Thursday, November 18, 2010

Never too smart to learn

I've said before that pride is the one thing that gets in the way of learning, and I was forced to remember it again tonight.

Arriving at a routine medical call for a laceration on the back of a hand, I was first in the door and took patient contact.  Checked the wound (top of the left hand), not too deep, roughly an inch long, I'd definitely seen worse.  Smiling reassuringly I asked the patient to move her fingers for me, which she did without issue, and then I made sure that she had feeling throughout her hand and a strong distal pulse.  Good on all counts, I asked if she wanted to go to the hospital, and she gave me an adamant "no", which I understood because I would have done the same if I were her.

Glancing back at one of the more experienced firefighters there on scene, I called out "she's refusing transport, we can return the ambulance".  He looked uncertain, and after glancing at her hand, asked me "has she had a tetanus shot?".  Realizing the thought hadn't even crossed my mind, I looked back at the woman and she said no.  Furthermore he pointed out that she might need stitches anyway and that the best chance of not getting an infection was to have it cleaned well by a professional.

Keep in mind, on the whole I'm a very confidant person.  I don't doubt myself easily, and that has it's advantages, but it also means that when someone else demonstrates better knowledge or skills than me I have to force myself to contain my pride well enough to learn from them.  My instinct in this kind of situation, as it is for many people, is to think "oh, come on man, it's a little cut, she's going to be fine, would you just return the ambulance?".

Why is that?  Is it because I'm sure that's the right thing to do, or is it because that's what I'd already decided we should do and I don't like being overruled?

I think the answer is obvious.  We aren't in this job to play the numbers, however favorable they may be.  Our job in patient care, past immediate stabilization, is to provide the patient with ALL the information necessary to make an educated decision about their treatment, and to always encourage treatment (liability is a mother, ain't it?).

The older firefighter was giving her the facts: you have a cut from a metal object, that means you can get tetanus, or another infection, and there could even be damage that we can't see just from looking at the surface. You're probably ok statistically speaking, but we recommend you get it looked at by a doctor.  And next time, that's the information I'll give too.  It's a little thing, but a habit of improving in all areas, every chance you get, has a cumulative effect over time in making you into a better and better firefighter, and once it's a habit you hardly even have to work at it anymore.

The best lesson to take from this, in my opinion, is that you're never so good that you can't get better.

Sunday, October 10, 2010

The infamous hose stretcher

Firefighting isn't all drama and speed. Although as an industry it's got it's own share of darkness (or maybe because of it), there is a lighter side that's worth examining.

Just yesterday, one of the rookies in my department's current recruit class asked me if I could help him find the hose stretcher, because he'd been sent to my station the night before and wasn't able to locate it. The guys who were home at the time told him that another station must have borrowed it for their own hose testing, since we'd already done ours a month ago.

I contained my hysterical laughter (barely) and composed myself before saying that I just wasn't sure myself, but the next station over had done their hose testing just last week and probably had it.

You see, with all the tools we have on our engines, it's not hard to understand why rookies make this mistake. They hear about a tool name like "hose stretcher" and they think of something like this:

Or this:


But when you think about a real fire incident, you realize what a hose stretcher actually looks like:

-----

-----

-----




That's right, rookie.  You ARE the hose stretcher.

Monday, May 10, 2010

The things that get to you.

You know how you sometimes see people walking down a street, and you think "man, that guy is just ASKING to get hit by a car"? That's what happened recently.

Delta response, auto pedestrian accident. The further is "a distraught complainant just keeps saying 'I hit her'".

First on scene, setup command. I really should have given a better sizeup. I should have said something useful like "one car, on it's wheels, moderate damage, patient is lying in the southbound lane apparently uncouncious with a serious amount of blood, make this a trauma alert". Instead I just got out something like "on the scene with *street* command, patient contact" before grabbing C-spine (I could hear her breathing, and my hands on her head could feel her pulse pounding in her temples, so there wasn't much to do but wait for backup).

She was hurt. About as bad as I've ever seen someone who wasn't already coding. One big laceration over the eye, another one down her back exposing some of that yellowish fatty tissue, blood and urine trickling out in a slow river downhill. She was twisted up like a rag doll, head facing one way, shoulders turned 90 degrees, hips another 30 degrees after that. No compound fractures that I could see, but with my hands tied up holding her head in place I couldn't do much but try to talk to her. It wasn't useful. All she could get out was "Hnnngh....Hnnngh....Hnnngh", every exhale another moan. I glanced over at the car that hit her, and the windshield was busted in like a bowling ball the size of a tractor wheel had been dropped on it. Hood was dented up, bumper flexed in, and the only thing it had hit was her body. The driver was a mess; physically fine, but crying and moaning.

The ambulance had been nearby and arrived quickly, and I was happy to see a paramedic. As she did an assessment, the clothes just came off in her hands, hardly had to cut a damn thing. a few other firefighters arrived too, and we managed to get her boarded and loaded pretty quick. In about 3 minutes, she was on her way to the hospital.

Finally I got to hear the story. This poor driver had been driving down the road late (no streetlights, no shoulders on the road, 45mph). He crests a hill, and there's a guy in front of him, wearing black, in the middle of the lane. With good reaction time, he swerves left....right into where the walker's friend (the patient) is walking in the other lane. Took her out hard, and it was probably her forehead and shoulder that busted in the windshield. Couldn't believe it, being in the middle of the road on a blind hill like that.

Yeah, the girl was hurt, but I don't mind so much looking at injuries anymore, after the first couple times, you're able to swallow most of the "horror" reaction. The driver is what really hit me. This was not his fault, not by any stretch of the imagination, and he was mentally broken up worse than anything I've seen before. Crying, gibbering, saying things like "I killed her...she's just a child...she's 17...I killed a CHILD". I know, sometimes people fake emotional responses to avoid lawsuits, but they usually say things like, "Oh god, I'm so sorry, there was no way I could have known!", not "I killed her" or other things that indicate it was his fault. I'd be willing to bet it's a few weeks before he sees anything else besides that girl coming through his windshield when he closes his eyes.

I didn't sleep really well that night, or the next. Luckily I have a new baby girl, so when most people ask why I look tired I can truthfully say the new baby keeps us up sometimes. In reality, I had a couple nightmares where I was that driver, unsuspecting, coming around a blind curve or over a hill and hearing the crunch as my bumper strikes an unsuspecting pedestrian.

I've heard it said before that everybody gets affected by different things. I've seen a man killed and baked by flames, a motorcyclist with organs protruding from the side of his body, a woman in labor drunk out of her mind, and I've felt pain for all of them. But the first thing that's really gotten into my mind since I've been a firefighter was this driver. His sobs echoed in my head the rest of the night, and I can still hear them sometimes. I guess what's most scary about it is that could so easily be me. You can't control what other people do, where they walk, what they think is a good idea. When you follow the rules of society you expect that everyone else will do the same, and suddenly when they don't you find that, though no fault of your own, you've potentially destroyed someone for the rest of their life.

There, but for the grace of God, go I.

Tuesday, March 9, 2010

New post on FireLink, how to deal with mistakes

If you're interested in some of my more professional writing work, you can find my latest post on firelink.com here:

How to Shake Off the Mistakes

Saturday, February 27, 2010

Special Forces in the Fire Service

I just attended my first fire-service relate course this weekend that has to do with technical rescue. This is all the cool stuff that firefighters might have to do at incidents not necessarily related to a fire. Not gonna lie, this stuff looks fun, especially the rope rescue training. Not everybody is excited at the thought of dangling from a rope supported by an improvised anchor, but as a hobbyist rock-climber, I already enjoy heights.

Rock climbing is a long shot from rope-rescue, though. I've clipped into my share of carabiners, but that's about it. This is a little more advanced. Think more along the lines of rigging up a system capable of supporting 2 rescuers plus a victim, lowering all the equipment necessary to package the injured party into a stokes basket dangling from the same set of equipment, and safely transitioning this whole party of people and hardware back to solid ground.

It's not an easy proposition, but it's certainly challenging and exciting. So far all we've really done its work on knots and anchors, but we'll be doing our share of rappelling practice and such before the class is done. I have no doubt that this will be one of my favorite experiences so far in the fire service.

What occurs to me is what I've experienced to a lesser degree on previous "rare" calls. You see, we don't exactly go flying off cliffs for rescues every other week. This is a really uncommon occurrence, and that makes training for it tougher. How much time should we be spending preparing for calls that almost never happen?

That's a tough question to answer because it's true that we spend most of our time on home medical calls. Our most widely applicable training, the most "bang for our buck", is what time we put in making our basic patient care better.

But we can't just ignore our uncommon scenarios. Vehicle extrications, for example, are uncommon; but they're horrendously dangerous if done wrong. Without proper knowledge, it would't be hard to end up with a car on top of you. We almost have to train harder for these things because we run into them so infrequently that we don't get that much practice.

How much more does that ring true for something like rope-rescues where we may not run into a serious one for a year or more at a time? A poorly constructed anchor or an improper knot could tip the balance of the incident away from heroic rescue and towards horrendous tragedy. Yet that's what could happen all too simply with a skill that we almost never have to use.

Think of something you maybe haven't done much of for a while. How about calculus? If you were woken up tonight at three in the morning and asked to find the derivative of a large polynomial, with someone's life riding on the line, how would you feel about your odds?

That's why I'm happy to do this kind of training as often as we can: because I don't want to doubt myself in the slightest when the time comes to use it.

It's also a great excuse to spend a weekend playing around with some pretty cool toys. :)

Thursday, February 25, 2010

Don't take yourself too seriously

We interrupt this normally deep and serious string of blog posts for an amusing anecdote:

I've been starting to help with the recruit class for the latest group of rookies. I got my instructor I certification recently, and I've been wanting to put it to use, so what better way than to volunteer to assist with recruit class in my free-time, right?

Well, the officer in charge paired me with my old instructor from back when I was in the rookie program to act as his assistant instructor for the day when we were teaching SCBA donning and emergency techniques. After watching the old man work with the first couple crews that came through the class, I got a chance to take over and show what I could do with my own group of recruits.

Trying to be as serious and authoritative as possible, I carefully went through the parts-and-components lecture, and orchestrated some practice donning the SCBAs. Great so far.

Preparing to go outside and start our confidence maze, I addressed the crew:

"Are you getting this? Everything making sense?"

Nods all around the room.

"Ok, gear up! We're going outside to do this for weal."

Blank stares, then smiles. Damn it. You can't sound tough when you replace an "R" with a "W".

There was my old instructor at the back of the room, doubled up and shoulders shaking in silent laughter.

"That was my encouraging voice, you won't hear it again", I said, trying to shake it off and recover gracefully.

Oh well, no sense in taking yourself TOO seriously.

Sunday, February 21, 2010

My new article on FireLink

To anyone who has interest, I've written a new article that's been accepted to FireLink.com for my "Day in the life of a Probie" column. Check it out at the link below:

http://firelink.monster.com/benefits/articles/10545-how-to-save-a-life

Thursday, February 18, 2010

The Big Day

Today is a big deal for me. Since January of 2009, I've been preparing for the day that I'd get my red helmet. Today I found out I passed my written EMT-B exam, which was the last item on my list of requirements to move out of my probationary stage.

In my department, the color of your helmet signifies your rank, and is what officers use when deciding who to give tasks to on scene.

Orange = Recruit Firefighter

This is what I had during recruit class. It means that you shouldn't even be on a scene, it's just for training gear. It's a big thing when you get to graduation and get to adorn it with the decal that gives you the next level.

Orange w/ Green Stripe = Probationary Firefighter

I've been wearing one of these for almost a year now. As a probie, you get to fight fire with the best of them, but the officers will be sure to keep somebody experienced with you to make sure you don't slip up and get someone hurt.

Red = Firefighter

Less is more, as is evidenced by the step up in recognition you have when you drop the "Recruit/Probationary" from in front of your title. In our department, this means that you have your firefighter I & II certifications, your haz-mat awareness & operations certifications, you've demonstrated competence on every apparatus in your station to your company officers, and finally (the milestone I reached today), you've fulfilled all the requirements to obtain your EMT-B license.

It's a long road, but looking back on it I can't believe how quickly it's gone. Maybe next month I'll take a step back and plan what I'm going to do next. For now, I'm going to relax and revel in the afterglow of another completed journey.

Saturday, January 9, 2010

Sometimes it works

Nothing under the scope of emergency medicine is as exciting or dreaded as a full arrest. It's something we train for regularly with CPR classes, AED practice, and extensive analysis and practical skill time in EMT classes, but it's a comparatively rare call. In my experience, you've got around 70% of your medical calls coming from real emergency problems that don't even progress to the point of unconsciousness (diabetic problems, breathing difficulty, and chest pain/heart problem), 25% from non-emergencies (over-concerned parents, hypochondriacs, and poorer people with a small problem who don't know any other way to get medical help), and the last 5% are the adrenaline boosters. That's your severe trauma, or catastrophic medical call, and even out of those I'd say that only 1/4 end up in a full code (CPR, AED, intubation).

However, even noting how rare they are, I've worked on enough to know how they generally go. Check vitals, start CPR, apply AED, intubate, pronounce them dead and allow the police to take over. It's a sad reality, but most of the people we do CPR on don't come back. It's not because we're doing it wrong, it's just because they're usually too far gone. I know people who have been running calls for years who have never had one of their CPR patients end up being saved. Given how all the patients I've worked on have fared so far, I was willing to bet I was going to be in that same pool of people.

Until 12/31/2009.

On that day, I was lucky enough to be performing CPR on a man who did not die immediately thereafter, and I have to tell you that it was invigorating. I was suprised beyond speech because I had just never seen anything like that happen. We showed up and he was grey and cold, no discernible pulse. By the time he was in the ambulance he was awake. A new years miracle.

But what I found most interesting was not the play by play re-enactments, although those are fun. What I continue to think about even today, over a week later, is the reaction we all had afterward. "Great job in there", we say. "Nice work". As though it were through our superior efforts that this man was brought back to life. As though we were so incredibly skillful on this day that our will and talent alone carried him back from the grave.

In truth, we did nothing different or more for our patient that morning than we had done for many patients before. Same pattern, same rhythm, same tools, even most of the same people. The difference was the patient. His body wasn't ready to go, and it responded to our efforts as others hadn't. If anyone were to be congratulated, it was our friend with the IV in his arm for having such a resilient body.

And within that truth lies the reason behind our training. We train for hours and hours every year on the proper sequence for a full arrest, knowing that most of the recipients will never benefit from it. It's only in the knowledge that every so often, every once in a while, there's that one person who's not QUITE so far gone yet, and he deserves a chance to come back. This week we found that person, and it's made me that much more willing to try just as hard on every man down hoping to find another one.