blog fan boys were in the bar and a fight broke out. I was so hammered that when they asked my name I told them it was Happy Medic. I tried using Motorcop as a cover, but dang it if they wouldn't let me have one twitter instead of a phone call.

My real name is Mitch Comstein and I've been writing this blog under an alias to protect my real life.
So before it ends up on celebrity mug shots, here I am in all my glory:


hehe - Phish concert goer arrested and posted at thesmokinggun.com. Happy April Fools' Day.