What a difference a few seconds makes. Two young women were travelling home at about four this morning when their car lost control, straddled the highway divider, took out 100′of guardrail and ended up facing the wrong way on the other side of Rt. 195. But for a few mph more, a twist or turn in either direction or the tiniest flick of the steering wheel during the crash the guard rail would have intruded the front passenger compartment, rather than the empty back seat.

The girls walked away with minor injuries. Their families and friends now have the opportunity to see them grow older, pursue their lives, maybe someday start a family of their own. The girls themselves, having never seen the mangled bodies that have littered these highways over the years will probably never know just how lucky they are to be alive. Those of us who have seen the dead and dying know, and are thankful that these two didn’t join all the others that left heartbroken families and friends where the miracle of life, hope and future generations should have been.

There are over 1000 vacant, boarded up houses in Providence. The three major fires we fought today were in occupied buildings. Four or five other, small fires we put out before they could get going, one in the basement of a day care. Two firefighters suffered injuries that required an emergency room visit, many more were able to walk their injuries off and keep fighting.

Night has arrived. Vacant houses have a tendancy to ignite when the sun goes down.

Stay safe, brothers and sisters, the night is young.

I just transported a psychiatric patient from Butler Hospital to Miriam hospital, a trip of about three miles. The patient was in Butler for a variety of reasons, today we were called for a medical problem. We were escorted through the hospital grounds by a security guard who led us to the ambulance bay. From there, another security guard walked us to the unit where our patient waited. Security was tight, we were escorted through a locked door into the patient area. Our patient was stable, we put her onto our stretcher and asked if security would be coming with us. “No,” was the answer. “We do this all the time, no security necessary.”

I could, and maybe should have made an issue out of the situation but felt as though I would be pushing water uphill. We left the facility, escorted by security until we left the hospital grounds. From there we were on our own. While reading the patients report it was noted in multiple places that the patient is volatile, unpredictable and prone to violence. Among other things she tried to kill her mother and sister. The psych eval was a day old. The trip was uneventful. This time.

Security at Miriam Hospital will keep an eye on her while she is treated.

This kind of thing goes on every day, nationwide. EMS providers are left vulnerable. Going along to get along will eventually, and probably already has get somebody seriously hurt, or killed.

I might have to write a letter. Never mind, I already did. (Friday, February 29th)
Lot of good that did.

Rhode Island Monthly’s “Best Of” issue will be out in a few months. There is a category for “best local web-site.” Vote early and vote often! Click on the title of this post to cast your ballot.

I think I need to get out more, I didn’t have an answer to most of their questions!

Every now and then the wrong thing gets nailed.

I was wondering what happened to Victoria, she had been missing since we moved. Poor thing had to chew her way out of the box we packed her in!

Fuel?

check

Lights and siren?

check

Medications, IV equipment?

check, check

Splints, bandages and peroxide?

check, check, check!

Stretcher?

Stretcher?

Stretcher?

Just when you think you are a hero somebody from East Providence needs a rescue and you don’t have a stretcher. Too bad we didn’t realize it before we got there. Thankfully, firefighters are a kind, forgiving lot and understand a little mistake. I’m sure this little fopar will be forgotten quickly.

That and I’ve got a bridge for sale in Brooklyn.

“Engine 10 to Rescue 1, heroin overdose, we’re working him now.”

“Rescue 1, received the message, eta three minutes.”

A few years ago, the patient would have been dead by the time we arrived. Instead, the fire companies in Providence and most places now are Advanced Life Support equipped. Three minutes is a lifetime. A person who has od’d on a narcotic goes into respiratory distress first. It’s all part of the high, manageable most of the time, the drug user has a chance of coming out of it on their own. Their respiration’s start slowing, from 18-20/ minutes, down, down, down to about ten. If they are fortunate and have people nearby who are not too high to recognize a problem they have a chance. The other addicts sometimes drag the person to a shower and soak them with cold water. It must do something because over half of the overdose victims we respond to are in a bathroom, soaked, with puddles of water on the floor.

If there is nobody around, the patient dies, most of the time. The respiration’s slow to 8, then 6, 3-2-1…0. The heart keeps pumping oxygen starved blood through the body until it, too shuts down. The patient dies, a peaceful descent into the other world, never aware of their final moments.

“Engine 10 to Rescue 1, we’re bagging.”

“Rescue 1, received, on scene.”

The guys from the engine are assisting ventilation’s, the patient must have stopped breathing. A crowd watches as Steve and I get out of the truck with the blue bag and walk down some stairs into a basement apartment. The patient looks like a corpse, soaking wet, pink sputum leaking from his nose and mouth. The smell of vomit rises from a lumpy puddle next to his head. We work around it.

“I couldn’t get a line,” says bill, a twenty gauge catheter in his hand, the blue tourniquet still on the patent’s arm. Engine 10′s med bag is open, I draw up 5 ml of narcan into a 10 ml syringe and administer 2 mg. of Narcan into the patients left triceps muscle. IM works, it just takes a little longer than IV access.

Keith continues to bag the patient, who remains motionless on the filthy floor as we get the gear ready to carry him out. After what seems like an hour but was actually only two minutes I see signs of life. The eyes start to flutter. He coughs. He opens his eyes. Keith stops bagging. We get him on a board and carry him outside. The crowd watches, speaking Spanish, entertained by all the commotion as we wheel their friend past them and into the stretcher. He sees them as he rolls past, gives a weak wave and disappears into the back of the truck.

Nobody knows anything, of course.

If you are interested, a nice review of my book ran it today’s Phoenix.* Click on the title of this post to visit the Phoenix

*(more shameless self-promotion)

Our patient lay on her back in an over sized bed, covered with blankets. Just her face peeped out from under the covers.

“What is the matter?” I asked.

“I feel like I’ve been drugged.”

“How does that feel?”

“I’m all woozy and happy.”

“Did you take any drugs?”

“Just some Oxycontin.”

“When did you take the Oxycontin?”

“Right before I started feeling like I was drugged.”

“Hippopotamus one, Hippopotamus two, Hippopotamus three…..”

She had a prescription for Oxycontin to help with some pain she had been experiencing following the birth a week ago of her daughter. Her family gathered around the bed as I explained that the effects she was feeling were perfectly normal and to be expected after taking a painkiller.

“That is exactly what the doctor said,” the baby’s father offered from the foot of the bed. “We just wanted to make sure so we called 911.”

I swear I don’t make these things up.

Monday she was drunk at home, a concerned friend called 911 to have strangers check on her well-being. I guess it is easier to call the fire department when a friend is in need than getting up and doing something yourself. We found her inside her apartment, empty beer cans littering the floor, highly intoxicated. There is no law against being drunk at home but our patient clearly needed some help. After a small brawl we talked her into going to the hospital for detox, hopefully eventual rehab.

Wednesday she was home again, drunk. This time she called 911 for a ride to the hospital because she wanted to go to detox. Apparently, rehab wasn’t in the cards on Monday.

Saturday we got a call for an intoxicated person at an address on Broad Street. Our friend, drunk at an acquaintance’s place. he was tired of her, wanted us to get rid of his “problem.” By now I thought we had become friends. It’s a short trip to the emergency room, but a bond quickly forms between patient and caregiver, especially a “frequent flyer.”

Monday we got a call for a person down in the bushes. I saw a hand rise from some hedges in front of one of the hi-rises that the elderly and disabled residents of Providence reside in. Walking closer I saw my old friend, drunk again, unable to extricate herself from where she fell. She fought for a while, learned quickly that one fifty-six year old former prostitute is no match for five firefighters sent to help her. “I have a knife,” she said, enraged now that we had her out of her nest.

You would think that after seventeen years I would learn never to let my guard down. Because familiarity sets in by no means diminishes the potential threat on every call. To the patients we are sent to treat we are no more than a blur, a momentary diversion from their otherwise dreary existence. Once we part ways we are forgotten, the next person who enters their lives more important than the last.

She ripped open the front of her coat and brandished a twelve inch butchers knife. Her eyes were wild, full of hate. Before she had a chance to hurt herself, or us, we disarmed her, put her on the stretcher and took her to the hospital. There was no real malice once the knife was out of her hands, but for one moment, when she was capable of murder, she could have altered a lot of lives.

http://provfiredocumentary.blogspot.com/

Erin Blackman has been working on a documentary supporting firefighter everywhere. Her latest post on her blog describing the documentary making process is a real eye-opener. If you click on the title of this post (Family) you will be directed to Erin’s site.

312 posts and I just figured out how to link to other sites!

He stood outside the apartment with his girlfriend, waiting for the rescue. His skin was gray when we arrived, the front of his shirt soaked with blood. We got him into the rescue, cut off his clothes, put him on oxygen, started two lines and ran an ekg. His vitals were crashing, 90/62, HR 120, spo2 90% on 10 Liters. Engine Co. 6 from Hartford Ave assisted, Heidi helped in back, the Captain drove the rescue and Coley followed with the Engine. We have been through similar jobs, everything went like clockwork.

He was stabbed in the chest by his friend. They were in the friends apartment watching TV. Our patient, now in critical condition in the Rhode Island Hospital Trauma Intensive Care Unit, lit up a smoke. His friend told him not to smoke in the apartment. Our patient puffed away. His friend rendered his lungs incapable of inhaling. One of them anyway, pneumothorax, right lung.

I stayed in the trauma room for a while, watching the ER doctors decompress the pleural space. A doctor felt inside the hole for any tearing of the diaphragm. Then they stuck a chest tube between the ribs and relieved the pressure that had built there. Buckets of blood poured from the tube onto the stretcher as the patient screamed in pain.

It looks like he will survive the ordeal. Quite a Saturday Afternoon Matinee.

He walked into the Dunkin Donuts in Olneyville, asked the help to call 911 then fell to the floor. His clothes left a puddle on the floor. He said no more until we arrived.

“I got hit in the head with something hard, ” he explained. “Then they threw me into the river.”

I did a primary evaluation and didn’t see any sign of trauma, no bleeding, no deformities, bumps ar bruises.

He told me he had a history of substance abuse but had been clean for months. “Can you call my mother?” he asked.

We put him into the rescue, stripped off his soaked clothing and wrapped him in blankets. I took off my coat and cranked up the heat. He gave me his mother’s number and I dialed. She answered on the first ring, sounding exhausted.

“Hello, this is Lt. Morse with the Providence Fire Department, I have your son in the rescue, he’s not injured but appears to have been out all night, we’re taking him to Rhode Island Hospital for an evaluation.”

I handed the phone to our patient, he talked for a minute then was quiet.

We got him to the hospital and transferred care in a few minutes. As I left the ER, a middle aged couple and girl about the patient’s age walked over to me.

“Excuse me, are you the Providence Firefighter who called from the rescue?”

They looked to me for answers concerning their family members ordeal. I honestly couldn’t tell them much more than I already had, he was out all night, says he was assaulted and ended up on a river bank in Olneyville.

He had been paid that morning and planned to visit his kids in another state by way of Kennedy Plaza, the city’s bus station. It also serves as the city’s place to get in all kinds of trouble with all kinds of people and all kinds of substances.

The family is holding out hope that he was mugged. I wish I shared their faith in his sobriety.

He lay face down in the street, a stab wound to the back of his head and a bleeding lump on his forehead. A butcher knife reflected the streetlight’s glow three feet from his head and a broken golf club rested near his feet.

He was conscious, barely. We put some gauze on front and back of his head to stop the bleeding, put him in a c-collar, rolled him onto a spine board and put him in back of the rescue. While we started an IV and did a secondary assessment a police officer stuck his head in the back of the rescue. “Has he been drinking?” he asked. “Looks like it,” I replied. “Maybe he tripped and fell,” suggested the cop.
“Maybe he got stabbed in the back of the head with a butcher knife and clubbed on the forehead with a nine-iron,” I replied.

Violent Crime is down in Providence for the fourth straight year.

We’re just people. Sure, we’re trained in advanced life saving techniques, yes we have at our disposal tools to be used in life saving efforts. We have experience, know-how and that special something that keeps us sane when time and time again all we do isn’t enough.

We get called when all else has failed. The finality of death is overwhelming when it comes unexpectedly. Most people watch, wishing they knew what to do but paralyzed by fear. There is no room for second guessing when a person has stopped breathing. Decisions must be made without thinking, actions carried out automatically, procedures followed, work to be done.

When all we do isn’t enough, when a person dies before his time all we have is the knowledge that we did all we could. Sometimes it is all we have.

Two off duty nurses took it upon themselves to call the head of Emergency Medical Services in Providence to express their dissatisfaction with two of our best EMT’s during an incident last week. A man in his fifties died in a restaurant. Our people did everything in their power to save the man’s life, and took it hard when all they had wasn’t enough. The head of Emergency Medical Services placated the “nurses”, told them he would sent the EMT’s in question for “re-training.”

I think they learned enough that night.

Thank God we have each other.

Air bags and seat belts are beautiful things. Scrapes and bruises, some neck and back pain and a few lacerations beat body bags every time.

“Rescue 1, respond with Ladder 5 to 990 Broad Street, at the pay phone for a fifty year old female experiencing chest pain.”

“Rescue 1, responding.”

Housework had been underway when the tone hit. Me and rob dropped our mops and made for the apparatus floor. A miniature dust cloud swept through the garage as the overhead door opened, inviting the cold wind into our home. The remains of a late winter snowstorm lingered on the roads of Providence where salt and sand accumulated, then stuck to our trucks as we plowed through the slush. When the ice melts from the vehicles a deposit is made on the floor, we spread it around as we walk to and from the vehicles. The floor is swept daily, we just can’t keep up. Spring cleaning is around the corner, that and warmer weather should clean things up.

Chest pain at the pay phone at 990 Broad Street at eight in the morning. Ninety-nine times out of one hundred this is a call for somebody who had been smoking crack all night. It is difficult to not get tunnel vision but I try to stay objective.

“Ladder 5 to fire alarm, advise rescue we have a fifty-year old female, chest pain radiating down her left arm, diaphoretic, obtaining vitals.”

“Rescue 1, received.” This patient sounded like the one out of a hundred.

Ladder 5′s crew had obtained vital signs, administered aspirin and oxygen and had a nitro on board when we arrived on scene. The woman looked like she just left a PTA meeting in one of the suburbs surrounding Providence. We loaded her into the rescue and continued care, first running an EKG, then starting a line. Vitals signs weren’t great, 160/100 after a nitro with a pulse of 120. The EKG read sinus tach. The patient looked anxious but her skin was now cool and dry.

Ladder 5 went back in service after doing most of my work, Rob and I transported the patient to the ER at Rhode Island Hospital. En route I found that the patient had been out all night looking for her car which had been “stolen” by an acquaintance. I didn’t want to ask, but had to.

“Did you do any drugs last night?”

“I had to smoke some to keep awake.”

“Smoke what?”

“Crack.”

One hundred out of one hundred.

She sat on the step of Engine 8, her dress ripped, no coat, shivering in the wind and snow. A one inch laceration to the top of her head and a huge welt on her left temple evidence of an assault. Blood streamed down her face, ruining the make-up she must have spent a long time applying. I imagine she spent hours getting ready for a fun night on the town.

Somebody cracked her head with a bottle. The bars had just let out spilling hundreds of drunken revelers into the streets of Providence. The chest pains, seizures and breathing difficulties would continue to trickle in but for the next hour or two our rescues will be tied up with assaults, robberies, and other assorted mayhem. Witnessing the aftermath of a night on the town makes me wonder why people even bother to go out.