Training or Trouble?

Idealistic Firefighter: "I think we should be doing more training on [x], so the guys at the station and I went out an played with the [x] equipment last weekend, it was pretty productive"

Concerned Officer: "How dare you?  We don't have an official policy on that, you didn't have any training materials or curriculum to work off of, you aren't allowed to do that!"

How many times have I heard this conversation or something similar?  It's a difficult situation, particularly for a volunteer fire department like ours.  Young firefighters come out of the recruit class, only 4 months of training under their belts, full of motivation and energy, wanting to do stuff, and quickly disappointed.  Formal training is only provided twice a month, and can be sterile; call volume is somewhat high, but mostly in-home medical calls, so it's impractical to do much "on-the-scene" training for working structure fires or rescues. As with most skills, those you don't practice you'll quickly forget.

It's hard to be surprised (and in fact it shows great intrinsic motivation) when firefighters take it upon themselves to get some practice. Four or more people hanging out at the station?  Let's find something to do! Amongst their peers they practice emergency SCBA maneuvers, strategize for fires in neighborhoods where water supply is a challenge, try different configurations for the rescue gear, and overall put hands on their equipment enough that when they're called to deploy it they aren't having to figure it out on the spot.

There is great value here.  Small groups produce training sessions on subjects they don't feel comfortable enough with, targeting gaps in operational readiness that are difficult to discover from the top organizational levels; it's hard to say to a chief "I don't feel like I can draft water into our engine very well", but it's easy to say to a couple of the experienced pump operators at the station "can you show me how to draft again?  I need a little practice".  Such sessions bring unique experiences to individuals, using their own equipment, in their own run area, with the very people they'll be running these actual calls with.

Then the station officers get wind of it.  Our firefighters are out there, completely unsupervised, without our knowledge, doing whatever they want! They could be practicing mistakes!  Who's making sure they're doing things right?  Who's authority are they doing this under?  Utter chaos! Mass pandemonium!

And so they come down on the group, sometimes by just giving our straight directives like "don't do that any more", sometimes more passively by creating enough procedural steps to be detrimental to any kind of impromptu training (you have to give me a curriculum copy before doing any kind of practice, with these forms filled out, scheduled at least 3 weeks in advance, etc).  All that energy and enthusiasm is stoppered up and lost.

Such officers should be ashamed of themselves.

I cannot be absolutely sure whether such a reaction from an officer roots itself in a misguided but genuine concern for quality of service, or in an emotional reaction to a perceived usurping of authority.  It almost doesn't matter.  The end result in either case is that the firefighters are discouraged and chastened, no longer willing to strive for any sort of learning experience outside of the bi-monthly department-approved training sessions.  The loss of line-personnel initiated impromptu training, targeting the needs and interests of the small group involved, is a true tragedy.

And here's the real loss: those impromptu sessions are occurring because somebody feels like they haven't had enough practice yet, and they're doing something about it.  They're practicing something that they may be called upon to do in a real emergency TODAY, and by attempting to cut these minor trainings off, an officer is saying basically "Don't practice this because you might get it wrong, never-mind that you might be called upon to perform this exact skill tomorrow for real.  It's better to learn frantically by guessing wilding during an emergency than to play with the equipment in a controlled setting when you have the opportunity".  Talk about setting your guys up for failure.

One of my core principles driving my authorship of these articles is that I don't ever want to be a complainer; I have no intention of identifying problems without attempting to provide solutions.

To the officer who cares for quality and is scared to have their firefighters practicing on their own for fear of mistakes, there is a better path than simply disallowing or discouraging informal trainings.  Your firefighters are showing you they have commitment and motivation, don't stifle that!  Instead, tell them how pleased you are that they take their responsibilities seriously, tell them you want to play too and ask to be invited next time they're going out to train, and show that you want to help by getting every departmental SOP and SOG you can related to the things they want to work on into a binder they can have with them at the station to reference if you aren't around to supervise so you know they're working off of accurate material.

There may be concern in this case, like there is in my department, about not having an SOP covering this skill.  The only thing I can say to that is your lack of an SOP is not an excuse not to train, unless it's also an excuse not to perform the skill on a real scene.  If you could actually be called upon to cut a hole in a roof tomorrow at a fire, than not having a vent-saw SOP doesn't mean you shouldn't be practicing with the chainsaw (you must be practicing with any equipment you could be asked to use), it just means you need to write a vent-saw SOP.  Period.

To the officer who's ego is wounded by their firefighters taking practice into their own hands: There's the door.  You should be absolutely delighted that your guys want to do more than sit around and play X-box.  Officers are put into place to ensure the operational readiness of their stations.  They are there to break down obstacles to their motivated firefighters getting whatever they need to be the best public servants they can be, and to prevent bad apples from spoiling the bunch.  Anyone who would stunt the growth of their station to preserve their sense of "authority" is not an officer in my book, they're just a bully with a different colored helmet.

And finally to the firefighter who wants to practice: don't let any of this junk stop you. Don't let politics stand in the way of you becoming a better firefighter. Find somebody who knows more than you, and stick close to them.  Find somebody who knows less than you, and bring them along.  Everything else will fall into place.

Round 2

     It's been a long time since I've had my voice out on the internet with respect to firefighting.  During that time period when I was brand new to the game, I was having new experiences every week, always something different to write about.  Once the novelty wore off, though, what did I have to say?  Ran another fire?  Saw another corpse?  No sense in publishing material just for the sake of producing a wall of text.

    Things are different now.  Several years under my belt, hundreds of calls, many educational experiences both as a student and as an instructor.  I'm no expert yet, not by a long shot, but I know enough now to have opinions that I think are worth spreading, and there should be a form somewhere for my brothers to pile on if they agree or fire back if they don't.  It's time for round 2.

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.

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.

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.

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

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. :)

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.

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

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.

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.

Helping those who don't want to be helped

Although firefighting is where the real excitement is, the majority of the calls we run are medical in nature. That's ok, though, I actually really enjoy medicals. I like the times when we're able to make a difference in a patient's life when things are going really badly. Helping someone out of a wrecked car, keeping an unstable patient alive until they get to the hospital, or even just providing a little comfort to someone who is dealing with a scary illness or injury; those things are all good experience and are their own reward.

Admittedly, there are many people you can't do much to help. Plenty of people are just not savable (already dead for too long, injury inconsistent with life, etc), and many others are not true emergencies and involve people who are just in a hard socio-economic group and the only way they know of to get medical help for any condition is to call 911.

But then there's a third class of medical call, one I had not experienced until just recently. You see, some people for one reason or another don't want your help at all and are angry at you for even being there. That's new to me.

The day of Thanksgiving, I ran a call to a middle-class neighborhood residence. It was dispatched as "Unconscious", and on the way we got enough information to know that this was a young guy who was visiting his parents for Thanksgiving, and who had gone into a really heavy state of sleep. So heavy that when he rolled off the bed and hit his head, he didn't even wake up. We were advised that he was taking Xanax, and one of the side-effects of Xanax is possible drowsiness, but this level of unresponsiveness was a little bit past "drowsy".

When we arrive, we walk into a bedroom and see...nothing.

"He's behind the bed!", the dad notes from the hallway.

We peak over the bed, and there he is, facedown and contorted up, wedged between the bed and the wall.

"Check his breathing, please" the Captain murmurs as he begins to open the med-bag.

Leaning close to the kid I can hear respiration and can feel it on my face. Smell it, too. Definitely breathing.

"He's breathing, but it's a little shallow, probably due to his position. Shall we move him?".

We each grab a body part and move him out into the center of the room. He moans and moves a bit as we move him, but goes flat out again as soon as we lay him down.

"Let's get him on some O's", I hear from over my shoulder.

I pull a non-rebreather out of the packaging and hook it up to the oxygen bottle that's already been primed for me, then apply it to the patient's face. He doesn't like that.

Sitting up groggily he yanks the mask off his face and asks what's going on.

"You were pretty unresponsive there, for a while", the captains says to him, checking his pupils (which are currently small pinpoints).

"I wass nnnapping" he slurs.

Now we have a paramedic from the ambulance in the room, already briefed by the parents, who asks what's been going on, pointing out that the heavy sleeping, The grogginess and slurred speech seem to indicated something is wrong.

"I'mmm sleeeepy" he manages to get out.

"Well, your behavior is not quite what we'd expect from someone who is just sleepy."

He REALLY doesn't like this

"Well! I didnn't knnnow...that..that...that therrre was a RIGHT wayyy to be SLLLEEPY!"

"Calm down, buddy..." the medic says

"NO! see, you'rrre starting to piss me off herrre! Herrre's what's going on...", his speech is improving a bit as his new found anger cuts through the haze, "...you all are in THIS house...telling ME how to be f***ing sleepy!....and I don't apppppreciate it....So all five of you motherf***ers can just take a flying f*** out the g**damn window....cause I swear if I find out where YOU live...."

by this point the medic's motioned everyone out of the room and were back out front, police on the way. Once someone starts to get potentially violent we are supposed to have law-enforcement on scene to handle that kind of stuff.

While we're talking out front, I'm still trying to figure this out. I mean, I don't even know this guy, so I shouldn't care, but the fact that he's so upset at us for coming in here to try and help him is bothering me a bit. It stings when you reach out with compassion and get met with anger.

As I though about it, I began to see why the guys who have been on the job for a long time seem more likely to be rather unconcerned regardless of the situation (almost to the point of being dispassionate). Apathy is hard to offend. If you don't care about someone that much, nothing short of a physical assault is really going to hurt you. But if you put yourself out there emotionally; if you try to feel some empathy for someone who's having a rough day and you do your best to have concern for them and help them, and they reject you, it feels like pretty much any other relationship where you get something nice pushed back in your face. Far safer to not care that much in the first place.

But is that unfairly punishing the patients who need empathy for the actions of those who are going to be a jerk about it? Certainly the number of people who call 911 who would benefit from some reassuring attention far outweigh those who are going to lash out at you. Should we dispense compassion based on nature of the call? Cardiac patients get sympathy, drug-addicts don't? That doesn't seem quite right either.

I guess I don't really have answers yet, just questions. Hopefully they'll come to me before the day arrives when I too start looking at patients with empty and uncaring eyes.

Bigger than you and me

I went to my third firefighter graduation at my department this week. This is the ceremony where the new recruit who have been training for the last 5 months are finally given their badges and released to start running calls. It's a big deal for those who are participating, because it's the realization of a goal that used to seem to far into the future, but what's less talked about at the time is what a big deal it is for the department.

My first graduation was as an outsider, when my brother was just joining up. I didn't know anybody there except him, and I didn't have any particular interest in firefighting at the time, but I remember being very moved by the ceremony. Afterwords my eyes were a little wet as I congratulated him and it was a silent drive back to college for me as I thought about what I'd seen.

My second was as a participant, a new firefighter excited to start doing stuff that mattered. After my brother pinned my badge on me, I could hardly wait to get out of the building and to start doing all those things I'd been training for all those months.
Now I've just been to my third, as a member of the department welcoming in the new blood. It's emotional, but in a different way: I'm proud to be part of such an organization, one that was important enough and meaningful enough to these outsiders that they decided to invest and sacrifice of themselves in order to be part of it as well.

And it will keep happening. Year after year, new men and women will take up the mantle as the most experienced ones start to step down. Logically it would seem that this adds up to a department that is of a constant status. Like a glass of water, some is poured out, some refilled, and you're always looking at basically the same thing. But this is inaccurate; any organization like this is actually cumulative. It's more like a river: individual drops of water travel through on a seemingly set course, but slowly the water as a whole continues to erode a new path for itself, shifting the banks and making it's way as a result of all the drops that has ever flowed through it.

The department will always have one chief, but it's current culture and structure is the result of layer upon layer of past leadership. We will always have new recruits, but our training and policies improve every year as a result of experiments on and suggestions from each group of orange-helmets that step up to do their part.

The continued existence and renewal of this entity, this fire district, is an ongoing validation of the fact that what we are doing here is worthwhile and necessary. The life of this department reaches far into the future, as long as there are people in this area to protect, and each firefighter through his participation gains for himself a piece of the immortality that such organizations by their nature preserve for their alumni.

It's bigger than you and me, and in a way this humbling realization makes you want to pay tribute to such a cause. But what to do? What do you give an entity with no emotion or consciousness? How do you show loyalty to an intangible abstraction? In my opinion, the only show of appreciation that has any lasting effect is the kind of participation that only makes us better.

Do nothing to detract from our reputation, but in all encounters give others reason to respect us. Teach the new generations of our ranks not just with the knowledge that you were taught, but also with the wisdom gained from your own mistakes, and let them start off knowing more than you did. Most importantly (for my department anyway), continue to provide a helping hand as long as there is even one person out there who needs it.

Pedagogy of the fire-ground

In a fire department, there are a lot of skills for new guys to learn. Fire suppression, apparatus operation, efficient communication, emergency medical care, vehicle extrication; the list goes on and on. One thing that I think should be placed higher on that list is pedagogy. If you're really great at vehicle extrication, you can make a difference when you're on the scene; if you're really great at TEACHING OTHER FIREFIGHTERS about vehicle extrication, then you make a difference every time one of the firefighters who learned something from you is cutting up a vehicle. The effects of a good teacher are like ripples that carry throughout a department as those who learn from the instructor teach others the way that they learned.

Let me give an example where we see three teaching styles on the same subject, and maybe it will be clear why this is such an important topic.

SCENE 1
Instructor: "don't forget this, it's important: when you are going to have the apparatus parked in one place for a while, engage the 'High Idle'".

Student: "Why is that? What does it do? Is it really important?"

Instructor: "What did I just say?"

Student: "When the apparatus is staying put for a while, engage the High Idle"

Instructor: "So what do you do when you're parking and you're going to leave the engine on?"

Student: "Engage the High Idle"

SCENE 2

Instructor: "don't forget this, it's important: when you are going to have the apparatus parked in one place for a while, engage the 'High Idle'".

Student: "Why is that? What does it do? Is it really important?"

Instructor: "That let's the engine generate more electricity so it's able to handle more things being on at once like warning equipment and panel lights, etc."

SCENE 3

Instructor: "don't forget this, it's important: when you are going to have the apparatus parked in one place for a while, engage the 'High Idle'".

Student: "Why is that? What does it do? Is it really important?"

Instructor: "well, what does your car do when it's idling?"

Student: "It's just running at a low speed"

Instructor: "And what does the term high-idle suggest?"

Student: "That it's running at a slightly higher than low speed?"

Instructor: "Good, that's right. Now, why would that be helpful?"

Student: "I don't know, I guess it's using more gas, that's actually BAD. Maybe it's maintenance related, do long periods of low idle damage the engine or something?"

Instructor: "Interesting thought, but no, you're thinking to specifically to the engine. What about all those blinking things on the apparatus?"

Student: "Warning lights?"

Instructor: "And what do they need in order to keep blinking?"

Student: "Electricity. I guess the high idle probably generates more electricity."

Instructor: "Right. All those lights take a toll on the battery, and if you leave it in low idle the load manager will eventually start switching lights off to conserve energy, which is a big deal if you're on a highway or something where you need all your warning equipment going."

Now let me give you a scenario: The student is now pumping the apparatus at a large vehicle fire, and the lights start to shut off one by one. High idle can't be engaged because it doesn't work when the apparatus is pumping. What will the student do about his quickly diminishing warning equipment? If he's been taught by the instructor in scene 1, probably nothing, as he won't even know there's a connection. This kind of teacher just bugs the hell out of me. Anytime someone answers a question with "Because I said so", they're doing the student a disservice. You can't think adaptively without having the necessary information to synthesize into a solution. If the student was taught by the instructor in scene 2, he'd probably suspect that he should be engaging high-idle, but he's been told he can't do that when pumping, so what should he do? After thinking about it, he'd probably have to resort to choosing which lights he needs least and manually shutting them down. He's been told what he needs to know, and he's doing the most he can with the information he has. But the student who learned from the instructor in scene 3 knows the mechanics of his truck. By having a long dialog on the subject, he's been forced to think it through and knows what the players in this equation are. He knows that the high-idle works by increasing the engine speed, thus generating more electricity. He also knows that pumping the apparatus involves using the engine to power the pump. Putting this information together, he'd probably figure out that all he has to do is gate down the water he's flowing out of the truck and throttle up the pump, causing the engine to work harder, and generating the extra electricity he needs.

Good firefighters aren't born, they're made. Let's recognize the great makers, and realize that within a department great teaching means better everything else.

Modern Emergency Medical Care

You know what I've found about being a firefighter? Fire's don't happen very often. Oh we get plenty of calls, but they're mostly made up of heart attacks, traumatic injuries, and breathing trouble.

That's why my department requires that every member obtain their EMT-B certification, and that's what I'm spending most of my time training for this fall.

At least, that's what I WILL be training for. A lot of the training we've been through so far in EMT class has centered more around just trying not to get sued. More than other jobs, being an emergency rescuer is fraught with opportunities for legal action against you. Driving an emergency vehical, you can easily get caught up in a car accident; there's a law suit for failure to use due regard. Caring for a patient may involve you having to make a split second decision that causes someone's condition to worsen; now there's some legal action regarding negligence. Maybe you drop a patient off at the hospital and the paperwork to transfer doesn't quite get completed properly. The ER's busy and the nurses don't check in on the patient for 15 minutes, by which time his situation has grown dire; now you're going to court for abandonment. I could give example after example, because I've heard hundreds of them; enough to scare me into almost not wanting to put myself in the position of having to care for someone because of the legal risk if something goes wrong.

What's different today about our society that means we sue at the drop of a hat? When did we become entitled to have nothing ever go wrong in our lives? After all, that's where this originates, right? Something bad has happened to me, I think someone else could have prevented it, so I'm going to sue for all kinds of damages because I shouldn't ever have to experience hardship or trouble in my life.

Don't get me wrong, I'm not speaking out against actual maliciousness or incompetence. If someone is driving 40 MPH over the speed limit to get to a call and strikes a pedestrian, that was negligent. If an ambulance worker shows up to a scene, decides he doesn't like the patient, and leaves him to die, that was abandonment. But the cautionary tales I've heard are nothing like that. They're all based around split-second decisions where a tough choice had to be made, and someone made it (right or wrong), and the end result was a lawsuit against the ambulance company, the fire department, and the responder personally.

It's a mess. Unfortunately, complaining about it on my blog won't change anything. I, along with every other emergency responder, have to continue in this field knowing that every action I take may have ramifications that could land me in court. We all have to function with a certain amount of cognitive dissonance in that we have two relationships with our patients; one as allies working for their well-being, and one as adversaries trying to cover our asses. I guess all I can say is "be careful out there".

Learning how to Learn

I am convinced that pride is the one thing that stands in the way of people achieving greatness.

Sounds silly doesn't it? After all, only those who are great would have reason to be proud, right?

Not exactly. Let me give you a few examples:

Recruit class, vehicle extrication practical; my crew is working with a Captain from the special operations division of the fire district. He sends me to retrieve a tool from the rescue squad on scene. When I return, he spends the next 5 minutes lecturing us on why we should be "moving with a purpose" at all times while staring directly into my eyes. The message was obvious; he felt like I wasn't moving quickly enough, and that it reflected some sort of attitude problem (like I didn't care about the tactic, or didn't have any respect for him or something like that). In truth, I didn't have an attitude problem just at the moment, but I didn't think I had been moving slowly the rest of my crew was witnessing him calling me out, so I was on the verge of developing one quickly.

My first vehicle fire, and it's in a different station's run box; I ride to the call with my younger brother (who's been doing this for a few years before me). The "fire" is really just a little smoke coming from the back axle of the vehicle. My brother tells me to go get the pressurized water can while he runs over to size it up. The engine from this station is different than the one at mine, and when I go to the compartment where it should be, I find that because of a different body design much of the equipment on this engine is stored in a different place. He yells over to ask what's taking so long, I tell him I don't know where the water can is, and as he rushes over and grabs it himself from another compartment he says in a frustrated voice "Exactly where it's SUPPOSED to be!". Words like "How the HELL am I supposed to know where anything is when the trucks are different!" fly through my head, but I stifle them.

Truck checks 2 weeks ago, at my home station; A week before the Sr. Firefighter at our station had admonished me for driving too slowly to a call a few miles down on the street that runs in front of our station. I stepped up my game and tried to put a little more speed on when driving to calls. Today the station captain is chastising me for driving too quickly and telling me to ease off on my adrenaline dump. In frustration, I want to say "Fine, that's the last time I drive, you can find someone else who's willing to freely spend their own time covering the station while the residents are out". I don't say it, of course.

A structure fire last week near my home; a good friend of mine who was my instructor in recruit class is first on the scene. It's a small fire, so it's quickly out. When I get inside, he tells me to go back out and get a scoop shovel from the engine to start carrying debris and ash out of the house. I set down the pike pole and radio I'm carrying and head outside to comply. On my way back in, I'm met at the garage door with a radio being thrust into my chest and a low growl saying "You need to hold onto your shit!". Having just had a fight with my wife over the phone not 30 minutes ago, my temper is already on edge, and I have to bite back the words I want to spit back in his face.

Each one of these scenarios has a common thread. I screwed up, and someone tried to correct me. Unfortunately, it doesn't always work. We all want to be good at what we do, and when someone points out our flaws, our pride is wounded. If you let it, that feeling of embarrassment and hurt can prevent you from becoming the capable, competent professional that we already want to think of ourselves as. It can, in fact, cause you to stubbornly continue doing things wrong just to prove to yourself that you weren't in the wrong to begin with. In every situation above, I wanted to lash out and tell them that I was doing fine and to lay off. The only problem is, I was wrong.

Everyone of the individuals above has been a firefighter for a long time, much longer than me. I probably wouldn't take advice from any of them when it comes to calculus, music, or software; but on the fireground, I'd pay attention to any one of them, even if it hurt my feelings just at the moment. Not moving quickly can mean someone dies before we can get them out; knowing where equipment is on different trucks is part of the job, and an important one; driving too fast can get you landed in court when you kill someone during an emergency response; and you need to keep your radio on you at all times because it's the only way the incident commander can get a-hold of you if there's an emergency. I know these things, but my actions indicated disregard for those truths, and my friends and brothers on the department were just trying to make me a better firefighter by pointing these things out. It's up to me to get past my desire to already be the best and take correction to heart.

Take pride in doing a job that helps people; but leave it at home while you're doing it.

Cross Country

I just got back from a 2-week vacation to California with my wife, where we visited some family. While out there, it was nice to relax after the long recruit class I finally completed last month, but I also wasn't completely away from the fire service. Every city has a fire station, and ever since I've become involved in the service I've tried to visit them wherever I travel. I try not to make a nuisance of myself, but if there are firefighters outside who don't seem busy, or if I can see them hanging out in a dayroom, I'll stop to introduce myself and ask about the station.

So while on vacation this time, I happened upon a small station in a residential area of San Mateo where the firefighters were outside washing a couple very-nice looking trucks. After stopping and talking to them a while, I found that this was a unique station in that both of the apparatus had a specialty, one being the US&R (Urban Search and Rescue) truck for the area, and the other being an engine specifically tasked with carrying all the specialty equipment needed for a RIC (rapid intervention crew). I took a video of them both with my iPhone and have posted it below if you're interested.

I guess the really cool thing is how being part of my local fire department makes me also part of a world-wide community. These guys didn't know me, didn't have any obligation towards me, but took time out of their shift to show me around their apparatus and answer all the questions that I naturally had for them as a member of a more rural department. One of them was even willing to give me one of his personal duty shirts from the department to contribute to my brother's collection. It's the sort of instant friendliness that can only come out of a knowledge of similar experiences, and it's one that I am truly glad to have become a recipient of.

Fire and Rain

It's been almost a week since my very first structure fire. I guess I've had a hard time sitting down to start writing about it. For days, I had been hoping for that first fire. Every time my pager went off, I was praying to hear some extra tightness in the dispatcher's voice as the words "structure fire" came over the radio. A week ago, it finally happened. But it wasn't exactly what I had in mind.

I was in bed, early in the morning, when the tones dropped. The first words to come over the radio were "commercial structure fire", and I was in my vehicle before they were even able to say anything else. My adrenaline and excitement were almost overwhelming. It was only just as I was reaching the highway that we got any further information from the dispatcher. Someone hadn't made it out yet. My excitement turned to dread, and although as personal vehicles we have no right to break traffic laws (preventing me from speeding), my fingers began to clutch the steering wheel even tighter than they had when I was merely suffering from adrenaline.

The first units on the scene gave a size up indicating that the house was already significantly involved in the fire. Still no sign of the man inside. All anyone knew was that he should be somewhere in the back right corner of the house. In the sky ahead of me, I could see the pillar of smoke rising up into the clouds. Although this was my first non-training fire, I knew enough to realize just how serious the fire must be given that huge visual indicator.

By the time I arrived, the whole of the House was mostly a wall of flames. I knew roughly what the odds were of someone still being alive in a situation like that, but I didn't want to admit that to myself. The crew I was assigned to was given the task of going in the back door to find this man. Reading the faces of my crewmates, I knew that this was probably a body recovery operation and not a rescue, but I didn't want to admit that to myself either. The flames were too intense for us to make a good entry, though, and eventually the roof came in. At the same time another crew of firefighters was cutting a hole in the wall of the house where they expected the man to be. Given the condition of what was left of the building, I was now certain of the outcome. But it wasn't until the hole was open and I saw the body that any real emotion hit me.

One of the division chiefs (the one who ran my training class) was standing by asking us to use the hose line to protect the body from the still raging flames, hoping to prevent any further damage for the sake of the family. I tried to focus on directing my water streamed towards hotspots in the room, but my mind was elsewhere. why wasn't he able to get out? why did it take so long to report the fire? How much fear must he have gone through, waking up in a blaze like that? how long was he conscious enough to experience it? Could we have saved him if we had arrived five minutes earlier? Did he feel any pain?

The man's charred remains held no answers for me. The gear on my body and the hose line in my hand, weapons to combat an enemy who had already won. I remembered bitterly how I had wanted so badly to get to fight a fire. well, I guess I got exactly what I wanted. As silly as it was, I felt a deep guilt for ever wishing for such a disaster to come into somebody's life, as though I might have prevented this incident by not desiring it so badly.

For the next couple hours we doused the entire building in water and foam, all to prevent it from reigniting. During that time I tried my best to focus on the task at hand and not to glance over at that corner where I knew the corpse lay. I kept a mantra going in my head, steeling myself for the time that I knew would be ahead when we would have to move the body from the building.

Finally the moment came, and other firefighters moved vehicles and strung up tarps to prevent the bystanders from witnessing what was about to occur. Me, I wanted to put my hands on the victim. I wanted to be the one to shoulder the unpleasant task of extricating the body from the smoldering remains of the house. As some sort of a self imposed penance, I wanted to force myself to deal with the consequences of the fire that I had been hoping for. And I did. The man, and a dog that had been trapped in the room with him, were both moved with as much dignity as possible into the vehicle that would carry them away.

I will be happy if I never have to do that again.

But with the pain and frustration and guilt came another emotion: relief. Ever since I started training to become a firefighter, my biggest worry had been that when I finally came face to face with gruesome and unjust death I would be unable to cope and unfit to perform my duties. I can think of very few scenarios that are worse in my mind than a fatality resulting from being trapped in a fire. yet there I was, witnessing one of the worst (I hope) calls I have or will ever have to deal with, and I was okay. Not happy, not calm, certainly not dispassionate, but able to perform efficiently the tasks assigned to me. Although I do not believe any amount of experience will stop me from feeling some sympathy for victims and patients, I know now that I can handle it. In the midst of my surprise and sadness at the loss of somebody's father I am relieved just to know that I can do my job.

I think I've had enough excitement for this week.

Getting Real

I've had a lot of fun playing hero. The gear was cool, the calls were fun, but last night I got a perspective adjustment that hit me like a 2x4 between the eyes.

We had just gotten back from a gas odor call. Although the emergency itself was not of any particular interest, it was the first time I've actually gotten to ride to a call on the fire truck. Now THAT is a cool experience. Driving fast, sirens blaring, people making way for you on the road; not gonna lie, that's fun. So we made sure everything was safe while the utility company sent a truck out to fix the gas line, no big deal.

Just as we're getting back off the truck in the station, the tones go off again. Everybody smiles, excited that the night is turning out to be so lively. We all pile back into the engine as we listen for the dispatch.

"Engine 801, engine 1408, motorcycle accident..."

My smile drops. This could turn out to be a little more intense than I'd expected. My brother is driving the engine, and I can feel our speed increase a little as further information comes over the radio. It doesn't sound good. One motorcycle, ran into a guardrail, victim is not moving.

I start rehearsing in my head every thing that will need to happen once we arrived at the scene. We'll need the medical pack and the backboard for sure. I pull my latex gloves on in preparation, half anxious to help, half hoping someone else will take care of the victim so that I don't have to.

No time to think about it though. The engine stops and we all jump out, each grabbing the equipment we were assigned. I throw the backboard off the engine over my shoulder and immediately start striding towards the cluster of people I can see already pulling the victim back onto the roadway. Secretly I don't want to look; I've never seen any trauma before, and honestly, I'm scared of how I might react. Will I get sick? Will I just freeze? But this is what I signed up for, and I know it, so I try to stay focused on what I need to do instead of processing what I'm seeing.

I throw the backboard on the ground and start tearing off the straps. In theory, I know what is supposed to happen next; we will put this guy on a backboard and load him into the ambulance. This isn't the same as working with a dummy though; the weight of his limbs is eerily familiar. Exactly what my leg would feel like if I lifted it with my arm. Just by touch, I can tell this is a real human. And he is dying.

The injuries are extensive, and the odds don't look good, but we start CPR in a desperate attempt to save him. Now, I'm well trained in CPR; we went through all the mechanics and techniques during recruit class. But it's just not the same on a human. I don't think I ever realized just how fragile our bodies really are.

I can feel my companions working around me. Dressing wounds, clearing clothing, a well oiled machine working at a feverish pace. I don't want to think about it. I just keep my eyes on my hands, pumping his chest, trying to keep enough blood moving to save him. I know if I think too hard about what I'm looking at, it will be too much. I'll see the damage done to him and to think "what would that feel like?". But speculation is not a luxury I can afford at the moment.

The medics call for everybody to clear the body for a second so they can check his vitals. I sit back on my knees, hands in the air to show 'I'm clear'; and that's when the feeling really hits me. This guy is not going to make it. Eyes vacant, skin pale, he stares blankly at the sky. The medics glanced forlornly at the paper printing out of their machine. "One more round, and then we'll call it." Frustrated and a little shocked, I start compressing the chest again with renewed vigor, somehow convincing myself that if we were to just try hard enough we might make a difference.

Just believing something doesn't make it so.

"Thank you everyone", the medic says, "that was a really good attempt".

I feel sick.

As I walk back to the engine (slowly now, all urgency gone), I try to figure out how I feel about the whole situation. Somebody is dead, and in a very traumatic way. Do I feel bad about it? Yeah, I guess so. I'm a little stunned for sure, but somehow not "devastated" the way it seems like I should be. It's a strange bit of cognitive dissonance. It's almost like I WANT to feel bad, but I can't summon enough emotion and feel any amount of depression or loss. Just a vague sense of malaise and failed effort. What's wrong with me? This is somebody's son, someone's friend, who is never coming back. Why can't I feel for them the way I should?

And yet, I feel terrible. Terrible for not being able to make a difference. For not being able to save a life, and for not feeling bad enough about the loss of a fellow human being.

I don't know what to think. So I don't.

My brother pulls me aside later and asks how I'm doing. I answer him honestly, I'm doing better than I thought I would be, but somehow I'm unsatisfied. He had some advice I hope I can take heart: "This is not your fault. You didn't cause of the crash. You didn't cause his injuries. You came here to help, and you can't win them all. Be happy about the ones you CAN save, but don't get hung up on the ones you can't."

He's right. The amount of death and loss that firefighters encounter is staggering. Empathy for one's fellow man is an admirable and virtuous trait, but it comes at a cost. If your friend were to lose a parent, you could cope. You could bear a part of their pain and sadness. Maybe even the suffering of a few friends simultaneously. But if an emergency worker were to take on the guilt, pain, loss, and sorrow of every loss of life they witnessed, the burden would be too great for any one soul to bear.

So I just don't think about it. Well, that's a lie. I try not to think about it. The first fatality I ever witnessed will probably stick in my memory for the rest of my life. But no amount of sorrow or depression will save his life or heal any of the family members he left behind. I've done everything I can for him, God rest his soul, and now the only thing left to do is focus on those will need help in the future.

That's life.

In the Field

It's been over a week since I graduated from recruit class. in that timeframe, I've run more calls than I expected to get my first month. So what has it taught me? A few things. For one, people really seem to like scheduling their emergencies for the middle of the night. that means I'm going to have to become accustomed to awaking around 2 AM, but that's actually okay for me because it means that there's less interference with my work or social life. A more important thing I've discovered, though, is that actual emergencies are nothing like recruit class. There are no coaches looking over my shoulder, making sure I don't screw up; the dummies we practiced on for medical care are now replaced with live human beings who are hurting and scared.

The rush of emotions that come with all these new experiences can be confusing in its variety. When driving to a call, I'm excited. It's all I can do to control my heart rate and the speed of my vehicle. When walking on to an emergency scene, I'm focused. What needs to be done? Who needs help? When actually performing my duties, I'm scared to hell. What if somebody realizes that I'm brand-new to this? What if a patient looks up at me and sees the uncertainty of someone who hasn't handled that many emergencies before? It can almost be overwhelming.

But I'm sure that will go away. Some day, maybe a year from now, I'll look back on these first calls as the building blocks of what will then be a confident and competent firefighter. For now, they are mostly notches in my belt; first-time experiences that will give me more knowledge and experience for next time.

In the last week, I've responded to emergencies of a surprising variety for such a short time span. The very first night I had my pager by my bed, a car went off a bridge in a rural area during early hours of the morning. The next night, a neighborhood women nearly gave birth in the middle of her driveway. A fall victim, a vehicle fire, respiratory distress, a flooded home, and most recently a head-on collision where one of the drivers needed to be extricated from her crumpled vehicle.

In a way it's exciting; I never know what's going to happen next or when it's going to happen. But the unpredictability can be intimidating. What if I'm the first one to show up at a major incident? Or any incident, really? Will I know what to do? Or will I freeze up?

I guess this post is kind of scattered, but that's how my mind is: half stoked, half freaked. Excited and frightened. That's the honest truth. But if anyone asks, just tell them I'm fine. Appearances are half the battle. And someday soon (I hope) my mind's state will match the confidence on my face when I go rushing in to help.