The Handover’s theme for this month is Respect. Great job, Chris!
http://lifeunderthelights.com/2010/03/respect-the-handover-blog-carnival-march-2010-edition/
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http://www.projo.com/slideshow/2010/0330_flood2/
Ever the smartass, I’ve been known to utter such smug comments as, “look at those dopes, how stupid do you have to be to live in a place that floods,” when watching the news. Places like New Orleans, Ohio or wherever flooding makes it to my TV are obviously places to avoid, and one must be deficient in common sense to settle in such an unstable enviornment.
Of course, the fact that I live a stones throw from Narragansett Bay never occurred to me while basking in my superior, dry state. But what is worse than the bay is the rivers that feed it. The once docile, now mighty Pawtuxet river is something like sixteen feet over fllod stage, the overflow conveniently finding its way into my basement, that as of this writing is a foot deep.
I’m at work now, the city is under water, lots of emergencies. Got to go. More later
Part of being a firefighter in Rhode Island includes public scrutiny of every aspect of our salary, benefits and work environment. I wish the people who know so much about what we do and how overpaid we are could spend a few days actually doing what we do rather than criticizing it.
http://www.projo.com/opinion/editorials/content/ED_firecontract29_03-29-10_JDHT0PK_v22.40576c1.html
Some of the comments are particularly sickening. I know I should simply not read them, but it’s kind of like roadkill, I don’t want to look, but can’t help myself.
We were able to get her into the chair, out the door and into the rescue while she seized. In retrospect, I would have started the IV in her bedroom and administered the Versed there, but things always are more clear after the fact.
She hadn’t had any seizure activity in years, said her son as we lifted her out of bed and strapped her to the stair chair.
Whenever I need an IV somebody gets it. This time it was Henry, from Engine 15 in the Mt. Pleasant section of the city. It wasn’t easy, with all the shaking, but he somehow pulled it off. The seizure had been going on for fifteen minutes now. Her sats were in the high eighties before supplemental 02. I held the mask to her sweat covered face and listened to the hiss from the tank, watched as the reservoir filled and emptied with each sharp intake of air. Her eyes rolled back in her head, she continued to seize.
I unlocked the drug box, located the right stuff and pushed. Within seconds the violent shaking slowed, then stopped. Her pulsox rose to 96%, heart rate lowered to about 100 and blood pressure stabilized.When we arrived at the hospital she was asleep.
Just Say Yes to Drugs! (Legal Ones Anyway)
The Lieutenant from Engine 15 opened the rear doors of the rescue and peeked in. The last time he saw the patient she was in a full blown seizure. Now she was still and quiet.
“Is she okay?” he asked.
“I think we killed her.”
He shook his head and walked away.
“I’m not dead, I’m just tired,” said my little friend in the stretcher. She gave us a little grin before she went back to her postictal state.
We brought the patient in, gave the report and got ready for the next call.
Ryan gets his head shaved today. Please make a donation, any amount will help. Visit the sidebar, follow the St. Baldricks link and fork over a few bucks!
I would have shaved my own head but I’m a vain coward, and am folically challenged to begin with.
My friend Jen, a firefighter, EMT, nursing student from Vermont started a new blog. Have a look and have a laugh!
I’m feeling a bit omnipotent today, must be Spring Fever. I figure I’d share some wisdom gathered through the last eighteen years. It’s worked for me, most of the time.
10 Simple Steps to EMS Success
1. Learn
An incompetent EMT is a useless EMT. Know the basics. Practice. Read. Get better. Every patient deserves competent care. Provide it.
2. Teach
People watch. Everything we do is scrutinized. If they must watch, give them something of value to watch . You are setting an example to everybody on scene. Make sure it is an example to be proud of.
3. Lead
Lead, follow or get out of the way. Sometimes you have to lead. When it’s your turn, do it well. People need direction, especially in an emergency. Take control.
4. Follow
Lead, Follow or Get out of the way. Too many cooks kill the patient. Following orders is just as important as giving them. And, if you need to get out of the way you are in the wrong line of work!
5. Know Thy Patient’s Name
Say it. Even if they are unconscious, seizing, having a stroke or dying. It brings comfort to the family, comfort to the provider and eases the patient’s anxiety.
6. Know Thy Place
We are not doctors. We are not gods. We are people trained to provided emergency medical services within the parameters of state protocols.
7. Less is More
Stabilize. Make comfortable. Transport.
8. Be Nice
People call us because they are looking for help. They are not looking for lectures. Or contempt.
9. Be Cool
No matter what happens around us remember, during the call you, your crew and your patient are the center of the universe. Nothing can rattle you if your scene is secure.
10. Be Excellent to Each Other
George Carlin told this to Bill and Ted after their Excellent Adventure, and it stands true in every aspect of life.
http://www.projo.com/news/content/new_gregory_03-18-10_HVHQP9T_v14.3c19fcb.html
Sincere condolences from every member of The Providence Fire Department to the family of Gregory Hart. Please remember that though not enough was done to find your friend, brother, son or Grandson, and the cruel circumstances that surround his demise are over, his memory will go on.
I worked with the firefighters from Ladder 6 the night they recovered Gregory from the river. It is a grim task, and one that forces us to slow down, reach out and appreciate our own. Please know the utmost respect and care was given to your loved one during the procedure. Two of our officers lost son’s this year, both about Gregory’s age. They are doing a good as can be expected, and will survive, though not without heavy hearts.
Rest in Peace, Gregory.
The portable radio is effective. At about twenty ounces, roughly the same weight as a good framing hammer it packs a wallop. Plus, it has a built in retrieval device, the remote mike. It’s range is six feet, more than enough room to drop prey anywhere in the box I call my office. I can take out a charging predator with one shot, usually, and reel the weapon home, all without having to rise from the Captains chair.
The clipboard is good for close quarter combat. I usually don’t like to get that close to an attacker, but if they are in range, and the tin is full of reports it will stop an aggressor cold, if enough torque is used. You need to commit to the clipboard once the decision has been made to utilize the weapon feature, a weak willed defense can result in disaster.
Sheets come in handy when an elusive lunatic attacks. I usually have one handy when I sense something not quite right. Bonnie, one of my first partners tells the story of an unruly passenger to this day, yet I barely remember the incident. Apparently, we were dispatched for one of the plentiful “emotional males out of control.” A two-hundred pound crying man was found at the address. Being new, I thought an easy ride to the hospital was in store, I suppose. Anyway, Bonnie tells of how she heard great commotion coming from the back of the rig as she drove toward Rhode Island Hospital, but also being new just kept driving. Eventually the racket stopped. She backed the truck into the rescue bay, got out, opened the rear door to see me, sitting on the Captains Chair, foot firmly planted on the back of the neck of a person completely wrapped in a hospital net, or sheet.
Improvise.
Today’s preditor was a tricky one. He claimed to be intoxicated, and looked the part. Forty years old, sloppy dresser, slightly menacing attitude. Nothing I couldn’t handle. I sat him on the bench seat, restrained him with the seat belt and had Brian drive toward the hospital. He gave me the creeps so I kept one eye on him, the other on the report I filled out while travelling the pot-hole filled terrain.
“Lucas” stared at me the entire time. He had a Great White Shark kind of eye, stone cold empty. His mouth began to leak. No warning, no noise, just vomit pouring from his mouth, down the front of his jacket. His expression never changed. I threw a towel toward him. He didn’t flinch, let it fall to the ground.
Radio? Check.
Clipboard? Check
Net? Check
More vomit flowed from his mouth, soaking his pants, dripping onto the floor of the rescue. Still, he didn’t move, or blink, or moan, just leaked. I threw a bucket toward him. It dropped to the floor. Two more towels, finally he reached for one, never taking his eyes from mine, then took the bucket, which he promptly filled with more bodily fluid.
He sat there, fully loaded weapon sitting on his lap, waiting for the opportunity to toss it my way.
And I had no defense.
Improvise.
“Turn off them lights, this ain’t no mergency!”
“What?” At times the brain is so overwhelmed with information a simple, what? is the only thing capable of seeping out.
“I dont want no tenntion, jus git my baby to the hos-pi-tal!”
“What?”
“This be the third time since yetaday! He been cryin since his noculations.”
“What?”
“You heard me, he ain’t stopped cryin!”
“Huh?” I was getting warmed up.
People call for rides to the Emergency Room. They do it because they can. There is no fee. We (911) don’t charge them, monetarily or criminally, the hospital doesn’t charge them, the taxpayer takes care of that, and the general public doesn’t charge, or judge them. They get away with it, over, and over and over.
So, who is this, “they?”
Are they “they the poor, disabled and infirm?”
I think not.
Are they the impoverished, underprivileged struggling immigrant?
Nope
Are they the elderly, unable to take care of themselves?
Hell no.
The “they” I speak of are the growing number of entitlement minded citizens who are in the second or third generation of living either completely or in some part government subsidised. Their homes are government subsidised. Once upon a time, people living in the projects were trying desperately to get out. They were a starting point, or a place to regroup after some disaster, divorce or illness. Their healthcare is subsidised. They pay nothing, no prescription or doctors office copay’s. Nothing. Zip. Their food is subsidised. EFT Accepted Here is more prominently displayed on stores in Providence than the weeks specials and coupons. When one doesn’t have many monthly bills, free transportation isn’t necessary, but is available. It is more convenient to take the Lexus that sits outside. Unless the baby is crying, then the most sensible thing to do is call 911.
I stepped through the door of this particular apartment in this housing project and thought I had entered the Touch of Class catalogue that my wife flips through whenever it comes in the mail, remarks at how expensive it is and throws it into the trash. Ornate couches, silk flowers place in lavish vases, paintings in ornate frames, (Paintings, not prints. Never a print) A Samsung big screen TV, Kitchen-Aid appliances, wool rugs.
All this in a housing project?
We left Shag-ri-la, crying baby in hand and headed toward Hasbro Children’s Hospital.
“Turn off them sireens, aint no sense rushin, took you long enough to get here, what’s the hurry.”
“What?”
I’m out of lectures. I’m out of anger. I’m even out of resentment, shock or awe. I just wonder how long we as a society will survive.
I wrote up the report, brought the crying infant back to the hospital, had the equally beaten nurse sign the report and waited for an emergency.
“I’ll do it,” said Hector.He was the only one among us who spoke fluent enough Spanish to articulate my desire to let this person pass peacefully. A minute at most, seconds from eternal rest.
She was ninety-four. Earlier in the week we took her from her comfortable bedroom in a recently rehabbed apartment building that once was a middle school. That day she nearly passed, her condition critical. She went into atrial fibrillation on the way to the hospital and lost consciousness. Modern medicine and the skill of the people at Rhode Island Hospital stabilized her enought to allow her another few days. Hours after we had brought her to one of the trauma rooms I saw members of her family standing vigil outside of her room. They cried, and thanked me the best they could. A few days later,the family took her home.
The building was originally built1906 or somewhere around there, an imposing brick structure, four stories high, ominous when you first look, only when you get close do the details reveal the true character of the place. The windows are new, but the brickwork the surrounds the new panes intricately layed, giving the potentially boring walls depth and character.
I looked closely at the woman lying on the bed. Her family had left the room, the door closed, leaving just us, Miles, Oliver, Brian and the woman whose tenuous grasp on this existance slipped away with every second. Her face was serene, the wrinkles that grew as her life progressed relaxing now, even as I placed the bag-valve mask over her mouth and nose, and waited for the resevior to fill with oxygen.
Hector returned.
“Let’s go.”
“Damn.”
Oliver started compressions, I pressed the bag, sealing the face piece around her delicate features, forcing air into her lungs, pushed through her body by the artificial pumping of her heart. Ribs cracked. Her serene face showed signs of pain. Nonexistent moments ago, but now appearing as the wrinkles creased, and deepened once again. Sometimes you need to look closely to see the details.
The family outside the bedroom cried, and prayed. I can’t blame them for wanting to squeeze another hour or two of life out of their matriarch, and felt guilty for making them, and Hector part of the choice to prolong her life. Instant decisions are not always the best. Of course they chose CPR, had they decided to do, or rather have us do nothing they never would have known.
We put her on a backboard, continued CPR, onto the stretcher and rolled her out of the bedroom, past the crowd and into the elevator, where we were alone again.
“Do your best .” They knew. I knew. I hope the patient didn’t.
I sat in the Captain’s chair, documenting everything we did.
Pt. found pulseless @ 1710
CPR begun, 1711
Asystole confirmed, 1712
IV established 1715
epi adm 1715
remained pulseless, asystolic
intubated at 1717
atropine at 1717
remained pulseless, asystolic
The report continued. The patient did not.
The medical team at Rhode Island Hospital took over where we left off but there was little more that they could do. The woman’s daughter, who rode with us agreed to stop the effort. The doctor in charge looked at the clock on the wall, checked his watch and called it.
“Time of death, 1731.”
I checked my memory, and looked at her face. Still, no pain now, but not as serene as it had been half an hour ago.
“Time of death, Tuesday.”
We cleaned the truck and got ready.
What in the world have I let my wife talk me into this time?
“Rescue 1, Respond to 677 Manton Avenue, at the salon, for a child who had her ear pierced complaining of “ear pain.”
“Surely they jest.”
“That’s the exact opposite end of the city!”
“That it is.”
We dropped whatever it was we were doing and started the journey. All of the other rescues were out, some gathering drunks from the sidewalks, some taking perfectly fit forty-year olds to the emergency room to treat their abdominal pains and sniffles. It was just one of those days.
“Rescue 1 on scene.”
It took nearly ten minutes but we had arrived. We are required to do an emergency response no matter what the call. I felt silly as cars moved to the side to let us through the busy streets, knowing our reason for endangering the citizenry likely ridiculous. Suffice it to say, I was a bit peeved when our patient, a beautiful one year old with a smudge of blood on her freshly pierced ear was presented to me by her Spanish speaking mother, grandmother close behind, literally screaming, also in Spanish, about the incompetent fools who ran the salon. I think.
I focused on the baby and felt my anger dissipate. Using a trace of peroxide on a sterile 4×4 I rubbed the blood off the ear, rewarded by a giant smile and infectious giggle. My teachers used to tell me that tuning out the world would lead to nothing but trouble, but teachers aren’t always right. My portable came to life as I handed the baby back to her mother.
“Engine 15, Respond with an out of town rescue to 1676 Smith Street for an Infant having a seizure.”
“That’s right around the corner.”
“Let’s go.”
We arrived thirty seconds behind the 15′s. Another one year old had gone unresponsive, turned blue and had stopped breathing. The parents were hysterical, even after the febrile seizure stopped and their daughter began breathing on her own. We helped them. Simple as that. Right place, right time. We took mom and baby to Hasbro Children’s Hospital, dad came later in the car. The baby was fine, but it was good to be close when the emergency happened.
Karma, I guess.
With no support, little direction and blatant contempt from our Mayor, the rank and file of The Providence Fire Department continues to put of the fires, protect the citizens and handle the ridiculous amount of Emergency Medical calls that pour in daily.
There are no Chief officers in the stations making sure we hit the poles and get out the door in thirty seconds every time the bell hits, no EMS Supervisor on the streets ensuring quality control on the thousands of rescue runs we respond to daily, no Mayoral Staff providing equipment or technology to keep track of these things.
I actually have to apologize to my patients while transporting them to area hospitals, advising them to “hold on tight,” it’s a bumpy ride due to my truck’s lack of suspension. There is no CPAP http://www.ems1.com/ems-products/medical-equipment/articles/390898-A-Look-at-CPAP-for-EMS/ on the rescues to which drastically help COPD patients. We have no on board computers, relying on seventies era hard copy reports. Our stations are falling apart, paint falling from walls and ceilings, bugs, broken windows and screens, doors that barely open.
With Zero communication between te administrative Chiefs and the firefighters on the streets we still manage to maintain the trust and respect of the citizens of the city, not by the endless press conferences, Mayoral support and funding enjoyed by the Providence Police Department http://newsblog.projo.com/2010/03/four-providence-officers-on-de.html rather by doing the job we are paid to do, maintaining the highest level of personal responsibility and earning the respect of the people.
I started my career with the Providence Fire Department in 1991. At the time , we were one of the most respected departments in the country. Morale was high, coming to work something to look forward to. Over the years, through complete lack of leadership I’ve watched the department sink to a level I could never have imagined.
The senior members have to lead by example, or the new people will fall into the trap of disillusionment, anger and entitlement. We are fortunate to be physically and mentally able to perform the duties of firefighters. Nothing the administration can do will change that. What could destroy our ambition needs to be fought with every bit of strength we have left. That strength comes from 99 Printery Street, headquarters of Local 799, The Providence Firefighters Union.
Stand Strong, Brothers and Sisters. If we don’t take care of this city, nobody else will.
“I can’t walk.”
“Yes you can.”
She shuffled down the stairs, out the door and into the side door of the rescue, plopping onto the stretcher.
“What’s your name?”
She wouldn’t answer. The wrist band from this afternoon’s visit to the ER was still there so I cut it off and wrote down the information.
“Why are we going back to the hospital?”
“I can’t walk.”
This is where my reports get interesting. I have to come up with some sort of cohesive narrative to give to the triage nurse.
“Pt. is a thirty-seven year old female, found at home, returning to the ER for unknown malady.”
It was the best I could do on short notice. She lived three blocks from Rhode Island Hospital. We moved her onto the hospital stretcher, I started to give my report.
“She can’t walk.”
An alert security guard asked,”Why are her shoes tied together?”
I looked over. He sneakers were indeed tied together, leaving about eight inches of space between them.
I’m going to have to do a more thorough primary in the future.
