Saturday, July 31, 2010

We don't need no Stinking Standards

Rhett over at the Fire Critic is Hosting this months edition of the First Due Blog Carnival. As this is both a Fire and EMS blog page and I have already put in a submission or two on the EMS side, I felt obliged to contribute something on the Fire Side of things, although this subject: What should the minimum standards be for firefighters?, is not as "simple" as Rhett would have us think. This subject also feels a lot like work for me because I teach this stuff and should really be working on my lesson plans (read: 'Select a subject and get moving') for next season's round of OSHA classes.
Currently, as Rhett points out, there are no consistent standards throughout the USA for Firefighters and some states have no stated minimums at all. These states mostly leave the setting of standards to the Authority Having Jurisdiction (AHJ) which in most cases are something like a Board of Fire Commissioners, or Executive Board in a in private Department.
I am a volunteer and can only speak to that area. In most states, there are minimums for career Firefighters as far as I know, but in my state, it is left up to the AHJ to decide what requirements they place on Volunteers. This passes the responsibility onto the AHJ so they can get sued instead of the State.
I have seen it run the gamut from requiring Nationally certified as a Firefighter II (pro-board cert) AND EMT-B for the minimum entry level, to having a pulse and being able to fog a mirror. I know of a Department not far from me that requires 3 airpack drills to be certified as interior qualified. I hate running calls in their district, I never feel safe.
For Volunteers, I feel that the equivalent of a nationally certified Firefighter one is acceptable as ENTRY LEVEL into the firefighting game, but it should not stop there and certifications should continue over time. There should also be a continuing ed program which can be rolled up into normal training cycles to keep the firefighter abreast of changes in technology, new threats and tactics. This stuff never ends and we all need to stay up on the things that can kill us. If you don't have time to train, you don't have time for the job either.
What's more important to me is the training our Officers receive and how well they stay up on what is current or even have basic scene management and decision making skills.
I have seen Officers at the assistant chief level and ABOVE that could not find their way around a scene is they had a map glued to their nose. These people scare the hell out of me because my ass is in their hands when I am on their job. Officers need to have required standard training because what I see in the volunteer service shows me that too many of the LODD's are caused by poor leadership.
That adjacent Department I mentioned has NO pre-plans! On a working fire job they shoot from the hip. They assign a water supply officer(WSO), interior attack officer, and a few others, but none of them are held accountable, nor do they talk to each other. I spent 5 minutes at a recent fire trying to find out who was the WSO only to find him at the REAR side of the structure advising the interior attack crew. He had tankers lined up coming in from both ends of a single lane road and we had no way to move water through. It was a mess. They also did not call a RIT team or a rehab crew in until after the fire was knocked down and their rehab crew staged at the end of the road 'waiting for patients'. This is all training related and the lack of working fires to tune up on.
All the ICS stuff is required and makes sense even if it is overplayed a bit, but what about managing a simple Single Family Dwelling fire? This is where many of us get killed or hurt. Why can't we come up with a practical exam that covers this basic skill and make sure EVERY Officer passes it with 98% accuracy? Lets put less emphasis on friction loss calculations and more effort into making sure any Officer in Charge can run a basic scene and put the right teams, apparatus, and support in place.
While we're at it, lets also teach all our Officers how to do a look test on their people and have the courage to pull them out when they don't pass. This would knock our LODD's down by 50%. Don't believe me? Read the next 6 LODD reports that come out and tell me if that Firefighter would not be here today if SOMEBODY had looked at them and recognized that something was wrong and MADE SURE they got the help they needed right then and there. I'll bet you a nickel that half of them would have survived if that simple function would have been completed. But that's a subject for another (long) post.

Help me out here..

OK folks, I've been rambling on here about all different sorts of subjects. By now you may have found something you like in my writing that makes you curious enough to come back. You also have decided what I might write that is of no interest to you.
I'd like to know, as most bloggers would, what is of interest to somebody who stops by here. Even if it is just general comments.
I'll be honest and say that in spite of what creative writing instructors will teach, I do not write with my audience in mind. I write for myself, to blow off steam, get things off my chest, and let the burden lay out there, instead of on me.
I can't promise I'll write what you like, but I will certainly consider it and maybe take a shot at it. By now I thought I would have found my groove, but it is still 'out there somewhere'.
Care to help me find it?

Friday, July 30, 2010

I suck

As a Human Being, I'm not a bad guy. People in my community think, and sometimes say out loud that I'm a great guy with a big heart who gives a lot to those who ask for it. I will not deny that mostly that is true. I have a hard time saying 'no' to good causes and intentions. I am an idealist, and I recognize that. I always hope for the best and try to help with worthy or worthy sounding causes. Over the years I have become a bit more cautious about how much time I offer, and make it clear where my limitations are, but for the most part, everybody can get some time out of me if they ask nice.
But as a grown adult, with a home and children, elderly parents (3), car payments, bills, and mortgage....I suck. I spend more time helping people who need it than helping my own family. For instance, if I hear about a needy family that can't afford a lawn mower to cut their grass, well I happen to know an elderly gent that gets old lawn mowers from the dump and fixes them up to run like new. But he refuses to sell them. I tell him the story, he gives me a mower, and I deliver it and show them how to use it safely. They give me a glass of iced tea, and we call it even. They can cut their grass, the old man feels good, and so do I. We all move on. I get sucked into cooking for fundraiser dinners for groups I don't know, giving ambulance/firehouse tours to Cub Scouts and Girl Scouts, running first aid meets for the Boy Scouts, helping setup events for the Church I do not even belong to, and all sorts of things I forget as soon as they are over. It seems that I'll help anybody as long as I have a hole in my schedule when they need me.
And therein lies my problem. One of the things I do not put on my schedule is my home and family. I guess I figure that the family stuff will always be there and I can do them when I have time. The problem is that I do so much stuff for others that I never have time at home. The house is in poor shape, the dishwasher is broken (wife doing dishes by hand for a month now), clothes washer not working properly. If my son didn't have a landscaping business, I don't know when the lawn would get mowed.
Tonight, my wife put her foot down (it's about time) and told me 'no more volunteering until we get some of this stuff fixed around the house' and she started to list a bunch of the smaller tasks, overlooking the big stuff I know I need to get done. In her charming way of pointing out my minor shortcomings, she has reminded me of the bigger ones. She never mentioned the department commitment, knowing that the 20 hours a week I put in goes without saying and she is not counting that as 'volunteer time'.
I'm glad she brought it up tonight, because I was thinking that I had some free time this weekend and could bring together a quick classroom session for driver training for my newer members. I think I'll hold that thought for a couple of weeks. If I didn't have my wife to tell me when I've gone over the line I would have strayed very far by now. Sometimes it's better to be a follower than a leader.

Thursday, July 29, 2010

Shorts or Pants?

Well EMT GFP was the sole voice responding to my query about whether EMT shorts are acceptable. In case you missed it, he came down in favor of the pants, but with some qualifications.
Perhaps I should better explain my reasoning in going with the shorts. Besides the normal volunteer EMS work, I do lot of volunteer work at public service events as an EMT. These are events like street fairs, concerts, and the like. A few weeks ago I did a 4 day bluegrass festival with about 10,000 of my closest friends camping for the weekend, 5 stages going 14 hours a day and lots of 'good times'. (It was an easy way for a lifelong bluegrass fan to get in for free, get fed, and have free camping for 4 days.) You can translate the numbers out into what an EMT would see over the course of those 4 days. But let me tell you that it was HOT. 95 degrees with 85% humidity and I can tell you that as I walked around the festival site and campground (about 75 acres). I believe I walked 25 miles during the weekend and doing that in long black pants would have had me looking like some of my patients.
The shorts I bought for the occasion were perfect!. Fit well, looked presentable, had the pockets (not that I would fill them in that heat), and allowed me to stay as cool as possible. The rest of our 25+ member crew wore shorts as well, EMS or whatever they had and would not have done otherwise. (By the way, I had a blast and learned a LOT working with the other providers because we had RN's, LPN's, PA's, A dentist/EMT, Paramedics, and EMT's all working on a BLS level and sharing notes and treatments. It's amazing how we all worked together and asked each other for opinions and help. All this without a single Administrator on site. I had an E/R RN turn a potentially unstable patient over to me saying "this is really your field, not mine". It blew me away. She meant the 'out of hospital' (no Doctors and no drugs) part. I had watched her all week, she was competent for sure, but out of her E/R environment. I think she gained a new appreciation for what we do on the street with the tools we have.)
On the other hand, this past weekend I did an 8 hour shift at a single day fundraiser concert with my home crew, all of which are half my age. I suggested we wear shorts, but the youngsters said they wanted to present a 'more professional' image. Being the type of leader that enjoys allowing my people to make decisions and share in the results, I went with the consensus opinion. Uniform shirts and EMS pants were the rule of the day. We were there for an hour before they started to re-think the decision. The promoter of the event came over to thank us at about the 7 hour mark and said "Man, you guys look great and provided a professional presence, but next year, please be comfortable and wear some shorts and tee shirts! I start sweating just LOOKING at you!" It was 95 degrees with a temperature/humidity index of 104. I found that standing in the sun for a few hours allowed me to acclimate eventually, but I am not sure what my energy level would have been if one of the big benefactors had dropped into SCA while dancing to a John Fogerty tune ("Down on the corner, Out in the street..." makes everybody dance).
Sorry folks, I may be against the mainstream and current teachings, but I'm gonna stick with the shorts. My comfort speaks to my ability to help my patients in extreme conditions. It's the same reason I wear long wool underwear in February when it's 20 below zero.
Feel differently? Leave a comment and let us all know.

Tuesday, July 27, 2010

Say What?

"HEY SIR!" I look around. I am just minding my own business walking down the middle of the street during a music festival checking out the vendors. Following the crowd. No uniform or distinguishing t-shirts as I am way off duty, and enough people at this fair recognize me anyway from various classes I have taught or jobs we've worked together. Hearing somebody calling to me is not unusual today, but hearing somebody call me "sir", means they don't know me. (I get called lots of names, nick-names, and 'other things', but "sir" is not one of them.)
I turn and finally identify the hailing party, a young man, probably mid twenties, giving me the thumbs up signal and he says "nice mustache sir!". His buddy nods in agreement and says "yeah man, we're working on it too!" and he strokes the close cropped hairs surrounding his mouth. I give them a wave, mumble something, smile, and keep moving.
The truth is, I'm speechless and don't know how to respond. They struck a staggering blow to my self esteem without even aiming. Facts: I am not a pretty guy. I have never been concerned with my looks and I know there is nothing special about me. I keep myself properly groomed and acceptable, but flashy haircuts, slick clothes, cologne, and things like that don't enter into my thought process. Also, for the new reader, please note that I am not a youngster and have been happily married for many many many years. I really get thrown when somebody makes a comment, good or bad, about my appearance. It reminds me people are LOOKING at me and I don't like it much.
My mustache is really nothing special. Some call it a funmanchu, but the fact is that it is grown such that it leaves my chin just above the jaw line and hangs down about 3 inches. I shave up and under it every morning to make sure the connected hairs don't get over the bone line. This is so that my SCBA mask goes on and makes a seal without interference. The 'stash just gets shoved up inside the mask. If it gives me a problem, I can cut it clean with a single hack from my trauma shears. My version of practical. No body seems to notice this except for a few friendly comments at work and some of my younger crew mates who joke about getting a hold of it to make sure it's real. I invite them to try if they want that to be the last thing they ever do on this earth, and we all chuckle. But having somebody pick me out and choose that to make note of is disarming to me.
It's only happened once before. About 2 years ago I attended a lecture presented by Chief Billy Goldfedder. During the break I went down front, introduced myself and told him how much I was enjoying his program. He looked up and said "hey, nice 'stash!". I think I blushed, I KNOW I was embarrassed. If you know the Chief, you know he sports a thick, heavy, well trimmed mustache. Mine is skinny, scrawny, spindly, and funny looking. I completely forgot the point of my attempting to speak with the Chief, thanked him again, and wandered off.
The young dudes who called me out yesterday threw me off and now I'm really wondering why. What's wrong with me that I can't just accept a nice comment and move on? Perhaps it's because I don't hear many nice comments and rarely take them seriously.
Maybe I should just cut the damned thing off and forget about it.

Sunday, July 25, 2010

In Fire & EMS EVERYTHING is Relative.

I’m thinking a little more in advance this time about the assignment for the next edition of the Handover Blog Carnival, which is “Crisis Patients”. Hopefully I’ll do a bit better this time due in part to the fact that I have more time and also because the ‘assignment’ fits a little bit better inside my head.
“Crisis” is a relative term. It’s a lot like “really bad”. I frequently work jobs where I find a particular senior Fire Officer there when I arrive. He’s a good Officer and has seen a lot, but most of us know that he ‘doesn’t do blood’. It’s just not his thing and he gets excited at any medical call where things aren’t calm and under control. He will frequently warn me as I enter a scene that “It’s ugly in there man, be careful”. I know he means it, but invariably when I get in there and scope it all out, it’s just a routine low level job. No big deal.
It’s the same with “Crisis”. One person’s crisis is another person’s routine job. There is also the perspective of view, i.e.: are you the person addressing the ‘crisis’ or the person experiencing the ‘crisis’?
After you play in this game a little while you start to collect incidents that could fairly be categorized as “crisis patients” and I’m sure there will be some good writing about these types of jobs by the other contributing writers to the Carnival.
In the case of serious life threatening jobs, the crisis is pretty evident and we all go to work applying our assessment, treatment, and transport options to the best of our abilities and within our various scopes of practice. On occasion, some of us pull a rabbit out of a hat and come up with a solution to a critical problem which helps a patient get to the next stage of treatment where they otherwise might not have. I love these stories because they teach me much about creative thinking and make me better.
Sometimes though, the crisis is hidden and can be easily missed by providers or crews that are just doing the job. These are the calls that concern me. Let’s face it, 95% of what we do is very routine, boring, or even useless. Transporting the drug-seeker so he can take another shot at fooling the E/D Doc to get his fix, bringing in the stubbed toe, toothache, or “I’m sweating too much” is enough to make you consider other options, but that’s the job we work.
Many times the patient themselves do not realize they are in ‘crisis’. Take for example the overweight 59 year old male who has chest pains and the monitor reveals a severe MI. We know this guy needs attention now and he is insisting that he just “needs some rest” and “will be fine in a little while”. It’s our job to identify these types of crisis and do what we can to mitigate them.
It’s along these lines that I find the patients that cause me concern. The LOLFDGB (Little Old Lady, Fall Down, Go Boom) who calls us for lifting assistance to get back up to her walker. On first glance, it’s a routine call, check her out, help her up, get the signature, and be back in service. But we make a habit of having one person check around to make sure everything is cool. Is there food in the fridge? Is it fresh, edible, and appropriate? Is this house in decent order, or is it a mess with garbage on the floor and filth in the kitchen? Does the home have adequate heating or cooling? In short, how is this patient coping? Do they need other assistance? Would a call to the proper agency be in order to help this person move through the stages of life and degeneration? The elderly can be in crisis and lack the ability to recognize it. I see these too often. Sometimes they just need an outsider to tell them the things their family has been trying to tell them for a while, and sometimes they need more.
Sometimes the ‘patient in crisis’ is not even the person we were called to help. On occasion it’s a family member, friend, or neighbor. I am thinking about the unexpected cardiac arrest or the suicide that comes from out of the blue. There is little we can do for the long deceased, but what about the person who discovered them and called us. These people are experiencing a true Personal Crisis. It might just be the worst day of their life. What can and do we do for them? What do YOU do?
There is little to no training in the EMT-Basic classes, and just a tad more in most Paramedic program and I believe this is a real problem. The agencies would tell us that we ‘treat and transport the sick and injured, the long deceased are not our problem and neither are the neighbors’. But the fact remains that we, the providers, ARE on scene, and DO see the anguish and possible symptoms of those affected by the incident. For myself, I can’t walk away until I have done what I can for these folks and gotten them referrals which might give them peace. What do YOU do with your Personal Crisis patients?

Friday, July 23, 2010


Never had them. All the ugly calls I've had have never caused nightmares, not one. I got into EMS as a result of an ugly call when I was a civilian and watched a friend die before my eyes. I didn't know what to do besides get help and call EMS, and as we were in the woods almost a mile from the road, that was tough enough, but there was nothing I could do to help my friend as everybody else worked on him. In truth, the autopsy results showed that even if he dropped in a cardiac care unit, they would not have been able to save him. (No, I can't explain further as I didn't understand the medical information at the time.)
I've had lots of sleepless nights after that event for about 2 years, reliving the moment and my failure to do something useful to make a difference. But those were not nightmares, only guilt. Bad dreams, sure, but no nightmares.
Since that event, I decided to be better prepared and I joined the local Squad. The short story of progression is this: Driver> Certified First responder> Exterior Firefighter> Interior Firefighter> EMT> EMS Lt.> EMS Capt.> Fire Service instructor> present. Of course there are a ton of other certs and classes in there like extrication, swiftwater, tech rescue, etc. But you get the idea.
Never had nightmares. Not for the fatal fires, the PED calls, the very ugly motorcycles accidents, nothing. Rough nights when it was hard to sleep? Of course, don't we all?
Last night was different. I had my first nightmares since I was a child. I have no idea why. No unusual stress at work, no recent bad calls with bad outcomes. Nothing. The details, like most dreams for me are sketchy, but basically I witnessed a shooting of a military officer by a subordinate while we were all operating at a domestic natural disaster. The subordinate was distraught due to the stress of the detail and he drew his sidearm. The officer tried to blow it off and talk the guy out if it, but got shot in the process. The bullet went through the femoral artery and I jumped on it, but had a hard time finding the hole and blood source. I only had my little side pack and minimal tools/toys to work with. I woke from the dream before I found out if I did him any good or not. My final impression was that of despair and frustration. I don't know why.
What I do know is that I could not close my eyes without the damned nightmare coming back. Thinking happy thoughts did not work.
I don't know which was more disturbing, having the nightmares themselves, or the fact that I got nightmares in the first place.
I'm thinking the latter is the bigger concern. I'm hoping that soaking my brain in a little ETOH tonight will help me sleep tonight.
Please, don't anybody out there mention CISD, it ain't happening.

Thursday, July 15, 2010

Back for a short one......

Well the time off visiting family was blissful. There was no internet or cell phone coverage at 'the farm' and it was interesting to watch all my cousins walking up and down the road staring into the little boxes in their hands looking for a signal. I broke the habit after just a day or so.
So I have been back in town and at the paying job for this week, but am leaving tomorrow to be part of the EMS team at a major music festival for the next 3 days. Should be fun and give me a chance to improve my skills.
But I have enough time to post this short one and ask y'all a question that has been burning at me for a couple of years.
We were all taught "BSI, Scene Safety" until we were sick of it. We all practice it without thought on a daily basis (RIGHT?). For most of us this means no unnecessary exposed skin and proper PPE at all times. In the Volunteer service we were all cautioned against showing up at calls in shorts and flip-flops. Very unprofessional, of course, but also dangerous for the responder. Glass, blood, torn steel, are all nasty on the dermal layers. So accepted practice has always been long pants (no shorts or skirts), at least a short sleeve shirt (long sleeve is better), sturdy shoes (preferably EMS boots with a composite toe), and the gloves, glasses, etc..
I know that I am NOT the only person that is uncomfortable working a job in the blazing sun on the side of a blacktop road or off in a field with those terribly comfortable (?) EMS pants. Yeah they look cool and have enough pocket space to store all the gadgets any whacker needs to have, but man, they wear me out. They are HOT, and they don't breath which keeps the heat in. They also suck the heat out of the sun and inject it in your body. They are EVIL.
This spring I decided enough is enough and I bought a couple of pairs of EMS shorts. I cover most weekends as a first responder (go direct to the job and let the rig meet me there). Those pants were killing me when I was carrying gear 1/2 mile to a patient in the woods, or carrying the same patient out. If we have a bad MVA I can always throw on my EMS bunker pants (BBP barrier, more pockets, etc.), but for the routine calls, the shorts have been SO much better. I'm sure they will rule this weekend in 90+ degree heat while treating the drunk, fallen, and over-partyed.
So here's my question to you all: Is it so bad wearing proper and neatly presented shorts as opposed to pants while on duty in the summer? I know your agency probably does not allow it, but if they do, let us know, and what the rules are. Everybody else, just leave a short comment and let us know what YOU think, not your agency. I think this might be an interesting point for discussion.
If it turns out to be of interest, I might continue to pursue which shorts work best, or are most comfortable. I have already purchased two pairs that are very different and I have begun forming opinions.
So leave a comment and let us all know what you think.

Wednesday, July 7, 2010


On vacation from the paying job this week (read: Forced plant shutdown), so I've been using the time to make all the calls we get and provide coverage for those who are out working in this heat.
Last night I spent a couple of hours listening in on the FirefighterNetCast with Justin Schorr, The Happy Medic as the guest host for this issue.
I Usually don't have time to listen to these long shows and mostly they focus on stuff in the career service which doesn't really parse with our way of life in a rural volunteer situation. This broadcast covered some of the more fundamental issues concerning staffing on the fire scene and how it relates to safety and getting the job done. Interesting callers helped mold the conversation and all in all it was very enjoyable and provided some learning.Also some very good stuff on situational awareness which is something I am always pounding into our people. Complacency Kills, Indeed. They also included some updates on the CoEMS naming contest and prizes as well as other things to do with where CoEMS is today and where it is headed. The broadcast is available today in the archive, so check it out if you can spare some time or download it into one of those pod thingies.
My posts will cease for a couple of days because the wife and I are headed off to one of the old New England states for a family reunion. I am looking forward to shutting off the pager and seeing cousins I haven't seen in two years or more from all over the country. If opportunity presents, I MIGHT just jump a call with the local Department where my cousin is Chief.
Everybody be Safe and stay Cool

Monday, July 5, 2010

Carpe Diem!

It's a new day and just Perfect weather early this morning. The heat and humidity will arrive in a few hours, but for just now, it's perfect.
Last night I was so tired I went to bed before 11pm, which I never do on a duty night, but I was short on sleep from a draining midnight call the previous night. I didn't get much sleep that night, just kept seeing the Mom's face in my dreams. But last night I was able to sleep the ENTIRE night through! It's probably been more than a week since I have slept from bedtime until wake up time. Wow, what a great feeling. Good sleep is underrated.
For the first time in several weeks I feel like DOING something. I've already figured out why Blogger will not allow me to paste my posts from Word and found a happy work around.
I am also listening to Confessions of an EMS Newbie which I found a week ago but only listened to the latest Podcast. Now I'm catching up. It's well done presentation and I hope it will help me to empathize with the new EMT's we have every year, and help them slide into the job easier. Sometimes we lose perspective.
I feel so good I may even go catch up on the EMS Garage Podcasts later in the day when the heat comes up. Most times when I listen to these I find myself nodding in agreement, but sometimes I find myself muttering at the PC and arguing with those who can't hear me. I am about a month behind on this one. Back when they were talking about how Bloggers who choose to remain anonymous have no credibility, I stopped listening because the panel had a single sided point of view. I have very good reasons for remaining anonymous, and the loss of Medc999's blog is just a single case where my reason's become evident. (cue the screaming rage> "I TOLD YOU SO!") I keep forgetting that good progressive dialog by definition means you will not always agree with it and will (hopefully) learn the other point of view and consider it. I just wish the broadcast was live and there was a chat board for real-time comments. (yeah, I realize the difficulties in making this happen.)
So lets see what today brings (no, I will NOT make any predictions). I am hoping for the best, and as usual, prepared for the worst. You can do a lot with a full night's sleep.

Sunday, July 4, 2010

Hey Doc, I got a pain right here.......

 I know that most of the 5 readers out there are either in EMS and Fire or sympathetic to those services and read other blogs of such stuff and might understand this one.
 I am wondering how many of you out there have heard this in some form before, or even on a regular basis: “You got a minute?” Then they go on without waiting for an answer, “I have this thing growing here, can you take a look?”, or “I have this funny thing going on in my chest”. They want you to look it over and tell them what to do or perhaps save them a trip to the Doctor. Perhaps they don’t trust Doctors, I don’t know, but I get this a LOT.
 I don’t know why people think that because I have a minimal amount of training as an EMT-B that I can solve their medical problems. I understand the folks that are confused and make calls like this. I’m getting used to those and they are dying down, mostly.
 But I’m confused as to what I did to become the “medical professional of choice” in many of the places I go. At my paying job, people come into my office almost every week, look around to see who is listening, then say “You got a minute?” They tell me all sorts of things about themselves and family members looking for advice. I assure you that I do NOT encourage this. (Especially the ones that start out “I’ve got this discharge from my rectum    ) I usually listen, then try to give them information about the possible causes and advise them to seek medical attention. If they do not have the means to see a physician, I will do vitals and check out what I can to see if there is anything serious going on. If there is, I step up my advisement to see a doctor and explain why. If they have no overt symptoms, I offer to check them again in a day or so. If it’s something like a cut or wound, that’s different. I can clean it, look for signs of infection, and dress it properly. I can SEE that and I have suitable training in infection control and wound care outside of the normal EMS track. If anything looks funky, I sound the alarm and get them to a Doctor. I also spend a lot of time explaining things their Doctors told them that they do not understand. If I don’t know the details of a particular malady or treatment, I look it up and go over it with them. (I was always thinking the Doctor was supposed to do this, but apparently not.)
 I suppose this happens because they see me out around the building helping with serious medical issues when they occur, which is not too often. That’s part of my job at the plant as the only EMT in the building. I supply initial incident assessment and stabilization. I guess they think that makes me an expert, even though many times I am wondering how long it will take the Medic to arrive with his/her monitor.
 Work, Family gatherings, social events, even at the firehouse I get pulled aside. “Hey, you got a minute?” Sometimes this happens when I am waiting in the checkout line at the local food store! Now I confess that I myself have done this to a couple of medical professionals who are close friends when I have had some issues, but I wasn’t asking them for treatment advice (ok, maybe just once), and I fully expected to make an appointment to see them the following week anyway.
 Thankfully, nobody calls me “Doc”, but they do call me. Does this happen to you?

Yup, That WAS stupid...

You would think I'd have learned years ago not to tempt fate. I hope I can manage to keep my mouth (and fingers) shut from now on. Ended the day with a bad PED call in the middle of the night with a medevac. Didn't get much sleep after that and my thoughts are with that family today. Not much of a National Holiday weekend for a family that just moved to this country, don't all speak the language, and don't understand the system. I can still see the agony on Mom's face.

Saturday, July 3, 2010

My Bad

I never should have tempted fate with that last post. Within 15 minutes that pager started going off and we were working back to back calls.
 I take it back.
 Everybody be safe and have a great Holiday weekend.


Finally the weekend has arrived. These last 2 weeks have been brutal at my paying job and I need a few days off to re-humanize myself.
 It's also a Holiday Weekend here in the USA and everybody is out doing "stuff". Lots of times, this "stuff" keeps us busy dealing with the "who'd have thought THAT would happen?" types of incidents. Usually these things begin with the statement "Hey Y'all, watch THIS!".
 Let the stupid human tricks begin!

Friday, July 2, 2010

Head Games in the Fire Service (LONG Post)

On occasion I find myself as the IC on some calls for VERY brief periods due to my proximity to the job location at time of dispatch, the hour of the day, or lack of available personnel. This usually ends when the Chief or an Assistant shows up and I go into a more useful or familiar role (for me). Having had the opportunity a few times now I can clearly see that I need to do some development in this area of making the initial calls for additional resources and thinking about EVERYTHING involved in the first 2 minutes, because that sets the course for the next 2 hours in many cases. I've taken (too) many classes on Fire and EMS leadership, but these rarely give you a good handle on how to program your head and make the critical decisions required in that first 2 minutes. That just takes practice in the field and finding out where you are weak and finding what works best for your particular brain.
So I have created a little game to play to help me develop my thinking:
I find an article on one of the better Fire or EMS pages that gives me enough information about an incident to get a good picture and then I come up with how I would handle the incident and think about my reasoning. I give myself about 30 seconds to do this, then I finish the article and read any follow up reports to find out how I did. Sometimes it takes months to get the rest of the story (such as the case of the dumpster explosion in Milwaukee which killed one firefighter and injured several others), sometimes it's later in the same day. Sometimes I get information from responders who were involved in the actual call.
Statter911, and FireGeezer are two good sources for my little game.
So now I found this one the other day which is an incident that occurred in Ulster County, NY on 6/29 and I decided it would be a good scenario for my little game. Take a look and read the article (with video) in the local paper.

I searched around for some other info and found a bunch and put together a picture. Let me be clear here: I don not know the people or Departments involved in this incident and I only vaguely know where this county is because I think I drove through it once. I am not second guessing anything they did. I am using this unfortunate incident to improve my own skills. I have also filled in some "facts" based on a best guess. Now follow my head as I play Incident commander for this. My imaginary thoughts, actions, and words are given in italics. The facts of the inhcdent, as they must have unfolded, are in bold. I am hoping this makes the reading and flow easier for both of us.

Begin the game:
We are dispatched to a 2 truck MVA rollover involving a building. While enroute we are updated that there is fire at the incident with the Sheriff's Department on scene.

OK, a slightly worse than the usual MVA. I'm thinking about entrapment and the extrication required with fire involved. I have a Rescue and Engine on the road along with EMS. On arrival, I will assess the need for extrication, additional fire response (tankers and manpower), and heavy rescue.
I am also wondering what these trucks were hauling and how the building is involved. Possibly we will need a foam truck and hazmat team.

On arrival, we learn that both drivers have self extricated and have minor burns (huge relief), most likely from radiated heat. The one truck was hauling a construction trailer with a small skid-steer and the other truck was a fuel oil tanker which has rolled on its side and split the tank spilling fuel against a steel warehouse type building of steel construction. The entire thing has lit up and the fire is intense. There are no occupants in the building and I find no life threats (or need for rescue). In addition, three power poles and their wires are down around the incident scene.

Holy crap, this is a mess. I make sure the drivers get moved to the safe zone and connected with EMS while PD does their initial interview.
I ask both drivers about their loads before they go. I then ask again for confirmation that there are no occupants in the building and ask dispatch to contact the owner and find out what is in there. I also ask dispatch for a second alarm which should trigger two more engines and three tankers as well as manpower. I ask for additional Fire Police to close the road. I ask for the hazmat team and I need them to get a spill response team moving. I request PD to start getting people evacuated from the nearby homes. I ask dispatch to get the utilities down here to cut power and assess what they will need to re-establish service when the time comes. Right now the priority is to secure this scene against what might happen next and get people out of harm's way. I want to shut the area down tight and set up good controls for getting apparatus in and out. Let's get all these un-involved vehicles out of here now. I want a big and clear playing field. I need to establish a physical command post so that we can form a unified command with Fire, EMS, PD, Utilities, and County Officials.

This fire is REALLY HOT (I know: all fire is hot, but if you're a firefighter you understand what I am saying here). A good portion of the tanker load has spilled and the rest is burning inside the split open tank. The building is rocking and rolling on the "A" and "D" corner.
Dispatch calls back and advises they can get an aviation foam truck on scene in 40 minutes and 2 CAFS units from the next county over. Some 'popping' can be heard from within the building which is inconsistent with a normal fire.

I accept all the foam units they can send me, this fire is getting big.
I set the first due engine to try to control spread on the building and minimize any additional exposures. I am really concerned about the unusual popping noises, especially when we start seeing flashes associated with them.

Dispatch calls again to say they've contacted the building owner who states there are 'some' fireworks stored in the building.

"Can you be a little more specific?"

Dispatch says the owner doesn't know, he let a friend store them there.

OK, sounds like not much else could go wrong here, lets back everybody out and get some deck guns on the building. Call dispatch for 2 ladder trucks, one to approach from the north, and one from the south to get some decent water on this thing and cool things down. 'Use all caution when setting up due to the downed power poles'. Let's get a tanker shuttle set up to support the water needs. I'd like to get 2 draft sites going because this scene may be broken in half as it grows. This means 2 more engines and at least 4 more tankers to support those operations.
It's also time to start moving Companies up to back fill the stations we've emptied so far. I also request an Aid Agency to supply food and refreshments for those working the job. I ask EMS to establish a Rehab Sector. It's gonna be a long day.

40 minutes have elapsed so far and everything is pretty well set. The word has gotten out to the media advising folks to find alternate routes and stay away. The following 3 hours goes by with the building fire being controlled and mostly out. The main body of fire is contained to the area around the trucks with only enough water and foam used to keep the fire from spreading. The strategy here is to let the fire burn itself, and all the hazmat, out into the air and keep it out of the groundwater. Environmental response is setting up containment dikes. After 4 hours, somebody smells gas and a meter confirms we have a natural gas leak. The underground plastic pipe has melted through.

I call dispatch and request an immediate evacuation order be given on all channels for ALL personnel. I want everybody back. On site I consult with the utility foreman and he explains how they can mitigate the problem. We call for 2 excavation crews to dig up the line on either end and pinch it off. This takes nearly 2 hours. Surely by now, nothing much could get worse.

The rehab sector informs me they are sending 2 firefighters to the hospital for heat related issues.

OK, no more predictions. The fire is reducing itself in size and we have no more spillage from the ruptured tanker. Consultation with the spill response folks confirms that it is time to put the fire out and let them get to work on the cleanup.

The fire is extinguished and everything is cooled down. Spill cleanup moves in to assess the next step and how best to remove the remaining fuel.

I request DPW  to assess the condition of the roadbed and determine a repair plan. I also get the building inspector to check out the building. PD is doing their own thing on the legal/illegal fireworks storage. Time to start shrinking the size of our forces and returning the mutual aid companies. I'll ask DPW to set up more fixed traffic controls to suit their needs and keep a  fresh crew on scene for fire watch until everything is cold and safe.
End of game

 If you read the article, you will note that I chose to let the fire burn itself mostly out. In the real incident the fire was extinguished as soon as possible. I am not second guessing those on scene, just saying that letting it burn in a controlled manner is something I would have strongly considered with the information I had. Those on scene probably had issues that caused them to extinguish the fire such as exposures, other potential hazards, etc.
  So that's my little game. Leave a comment and let me know what I missed. I can think of a few things, but I was honest here and only included things that came into my mind in the first 30 seconds. Would you have let it burn or put it out? (HM, are you out there? I'd like to hear your thoughts.)

Thursday, July 1, 2010

Setting the (Bad) Example

OK, no waiting period on this one and no changing some facts to hide anything. I’m just gonna tell it straight even though it’s 2am and I could have posted this tomorrow.
I just got back from a vehicle fire job, it was a car in a residential driveway. The fire had been put out by an alert passing Patrol Officer and his partner, they dumped two 10 pound ABC extinguishers on it and brought it to a halt. It started in the rear of the parked car which was unattended. We traced it to an electrical short. The car was totaled as they always are, but the exposures (three other vehicles and a Peterbuilt tractor were untouched. Good story all around, right?
Yeah until some idiot enters the scene to do overhaul. As the fire was out and we just had a small bit of smoke coming from some plastic and carpet smoldering, we only needed to do some clean up to make sure the vehicle was safe. Most of the guys didn’t get their gear on and let 3 of us finish the job. In this story I play the idiot.
Three simple tasks need to be done: 1) disconnect the battery, 2) Check for hidden extension, and 3) make sure everything in, under and around the car is cold. The first 2 tasks went easy and we even saved the battery screws for the owner by unscrewing them instead of cutting the cables. There was no extension, but the carpet in the back had to be cut out and everything had to be exposed to make sure we got it all. I worked with one of the young guys to do this as we were both fully dressed. We did not have SCBA on as there was no real smoke, just a few small wisps. We used the irons to neatly pop the hatchback. I figure the car could be saved with a lot of work and knowing the owner, he was the type to do just that so we didn’t want to hack or cut anything we didn’t need to. I cut out the carpet which was melted together with the plastic rear interior panel as my partner wetted everything down carefully. When I got the carpet out, we could identify the spare tire cover panel and the tire below, but it was held shut by the melted plastic that dripped everywhere in this area.
I need to mention here that I HATE DRY CHEMICAL powder. It gets in my sinuses and gives me a headache for days and this car was covered in the stuff.
I was being careful not to disturb too much and worked carefully. However, when I was trying to yank up the spare tire cover panel by breaking the melted plastic it finally yielded and I got a face full of that magic and hateful powder. I was careful not to breath it in and flushed my eyes with the hose immediately. Nobody said a word about it but I thought ‘Damn!, you jerk, why didn’t you have eye protection on?’ I had my shield down while we were popping the trunk but that didn’t do much to stop the powder approaching from below. I got back to the station and went in to take a leak. As I passed the mirror I was shocked to see that I looked like a probie at his first fire. I was completely black with that crap all over my face. “Damn’ I thought, “I really should have had those glasses on. But I haven’t used them in a while, now where are they? OH yeah, that’s right, they were inches away from my face in my left breast radio pocket!’ What an ass I am. I teach safety all the time and here I am making a rookie mistake by not taking 15 seconds to put my glasses on.
I hope the next time one of my guys sees me repeating the error that they haul back and kick me in the ass real hard. Maybe that will help me remember. I would do the same for them, in fact I already have.