Sunday, March 23, 2014

Blood, Sweat, and Tears (Part 1 of 2)

I had only been running with the ambulance association for a few months.  In fact, the patches on my uniform sleeves were still very crisp and clean.  To this point, however, I had proven myself to be a reliable asset to whichever crew I was riding with.  As a “third”, I was like a bonus provider… not necessary, but often very valuable.  I was learning the “old school” methodical treatment from the regular Monday night stalwarts, Ron and Glen, and picked up loads of great experience by watching them work.  You could tell right away that they had been partners for quite some time.  Each knew exactly what needed to be done, and there was seldom any unnecessary activity or discussion; just compassionate care delivered with confidence and efficiency.  

During the weekdays, things were different.  There was much less regularity in the crew schedule.  This gave me the opportunity to learn from a host of different providers.  I picked up many great habits from a number of different partners, and the diversity helped me hone my own style of emergency medicine rather quickly.  I learned I could deliver the skills required by protocol in the manner dictated by my own personality.  I had been on a few difficult calls, helped save a few lives, saw some trauma, and of course, dealt with the multitude of “hospitality calls” that required a smiling face, a little bit of TLC, and 2% oxygen via nasal cannula during the trip to the emergency room.  

One particular afternoon sticks in my head.  While some of the specific details have faded over the years, I still remember the roller coaster of emotions that I felt as the event unfolded.  It was the kind of call that you knew right away would be in your memory for a long, long time.  The radio began to squawk about a 10-73 (yes, I pre-date the elimination of the 10-codes) in a town about 15 to 20 miles away.  The severity quickly escalated, and before long we were dispatched to assist.  Because of the location and status of several units in the area, we went from 4th or 5th due, to “guess what, we will be 2nd arriving”.  I had the swagger of a young trauma junkie, but was ill-prepared for what we were about to encounter.

What started as excitement soon eroded into terror as we went screaming up the highway toward the scene.  The radio chatter painted a rather bleak picture of a head-on, two-vehicle crash with conflicting reports of up to 8 patients and heavy entrapment in both vehicles.  I had been running rescue calls as a firefighter for a couple of years, but my company was rich with very talented rescue technicians and a strong tradition of earning your place.  Most of my on scene work included staging, cribbing, tool set-up, and peeking over the shoulders of the more experienced guys.  As an EMT, most of my trauma experiences were visual only, from endless slideshows (with actual 35mm slides) during training.  All of that was about to change.  I could do the math…8 patients, 5 EMTs… It was time to suck it up and prove my worth.  

I sat back, and tried my best to quietly control my adrenaline rush.  I needed to compose myself, but my brain was spinning with all the things I may be called upon to assist with.  I didn’t want to screw up, and I could tell by the tone of the voices of my crew that the normal ass-busting and goofing around that was sometimes an appropriate part of our team-building was not part of this mission.  We were about 2-3 minutes from the scene when I heard quite a bit of “exasperation” from the cab.  I broke from my attempts of calming meditation to spin around and look through the windshield to see the first due ambulance whiz by us, en route to the Reading Hospital with two Class 1 trauma patients.  Through the profanity laced heat -of-the-moment critique being conducted by the other 2/3rds of my crew, I gained immediate understanding of the need to triage when you are first-due.  We were now, for all intents and purposes, starting fresh, and would be FIRST DUE to an accident involving 6 patients and multiple entrapment.  I felt oddly comforted knowing the two in the front of our rig were as stressed about this call as I was, despite their experience during their years of service.  

We approached the scene, which by now looked like a disaster area!  There were car parts splashed from one side of the road to the other.  A few public servants were on the scene, but the majority of the people swarming the site were civilians… panicking, hollering, pointing, crying civilians.  There were so many cars and people choking up the scene that we still hadn’t laid eyes on the involved vehicles.  We hopped from the rig, and grabbed as much trauma gear as we could, and headed into the core of the disaster. 

Along the guardrail was one young, teenage patient, buckled over from pain and spilling blood on the side of the road, but sitting and conscious.  The two vehicles involved in the wreck sat only 20 feet from each other, after what was an obvious headlight to headlight impact.  The first vehicle had one male, heavily trapped behind the wheel, and gravely injured.  The second still held three young patients, also in poor condition from first glance.  Our medic and the driver were forced to make a quick game plan, as the next due EMS unit was about 20 minutes away.  We would triage and treat the remaining patients (as the first unit should have) and through the process of selective elimination, I was assigned to assess the old man in the first car.  I gulped back the fear of the overwhelming responsibility that was just entrusted to me, grabbed what I thought I may need from the jump bag, and made my way over toward him.  I have to admit that I was mentally prepared, and fully expecting to perform a quick assessment and determine that there was nothing we could do for him.  The minutes that followed would test my skills of emergency medicine and patient care in a manner that would mold my compassion for all future patients that would ever be in my care.  

Watch for my next blog post on “Hittin’ the Hot Spot” for the conclusion of this story…           

Friday, March 14, 2014

Do You Remember Your First Time?

They say you’ll always remember your first time.  I believe that to be very true.  My first time was about 32 years ago.  I can remember how excited I was; and my partner was a “virgin” as well.  We both felt that performance anxiety and worried whether we would be able to do it right.  We had been thinking about this moment for quite a while, and on this day, it was finally going to happen.  The one thing I was not prepared for was how quickly it would be over.  Nevertheless, both Dan and I were left sweaty and satisfied when it was over.  Everyone congratulated us and said we did a great job!

Of course, I am talking about my first interior fire attack; what did you pigs think I was referring to?

It was a typical afternoon at the “hosey”, the regular gang was hanging around the station, watching Leave It To Beaver, playing Burger Time, shooting pool, and snacking on Mays’ food and Icy Tea in the little cardboard cartons.  Fire calls were scarce “back in the day”, so we weren’t exactly expecting any action.  Even if the tones did drop, there was no telling how long we would wait for a driver to show up to get the apparatus out.  That was the worst part of being the “daytime crew”.

I had been a senior firefighter for a few months, and had been in on some fires, but Dan was a few years younger and had not had the opportunity to “pack up” on an actual fire yet.  We both had done our time as junior brigade members, “laying out and staying out” for the first two years in the company.  But we knew where every piece of equipment was, and we sponged up as much education that was available at the time.  We knew that one day, it would be our time.  Mentally, we were prepared; we had been trained, we practiced, and we dreamed about finally getting the opportunity to have “the knob” on a working fire.  

Then the tones started dropping… reported structure fire at 8 Hawthorne Road.  We saddled up quickly, lucky enough to have a driver, and a chief, plus Sticks and me.  Because of the terrain, we could see no header on our approach, and began convincing ourselves that this would be a letdown.  Boy, were we wrong!  We pulled up in front of this rancher, and saw the gray smoke squeezing out of every open window, crack and seam of the house.  Told that the fire was in the rear, Assistant Chief Powell ordered us to stretch the line to the back of the house.  We sprang into action… this was our time!   

The house sat on a steep slope, and the rear of the house had a walk-out basement.  One of the upper level windows was spewing fire like there was no tomorrow.  Ignoring the fact that we were petrified with fear, we masked up and within seconds, the hose line swelled with water pressure.  It was time to put out some fire.

Despite all we knew about getting inside and pushing the fire out, we panicked, and drilled the fiery window with a straight stream of water until it darkened down.   “Now let’s go get it”, I mumbled through my mask, as we yanked all the hose we could into position for the interior attack.  I felt like a bull, pulling open the screen door and kicking in the wooden door with a single boot strike!  The downstairs scene was eerie.  It was a finished recreation room with a pool table, and barely a thin wisp of smoke.  There were no signs of the inferno that raged one floor above.  Hell, this was going to be easy… or so I thought!  

We spotted the stairs immediately, and dragged the hose toward it, around the corner, and started up the steps.  We reached the top of the stairs, and BAM, we ran out of hose!  We were so close!  A quick peak around the corner and down the hall revealed fire still pouring out of the room of origin; it had lit off again.  We were able to stretch a few more feet of hose up the steps and direct a stream of water into the doorway, and again knocked down a bulk of the fire with our indirect attack.  I remember thinking, “if we just had 10 more feet of hose…” merely seconds before my wish was granted.  

I heard banging at the front door, as the second arriving crew was trying to gain access with the back-up line.  The cussing I heard from Mike and Jason on the other side told me their door was a bit more of a challenge than ours was.  I scooted over to the door, flipped open the deadbolt, and yanked the door open.  The look in their eyes was priceless as the object of their frustration disappeared into the billows of smoke and was replaced with my smiling face.  Taking advantage of their moment of hesitation, I grabbed their nozzle, and remember saying, “Thanks, we need this!”   I dragged it back to where Danny was holding his ground at the top of the basement steps.  “Look what I found”,  I yelled enthusiastically as I showed him the second hose line now in my possession.  He didn’t hesitate to drop his line and join me as we turned the corner into the kitchen and finished dousing the flames that had devoured that room.  

We basked in the afterglow of our achievements and loved that, despite not exactly going by the book, we successfully stopped this fire from taking the whole house.  It took a few decades, but the latest scientific studies now are suggesting that fires be attacked exactly the way a couple of green, smart-assed eighteen year-olds did that warm afternoon.  Ah yes, we were so far ahead of our time!

I have done battle with so many fires since that one, but will always have fond memories of that first time.  If there were ever any doubts about whether I would love doing this “job”, they were washed away that day.  I had a taste, and I liked it!