Culture of Preparedness

With everything that's going on in the world today, I hope everyone's thoughts have turned to what can be done to be a little more self reliant. Following the destruction of Hurricane Katrina, I heard from several city officials how the Mormons were on the scene almost immediately. They commented on how the Mormons live in a "Culture of Preparedness". Being raised LDS, I grew up hearing the counsel to keep a full year's supply of food for your entire family. I have heard the same counsel that millions of other members of the church have heard. Now I'm not saying that I'm there. We're far from it. I do feel like we are doing everything in our means to be more self reliant. Ridding ourselves of debt and taking the steps necessary to look after our needs. Now I pose the question, rhetorical or not, you choose. What have you done recently to see to your long term needs? Us? Most recently we added 40 gallons of water to our stores and finished up my long term medical supplies.

Broken Home

For the most part I try to fill my blog with the more humorous side of my job. I think there's plenty in this world for people to worry about and I don't want to seem like the doom and gloom type. I do, however, want to share what it is I do and show how the job changes those within its ranks, myself included. There isn't always a silver lining in life. Anyone who tells you otherwise is selling something. There is, however, a positive note to end this story on. Last night, as we were sitting around the table at the firehouse, I commented on how long it had been since I had worked a cardiac arrest. That is blatant taboo on the job and I knew it, but the fact remains that it had been a while since my craft had truly been put to the test. True to superstition, not twenty minutes later, we were tearing up the road on our way to a cardiac arrest. The computer isn't working in the truck, which is par for the course these days. We spend $30,000 on new mobile terminals and the accompanying software and in nearly a year I don't think it's seen two consecutive months of service. You can't tell me this isn't a government operation! So I get on the radio and ask for anything dispatch has to offer up on the subject. The report comes back as a 22 year old female unconscious, not breathing, CPR in progress. Now, it doesn't take long for that jaded cloud to settle over any emergency responder and when I heard "22 year old female" my mind completed the picture. I see an attention seeker, a fight and a few burns from a shoelace. Reality kicked me in the como se llama as the report continued. "Sounds like the real deal." Is the extent of the discussion on the matter. I know my job, I know my partner knows his. There really isn't a need for chit chat. The cops are on the scene about 30 seconds before us. I know they know their jobs as well. The room opens up as we come through the door, but it never really provides more room. There is clutter everywhere. A pretty common scene, really. You learn real quick to kneel without ever putting your knee on the ground. Needles and feces are a pretty good deterrent. The patient looks young, even for 20. Pale. Ligature marks of necrotic tissue around her neck. I reach down and pick up her hand. It's cool, but not the waxy cold of long dead tissue. My partner, knowing what was needed without being asked, hands the cardiac monitoring pads to me. I put them on expecting, well, nothing really. Instead I find a rhythm that, while not effectively circulating blood, shows me that the heart muscle isn't dead. "J. compressions, please. L. Bag her. S. gurney, please." In less than ten seconds we begin providing what is needed to sustain life. I gather the information I need from the Deputies on scene and turn back to my patient. "J., scoop her up. Let's go." J.N., Firefighter/EMT is a 6 foot 10 inch behemoth. A former NFL lineman, he will from now on be called "Tiny", because calling him "Gigantor" hurts his feelings. His big, big feelings. With the discipline of a Marine, he stops what he's doing and without thought picks up the lifeless girl and steams out the door. He crosses the small yard and, with what I would call expedited reverence, lays her body on the gurney as gently as he would his own child, clearing her hair from her face. I leave my crew to get her in the truck and go in through the other door. By the time the cot is locked into place I have laid out my intubation kit and drug box. As the guys pile in, the orders are the same. "Tiny, compressions. L., bag her. S., Epi and Atropine, please." I don't look at my patient. I don't need to. They do it right, every time. My focus is on protecting her airway and for that, the tools are simple. Blade to move the tongue and light the way, and the tube. 6.5 mm for her considering she can't weigh 100 lbs. A brief moment of panic is felt as I insert the blade and hear a crack. "Crap!" I pull the blade and check her teeth. L. asks, "Break a tooth?" I know the answer already, but I'm a bit confused. "No..." I trail off. Then I see it. The light bulb on the scope is in pieces. "Oh, come on!" Spare handle, spare handle, spare handle. "S. Pedi kit, please." Finally, she's intubated. IV is in place. Epi is in. In the military they operate inside the OODA loop. That stands for Observe, Orient, Decide, Act. It is now that we ask, "What's the story?" Before now, it doesn't matter. The body is a machine. An extremely advanced, biological machine. We are merely trouble shooting. Reversing possible causes. "22 year old single mom. Post partum depression. That was her kid in the car seat on the couch. She had fought with the boyfriend somewhere else and come back here. I guess she was serious about it. He found her. He's the one who cut her down." Back to solving the problem. "Stop CPR." I check the monitor to find organized electrical activity. "Tiny you got a pulse with that." A second or two pass. "Got one. Rapid. Regular." Never be ungrateful. "Good work guys. Let's get out of here. L. would you drive? Smooth but fast." There is a bitter sweet moment that comes for everyone that has been is my boat. The patient's heart is beating, but patient isn't breathing on her own. Her pupils are non-reactive. She has no Babinski response. She's brain dead. The heart can beat independently. It has its own power supply of sorts. So that's where we're at. The heart is healthy and continues to run. The brain has suffered a hypoxic injury and now cannot control any other functions. It's a long nine miles to the hospital. We check and recheck our interventions. We call the hospital and let them know we're on our way. And we trade off bagging the patient. I suppose we could have put her on the vent, but that's just one more thing to go wrong. I'm more of a hands on kind of guy. Just ask my wife! After transferring our patient to the hospital's care, we sit outside and have a drink. Tiny is a Pepsi man and I drink a chocolate milk. "Good work J. Looks like we saved a donor." See, there's that silver lining. I said there isn't ALWAYS a silver lining. Last night there was. We don't hear a lot about our patients after we drop them off. We made it back to the ER a few more times and eventually heard that she was confirmed brain dead and they were waiting for family to come in to town to make some decisions. I went home the next morning, kissed my wife and hugged my boys.

Push Hard, Push Fast

I don't even know how to start this one so here it goes. The story is true. The names have been change to protect me!

On Wednesday, during the Rotary Club luncheon, the Mayor wanted to spotlight the Fire Dept to the local business community. His plan was to simulate a cardiac arrest, have the firemen present render aid, and take the opportunity to educate the public.

A city council member volunteered for this bit of acting and was subsequently educated by the medics as to how to act.

There were several shortcomings to this bird-brained plan, one of which was the fact that there were about ten additional firemen present at the meeting. This bunch was not privy to the plan.

Councilman H. tipped over at the lunch table, as planned. The crew from Station 4 dove in, as planned. Captain J. from Engine 5, believing that Councilman H. was truly having an emergency, and seeing that Fireman M. was doing sub-par chest compressions, as planned, relieved M. of his duties and went to work, as any well trained fireman would. NOT PLANNED!

The "Patient" took the first few compressions like a champ! Not even a whisper. But after about number seven or eight, he began to wince. The show wasn't over yet, though. Capt J. looks to Medic H. and says, "H., I think you should check him. I think he's coming around!" That's when the confusion really set in. "Didn't anyone tell you?" Was the question posed. "What do you mean?" "This is staged, J. He's faking." Things weren't quit as comical after that. "Are you kidding me? Are you f****** kidding me? This is f***** up!!!!!"

Captain J. excused himself in a rather colorful fashion, which is probably best. I'm sure he would have said something to be regretted later.

Councilman H. was taken to the hospital for broken ribs and understandable chest pain.

Starting Over

Things didn't end well for the last blog. Left by the wayside and forgotten. Well, the User Name and Password were anyways. So here we are. Starting anew.