Everyone has a Backstory

Ran a call the other evening for a 92 year-old female with a fall injury. Just the typical call we get when someone is aging and getting weaker. We arrived to find a neat "mother-in-law" detached house, nicely matched to a beautifully groomed house. Since it was dark and the houses were a bit off the street, the man of the house met us at the curb.

My engineer immediately recognized him and they began discussing the horrible fall he had about a month ago that broke off several of his teeth and from all accounts was a pretty bad fall. We went on up to the side house and met the wife with her elderly mother. The elderly lady was not significantly injured, but we decided to transport because she was generally getting weaker and the wife said she was not really able to take care of her mother so much. As conversation continued, the wife causally stated that she (the wife) had had two pulmonary embolisms within the past several weeks and had nearly died. Consequentially, the wife was in not position to care for her mother.

I continued to have a conversation with the wife as we "packaged" the patient and headed for the door. I said something about how the family was really having a hard time of it with all the medical issues. Then she turns and says something about her husband having his finger bit off. "WHAT?" I asked...

"Yes," she says, "he is missing about a half inch of his little finger." She continues to relate the story where their 24 year-old son had a psychotic break within the last few weeks (not sure about the time frame) and bit off the husband's finger and was now institutionalized.

Sometimes it is good to remember that we all go through some rough times and people next to you might be struggling more than you know...

Problem Solved

Having recently returned from the East Coast and the wonderful snow, it made me appreciate the relatively mild climate in which I work. I do not need to worry about hose lines freezing full of water, hydrants buried in snow, and the general fun and games that goes with emergency operations in the bitter cold. On a related note, apparently snow can be a real problem as you need to push and pile it somewhere...

In New Hampshire (per a animated Celtic firefighter named Don) the piled snow becomes a real problem. It was decided that they should just push all the piled snow into the ocean, but somehow that was not environmentally friendly. While I was pondering that conundrum, he went on to describe how one transplanted redneck decided to fix the problem of the huge pile of snow in his driveway in town.

Apparently, the simple solution what to construct a teepee type shelter over the giant snow pile, light a fire in said tent, and wait for the magic to happen. Enter Don the firefighter who explained that this was not a good idea in several ways. As the "discussion" about the appropriateness of the snow pile reduction project continued, there was a giant sparking commotion as the fire set the tent on fire and then promptly burned through the power lines above, leaving the homeowner without power - and underscoring Don's analysis of the validity of using a fire - in a tent - under the power lines - to reduce the snow pile...

When Animals Attack

This morning on the way to work, the radio personalities were asking for animal stories which got me to thinking...

A few years back we were dispatched to some low income housing for a "medical problem". Now this kind of problem can range from a sliver in the toe (actual dispatch), to itching private parts (actual call), to my cat is sick and I am afraid I will catch whatever the cat has (actual call)... so I think you get the idea that this type of call does not rate high on the excitement scale.

We arrived on a beautiful spring afternoon to find a 30 something year old male sitting in the semi-dark of his living room. As we begin chatting about why he might need the services of three highly trained medical professionals, I noticed the very symmetrical stack of pizza boxes that had accumulated next to the lazy-boy chair. It was interesting to note that apparently if you order enough pizzas  and then stack those boxes, eventually they will be the correct height to serve as a very functional and highly stylish end table near your chair.

As amazing as the pizza box stack was, we were suddenly distracted by a "fluffing" wind like noise somewhere down the hall. Out of the gloom of the back bedroom flies the biggest parrot I have ever seen. As it sails into the living room, it takes aim at my firefighter and decides her shoulder would make a perfect roost. She ducks and tries to avoid the bird, but not to be dissuaded, it lands on her shoulder. There she is looking like a firefighter pirate, and meanwhile the conversation about how much the patient's stomach hurts continues.

At this point, I make eye contact with my firefighter, and we both start losing it. She manages to unload the bird and we both head for the door, leaving the poor engineer to continue the patient exam, while we do our best to dash outdoors to stifle the extreme case of very contagious giggles.

Prius Attacks Man in Parking Lot

News story

Some people are just lucky I guess. This man gets out of his Prius which is beeping/cussing at him. Mostly likely, that is because he is getting out of the car, and it is still in REVERSE. Something about those electric cars seem to confuse older people when they don't hear the engine running.

Anyway, the older gentleman simply stepped out and the car went to dragging him until it ran into another car. Only problem was that the car door was completely bent forward on his car until it basically touched his front bumper, and it was sitting on his chest.

We arrived to find two bony legs sticking out from between the cars, and the old guy definitely pinned with that car door on his chest. We attempted to move his legs and found that his front tire was sitting on his pants so that his leg was pinned.

We quickly jacked the car up (releasing the pant leg and the weight from his chest). He then brushed himself off and decided he was fine!

Spooky Fire

On a run the other night were the caller was very specific; the flames were about 10 feet high and that was a really big fire in that backyard across the railroad tracks. So we got in our gear, turned on the lights and siren, and got ready for some hero like action.

In the neighborhood where the fire was reported, all was quiet. We slowed down, rolled the windows down to smell for smoke, and started searching. No smoke was wafting on the evening air, and one of the guys comments, "we should be smelling or seeing something by now!" After all, ten foot of flames is hard to hide on a dark evening.

Finally at the described address we sat - wondering where to look next. Then it hit me! The inflated Halloween ghosts decorations in the yard were well lit, waving in the light breeze, and...were about ten feet tall.

I'm in PAIN!

The other day while browsing through a JEMS (Journal of Emergency Medical Service) article about "drug seekers" I found a very humorous list of symptoms/behaviors. Within the medical services, it is common for people to seek narcotics. Often it is because of drug addictions or occasionally, because they can sell the pills on the street for greatly inflated prices. Anyway, I was reading this list of behaviors that ran something like this:
- "I have pain that is a 30 on a scale of 1 to 10"
- "I am allergic to Tylenol, Ibuprofen, aspirin, etc" (all the common non-narcotic drugs)
- "Please give me some ________ (always a very specific narcotic drug)
- "I cannot get in touch with my regular doctor today (it is Saturday and they state the pain started two days ago)"

Not sure if that is a complete list, but you get the idea. Within the hour, we were dispatched to woman complaining of chronic 'hurts all over' pain. She was overly verbal, and spewed a plethora of symptoms, history, and complaints. I suddenly found myself having a hard time not laughing as I realized she was basically going down the list I had just read. As I moved outside to get the gurney I noticed her car as being perfectly capable of transporting her down to the ER for her pain medication. As I looked closer I saw what I thought was the typical white outlines of the family, kids, dogs, etc. but in this case it was the universal pain scale.


All I can say, this woman seemed to have taken the concept of pain and turned it into a lifestyle.

Grumbling

Sometimes it is a little hard not to grumble when we get dispatched to the Alzheimer's ward for the fourth time in a shift. Usually, the complaint is confusion or chest pain or back ache or something else that the patient, CNA, or other disinterested by-standers have a hard time describing. In most cases, we get called late at night for something that has been an on-going problem for several hours or even days.

So when we were dispatched once again to a chest pain call - I was grumbling. It was late in the evening, the location was the same old place we had been responding to all day. As we went en route, we got a bit more information - the patient was a 39 year-old female and had just walked in off the street, smelling of alcohol. This elicited and whole new line of grumbling and complaining as this was sorting out to be a transient who probably just wanted a warm place to sleep for the night.

Once we arrived, the grumbling stopped (at least the verbal part) even though one of the first things we discovered was that she had anxiety problems, for which she was taking medication. At least that made sense, because she did appear anxious.

But then, even though there was a bit of alcohol odor, she was not intoxicated, was clean, articulate, healthy, etc. About this time, I was thinking we might have miss-judged the situation. A quick EKG and it was confirmed. At a heart rate of over 180, she was quickly headed towards complete cardiac failure and death. The grumbling suddenly was ancient history as we started an IV, delivered Adenosine, momentarily freaked her out completely as the medication stopped her heart for about 2 or 3 seconds, and then we all (especially the patient) breathed a bit sigh of relief as her heart rate returned to normal and she was fine.

Oops...

Every now and then, we get a bit caught up the moment when it comes to fires. Even with years of experience, there is a sense of urgency when people's lives and property are at stake. So when two well-experienced officers responded to a house fire, the only real unusual thing was that both were on a medic unit due to an rare overtime scheduling issue.

Since they were out and about on the streets the time of the call, they arrived ahead of the engine. It was obvious to them that there was a large volume of smoke to the rear of the house. They quickly donned their gear and radioed the first in engine that they were ready to make things happen as soon as they could get a hose line.

As the engine arrived, there was a flurry of activity and a charge to the front door. One of the previously mentioned officers banged on the door, checked to see if it was locked, and then turned and "mule kicked" the door nearly off it's hinges.

This turned out to be fairly disturbing to the little old couple sitting watching television in the same room. It also became rapidly apparent that that smoke was actually steam from the dryer vent due to the unusually cold and moist weather.

Like the title says...ooops!

Dark and Stormy Night

Tonight it raining hard and most people are safe at home watching football. Then there are exceptions like the woman who called 911 three times within the hour. First, she reported a man with a broken neck on the bike path. Of course, that is pretty unlikely, but we still had to spend twenty minutes hiking down the path in the driving rain. The second time she called, she reported that the man was now floating face down in the canal. That too is bad, so we spend thirty minutes slogging through the wet grass and frightening the sleepy ducks. We then looked for the caller with no success.

On returning to the station, I decided to walk over to the dispatch center and see what else I could find out or probably to be more honest...make sure that they knew that this was a police problem and NOT a fire department problem.

In dispatch, I found the staff discussing that the police had found the "body". He was walking around in Taco Bell and the woman who kept calling was looking for him in Shari's Restaurant. Truly...it WAS a police problem.

Career Firsts

After almost 20 years as a firefighter, I often feel that most of the calls we run are so routine as to almost be boring most days. So it was quite a shock to find that I have had four "never before in my career" experiences in about one week.

It all started with the horse being ejected from the trailer (see last post). Then the weirdness continued...

#2 - We have always said that if you have a panic attack, start hyperventilating, and do nothing to correct the situation, eventually you will pass out and your body will correct the problem for you. Well, that had been somewhat theoretical in my mind up to the point we were dispatched to a 24 year old woman who actually breathed so rapidly for so long that she did pass out. All was well as her body "rested" and was allowing the carbon dioxide levels to built up to a normal level. Of course, while this was happening, her body had no desire to breath...so the husband called 911, received CPR instruction, and started crunching on her chest. We arrived just in time to have her somewhat wake up only to get startled by the firefighters and the pain in chest. This caused the panic, rapid breathing, passing out, etc. for another cycle or two until she finally calmed down and was transported for a bruised chest.

#3 - While working at the airport station, life is mostly a slow, somewhat boring routine. At least, usually it is that way. On occasion, we are tapped out on time trials, which consist of dashing out with our truck, spraying some water, and satisfying the FAA requirements. When the tones went off last week, it was one of the time trials again...or so I thought. Actually, it was a small airplane with its engine on fire. Although it was a fairly small fire and I was able to put it out with a hand extinguisher, it was one of those calls that most people go their whole careers without actually having an aircraft fire.

#4 - They say things come in groups of three. With that in mind, I would have preferred not to add this one to the list of career firsts. It all started with a routine respiratory distress call. As the house was rather cluttered, I was crouched down by the couch, sorting through the patient's medications, and typing up the report on the laptop. All was going well until someone opened the back door. Suddenly there was a small bulldog prancing on my keyboard and barking in my face. I immediately closed the lid on the laptop to protect the keys, just in time to have a family member reach over the couch to grab the dog. Apparently, this was like squeezing a lemon because the dog promptly urinated all over my paperwork, clipboard, and everything else in the vicinity. Like I said, could have gone the rest of my career with out this particular experience!

A Horse of Course

Last shift at about noon we were dispatched to a motor vehicle accident on the freeway near our station. Enroute, we learned that a horse was involved. Already, we were thinking this was going to be a issue, since horses and freeway traffic do not mix so well socially. When we arrived we found that no humans were hurt, but a horse trailer has come unhooked from the pickup, swapped ends, backed into the concrete barrier, and ejected a horse out the back. The horse was lying at the back of the trailer with flailing feet beneath the trailer. I took one look at the wild eyes and decided that we were going to have a problem when that horse finally got to it's feet and ran out into the heavy freeway traffic going by on the blind corner.

As luck would have it, a veterinarian was on scene within minutes. He was a little guy, but he just reached down, grabbed a handful of mane, and dragged the horse out from under the trailer. He then sedated the other horse in the trailer that was about to come uncorked. Within a few minutes the horse on the ground slowly stood up on three feet, gradually shifted weight onto the fourth leg, and decided that the experience of crashing on the freeway was something not to be repeated. The horse inside the trailer calmed down and was led out on the shoulder of the freeway. A few minutes later, the horses calmly were led to the nearest exit, boarded another trailer, and continued their much interupted journey.

Diagnostic Insight

Sometimes when trying to diagnose a medical problem or complaint, one must use all of the experience, tack, insight, and training you can muster. Such was the case the other day when my firefighter/paramedic Mike was dispatched to a seemingly routine chest pain call at a nursing home.

Old ladies are somewhat like young children - they do some interesting things and use somewhat obscure logic on which to base their actions. This came into play as Mike tried to determine the nature of this lady's chest pain. Since some cardiac problems are brought about by exertion, he asked what she had be doing that day. "Shopping" was her short answer. After he did a bit more of the exam, he determined that her chest was actually very painful to pressure. This pretty much rules out cardiac problems as the source of the pain...and leads to muscle or skeletal issues.

So - next question he asks is "What did you buy?" thinking that she might have bought a large item like a vacuum cleaner or something that strained her ancient frame. No, she said - just a bra.

At that point, Mike summoned the staff nurse and quietly asked for her to unhook the old lady's bra in the back. Immediately, the old lady exclaims, "Wow! All my chest pain just went away!"

And You Think YOU are Having a Bad Day?

A few shifts ago we were sitting in the station drinking our morning coffee and waiting for something exciting to happen. At that point, the tones went off and we were dispatched to a pedestrian vs. auto. Usually, this is of some significant concern (mostly for the victim) but since this was in a small parking lot, we immediately assumed this was probably some minor scrapes and bruises sort of call.

As we arrived, I saw a well-dressed 60 year old lady lying on her back in the middle of the parking lot. Not so much unusual about that, until I noticed and very distinct tire track that ran diagonal from shoulder to hip. And yes...she had been ran over by her own vehicle (Ford Escape) as she tried to stop it from rolling as she forgot to set the brake.

The long and short of the story is that she was really was not hurt badly. Since in my assessment, she had some built-in "padding", the vehicle caused some bruising and broken skin, but really not much beyond that. In the end, as she was trying to straighten her wig, I realized her dignity was probably bruised almost as much as her body.

Diagnostic Experts in the Field

It is common and downright entertaining to have self-proclaimed experts doing diagnostic work in the field. Sometimes this is the crowd gathered around some hapless old lady who happened to slip and stumble over a curb. The crowd usually insists that the victim must lie down on the cold ground until we arrive because of a broken hip, heart attack, paralysis, hyperglycemia, etc., never mind that the victim usually bounces to their feet and dust themselves off, given half a chance. This same process is a purveyor of sinister and worst-case scenario predictions. Kind of like the kid that thinks a headache MUST be a tumor.

Within the last week, we have had two calls that fall into the above mention category. One was nursing home request for transport for a guy recuperating from back surgery. When the nurse decided he was in pain (note that the patient wasn't the one making decision about calling 911) we got called to haul him back to the hospital. Of course we were dispatched code 3 (lights and siren) and on our arrival the patient was resting as comfortably as you can with recent back surgery and really did not have a complaint. It was then that the nurse quietly announced that we were called because of a possible DVT (Deep Vein Thrombosis), which does occasionally happen, but is very unlikely and would rarely be considered an emergency.

And just today...we were dispatched to a not breathing, unconscious older lady. After making the best speed possible, we arrived to find the husband on the porch saying that his wife was in a coma. As soon as I entered the bedroom, I found the wife chatting on the telephone - obviously NOT in a coma. Apparently, she had been asleep, and with the sleep medication she took, was a bit hard to wake. On the return to the station, we decided that technically the old man's diagnosis of a coma was correct, but the sleeping was a very common type of coma with a rather short duration.

Old and Experienced

This morning we responded to a 92 year old lady with some chest pain. That is about as routine of a call as you can get. City-wide, we probably responded to a similar call about five to ten times a day, every day of the year.

As we arrived, we found a little old lady sitting in bed, really not looking too bad considering that she was born during WWI, the Russian Revolution, and the same year as Ernest Borgnine. When asked what the problem was, she stated, "Well, my chest feels heavy since I had a heart attack on Sunday (this being Tuesday)". This of course lead to questions about what the doctors said about the heart attack and if this was her first one, etc. She was certain that she had never really had heart trouble before, but she was just as certain that her old ticker was not ticking normally. As we focused on how she was treating her heart attack, she finally gave us the whole truth. Apparently, at 92 years old you learn some things because she then stated, "I did not go to the doctor or the hospital, but I had a heart attack...I KNOW how they feel!"

The Games We Play

As I have related before, some firefighters take no small pleasure in playing practical (and sometimes not so practical) jokes on one another. Of course, the practical joke is usually improved, enhanced, or otherwise made more outrageous with the repeated telling of the story.

A good engineer is more than just the guy that drives the firetruck. He also take great pride in the equipment, polishing things until they shine. Some take the details and specifications of all to a whole art form, with extensive memorization of minutia down to the number of bolts required to hold the motor to the frame. So when one engineer got the reputation of being more detail oriented then any other engineer, the stage was properly set for a practical joke.

Another crusty old engineer, seeing the effort to detail, seized the opportunity to pick up any old bolt, nut, or other small part lying in the street, hit it with some red paint, and throw it under the engine. This caused a great deal of mirth and entertainment, as the detail oriented engineer spend hours with a flashlight under the engine, determined to find where that loose part belonged.

In another case, a firefighter rolled up several towels and stuffed them between the box springs and mattress of the probie. Three weeks later, he noticed there was more sheets and other "stuffing" in the same space in an attempt to level the bed. Eventually, the probie complained about how another very large firefighter how worn out the mattress. Dispite the presumed many nights of tossing and turning, did anyone ever mention the real problem to the probie.

Bird Gone Bad

Today we were dispatched a small grass fire. This being July, that is really quite common. As usual, we were trying to piece together all the information about the size of the fire, the location, any buildings that might be threatened, and the best access to the area. Into the mix of information coming to my computer was a note about a large bird. Typical of emergency communication, some weird notation is pretty much ignored in light of the more evident column of smoke spreading across town.

As we put the fire out, more details came floating in. The business said that their electricity briefly went out. Another report specifically said a large Peregrine falcon landed on the wires and burst into flames. What we found...one leg with attached talon...well cooked.

Trying to Help

It is very common to get dispatched to respiratory distress. For some reason, this is the "catch-all" term that is used to describe everything from traumatic murder victims to someone with left toe pain (on-going for the past 3 days). Then on very rare occasions, we actually have someone gasping for air, circling the drain, or otherwise failing to properly use oxygen.

So with nearly every medical call being dispatched as respiratory distress and most if not all, being false alarms, it is very easy to become a bit jaded and suspect of the patients when we arrive.

On one occasion, after being dispatched to a "respiratory distress" we found a very large woman sitting in a chair in no obvious distress. The questioning continued as we began taking vitals (all normal of course). Typical of a scene like this, there is always at least one family member, concerned friend, or casual passer-by that has all the answers, knows exactly what is wrong, and is shocked that we with all our training and equipment, do not agree with their obviously superior diagnosis of the patient.

So initially, the old duffer in the corner was ignored as he seemingly wanted to weigh in on the proceedings. Eventually, one of the crew managed to pay enough attention to realize he was actually in respiratory distress as he croked, "hey....you are...gasp gasp....standing...gasp...on my ...gasp...oxygen......supply tube...gasp".

Well, at least we now had a legitimate respiratory distress patient that we could easily help!

So What CAN You Do?

Firefighters are action oriented and have strong tendency to try to fix or improve the situation, no matter what. So you can imagine the growing frustration in the following story, related to me by the crew of Truck One.

It started out as a routine car fire in a parking lot downtown. Usually this is a single engine response, but since Engine One was on another call, the truck was dispatched. This truck in particular did have a small pump, a booster line (hard rubber hose), and about 200 gallons of water. This would normally allowed the firefighter to rapidly "fix" the situation and get back to the station. But not today...

The car was a VW bug very much on fire, and all was going well as the truck arrived and attempted to put some water on the fire. Immediately, the rubber hose blew apart due to some recent and obviously incomplete repairs. Then...the battery of the car shorted out through the starter and with the car in gear, the car started moving. The firefighters grabbed and used every fire extinguisher to no avail. The took an axe and flattened all the tires. The valiant VW still sputtered along. Eventually, with three (count 'em three) more cars now on fire, backup arrived to relieve the crew who were now wishing for hole in which to hide.

To the crews defense, VW bugs are known to have magnesium which will burn at a very high temperature and is not readily extinguished with water or pretty much anything for that matter.

Life of a Probie

The new guy (known as a "probie" for probationary) often has to put up with a lot of teasing, extra work, and sometimes downright harassment. Most of it is all in good fun, such as telling him that he has to be the first one to answer the telephone when it rings - then dashing to get there ahead of him. This trick alone has accounted for at least one "time lost" injury. Reading between the line, you will realize that the dash for the telephone is hard on carpets, furniture, and firefighter's anatomy.

The new probie at Station One is not that young, has been in the military, and is a challenge to the guys trying hard to make life entertaining while picking on the probie.

So there is a Paramedic Firefighter named Joe that does field training for the new guys. He is a church going Christian and about as nice and quiet of a guy that you would ever meet. As the probie was soon to be working with Joe, the guys at Station One decided to set thing up for sheer entertainment value.

Under the guise of giving the probie some helpful advise, they warned him about the horrible temper and anger problem that Joe exhibited on rare occasions. They then picked out a few things, like the morning paper in disarray on the table and told the probie, if Joe ever finds the paper like that...well, it just would not be good for the probie's career. Of course, then they would follow around behind the probie as he scurried to arrange the paper neatly, and promptly scatter it around the table.

After about 6 months of this, the probie finally announced to the crew when they again stressed how Joe was going have a fit of rage over some minor infraction, "I am beginning to think that this is just an elaborate ruse". Which was actually a relief to Joe and the rest of the guys, since the prank had gone on for so long, some were starting to forget their role in this charade.