First, I'd like to thank you for stopping by my blog. Visitors keep me writing, for if not for you, there really wouldn't be any reason to write this stuff down, I already know what I'm thinking.

In case anybody is interested, and judging from the Amazon ranking over the last few weeks a lot of you are, Rescuing Providence is now available in Kindle format. I'd sure appreciate it if you bought a copy, if you haven't already.

On the new book front, nothing concrete yet, but it looks like Emergency Publishers is going to publish it, hopefully in time for Christmas! Kelley Grayson, aka Ambulance Driver steered me in their direction, and introduced me to the owner via a very nice letter, so many thanks to you, AD!

I'll keep you posted on any developments, it's been a long time coming and a lot of ups and downs, thanks for hanging in there!

"A fire department based EMS system is the most effective way to deliver quality patient care to the community. When the people assigned to those fire companies are trained and motivated, which they are in Providence, nothing beats it."" Michael Morse, July 28, 2011

"TOTWTYTR, our system is crap. I wrote the post after a thirty-eight and in that time the guys on the engine companies were simply awesome, and usually are, figured I give some credit where credit was due. As for the rest, forget it, it's horrible, lost cause, honestly. We as individuals can simply do the best we can with a broken system."  Michael Morse July 29, 2011

For those of you not familiar with my blog, I sometimes refer to it as my bi-polar blog for a reason. This is a stream of consciousness kind of writing, I usually start pecking away at my keyboard in the middle of the night, usually in the quiet hours between three and six a.m., normally with hardly any sleep and most often after a call that stoked some kind of emotion from me. It doesn't need to be dramatic or traumatic, as long as it is not the usual automatic response where I never attain full consciousness.

I guess the that is the best way I can explain the obvious two end of the spectrum sentiments concerning EMS in Providence. The system stinks, the people are great. A lousy system comprised of great people will eventually collapse, and a great system full of lousy people will also collapse.

Providence does over thirty thousand EMS calls every year with six units, and every year the numbers increase. Whether it is an ALS, BLS or CBS (complete BS) call, an ALS crew is dispatched. It is absurd, a waste of taxpayer dollars, a waste of human resources and unsustainable. We are mired in mediocrity. The citizens seldom complain because the people who show up when called do a fantastic job. If they knew we did not carry CPAP equipment because it is too expensive, or the people who show up and do an excellent job are finishing a thirty-eight hour shift with no breaks, or the vehicle they are in is held together with duct tape, they might think differently. But they don't know how close to collapse the system is, and the reason they do not know is because we don't let them know. We have been doing so much with so little for so long, it is second nature for us to do everything with nothing now.

There is a better way.  I think fire departments have the potential to be industry leaders delivering EMS services to the public in the most efficient manner possible. Firefighters are everywhere, and can be at a person's door usually within eight minutes, most of the time far less. Firefighters are  (or should be) trained and equipped when they arrive. They should be paid, and not motivated to use the patient as a cash cow.

Firefighters not helping EMS? That is completely unacceptable. Firefighters ARE EMS, and the sooner they get that through their thick skulls the better. Competition, rivalry and what comes with it have their place, and are part of what makes the fire service one of the great jobs, anywhere. But leave it in the stations, or the musters, and get with the program, or the program will end, and we'll be stuck with the business as usual re-runs forever.

This is all well and good, but ultimately it is up to the leaders in the fire services to leave their caves and take the reigns before it is too late. EMS as a third public safety agency works, and works well, but in my opinion the people on the trucks will suffer. EMS work is every bit as dangerous as police and firefighting, and the same benefits should apply for all positions. I did ten years on some of New England's busiest Engine and Ladder companies, and ten years on New Englands busiest ambulance, and the number of life threatening incidents on the ambulance exceeds those on the fire trucks. People are unpredictable. They attack when you least expect it, or crash into emergency vehicles and responders too often.

EMS for profit is just that, EMS for profit. Profiting from other peoples emergencies is vulture capitalism of the worst kind. Just the thought of crews waiting in garages for an emergency to happen so they can pay the rent this month makes me crazy.

That's enough out of me. Feel free to dissect, overanalyse and ridicule the above post, I really don't mind.

"A fire department based EMS system is the most effective way to deliver quality patient care to the community. When the people assigned to those fire companies are trained and motivated, which they are in Providence, nothing beats it."

http://rescuingprovidence.com/?feb_network_search_context=blog&s=diabetics+and+firefighters

That little comment and subsequent link created a little debate here at Rescuing Providence. Debates here are nearly unheard of, considering I am the Supreme Being here, and the world revolves me, and I can squelch rebellion with a swift, ferocious keystroke.

Nevertheless, even Supreme Beings can be wwwrrrong (anybody reading old enough to remember The Fonz?) now and then.

I learned that outside my little bubble, things are not so rosy between firefighters and EMT's, and that is a shame.  Battles between the two distinctly different agencies, often under the umbrella of one organization, mostly the Fire Department, exist. 

It just makes no sense to me when people whose primary function is public safety cannot work together. It speaks poorly of both our vocations when ego gets in the way of delivery of services. I've heard some pretty disturbing stories about firefighters offering the bare minimum help at EMS scenes, and EMS crews reticent to enlist the help of their local fire department at the detriment of patient care.

This weeks examples of how it could be:

     -A diabetic, unconscious in Mount Pleasant. All Providence Rescues out, Engine 15 arrives three minutes after initial call. Rescue 1 clears Rhode island hospital, ETA eleven minutes. We arrive, patient is alert and conscious, BG 145 from a 22, IV established, D-50 administered, wondering what all the fuss is about.

     -Overdose in the West End. Rescue 1 is fifth due, ETA eight minutes. Engine 8 arrives on scene in two. 2.0 mg narcan adm. IM, the patient who was seconds from death prior to their arrival now alert and conscious, denying drug use.

     -Seizure in Washington Park. Seventeen year old kid, first seizure. Family going berserk. Firefighter from E-13 speaks fluent Spanish, calms the scene, two firefighters lift the two-hundred pound kid from his bed, postictal at the time, secure him to stair chair while the patient gets combative, figures a way to get him out of the bedroom and down the stairs while the Rescue Officer gets pertinent information from family. Once in rescue, IV's established, meds administered, vitals assessed and a report radioed to the ER. Impossible to do with two hands, six worked just fine, thank you.

     -Two intoxicated males, on the street in South Providence. Upon arrival, Rescue 1 is attacked by intoxicated males. Police called. Engine Company dispatched. Two minutes later, Engine 10 arrives on scene, order is restored, the intoxicated males subdued, and restrained in the back of the Rescue with assistance from firefighters. Police arrive on scene as we depart, Engine Company following.

     -Chest Pain in the North End, Rescue 1 ETA twelve minutes. Engine Company 2 on scene in three. Nitro, aspirin and oxygen delivered in four, vitals and an IV to boot. Rescue 1 arrives on scene, the Engine crew carries the elderly gent down two flights of stairs and into the rescue. I do the paperwork and say thanks.

     -MVA on Rt. 95. Engine 11 arrives on scene five minutes prior to Rescue 1, and seven minutes prior to police. WE arrive, the lights and presence of the Engine providing some safety from passing motorists, bleeding from vehicle occupant controlled, c-traction applied, leaking fluids contained an patient history assessed and documented. The firefighters retrieve the spine board from the Rescue's compartment, extricate the patient and deliver her to the rescue, then stay on scene until we depart.

    I have dozens more, from the last four days alone. I am fortunate to work in a department with great people beside me. I cannot do this alone, or with my partner.

     In addition, during the tour three building fires and countless other fire department responses were handled, four firefighters transported by Providence Fire Department Rescues to area hospitals for injuries during operations.

     Thanks to each and every Providence Firefighter, for doing the job the way it should be done. Great work, as always.

His hand went wrist deep into a vat of hot- 350 degree hot- tar. He pulled it out, looked at it and had his son call 911. We were enroute to a combative, emotional, suicidal female at the time, and were driving right past the man with the tarred hand. The emotional combative female could wait.

It's a family business, he had stopped for a coffee with his son and daughter between jobs. They waved us down and directed us to their dad, who sat on the bumper of the trailer that held the tar vat. He looked at me, and I could sense the pain coming from him, but he acted like it was no big deal, for his kids sake, and walked into the rescue. I helped him in, and iced the hand with sterile water and some ice bags. The ER was less than a minute away, we got rolling, taking his daughter with us.

He was able to tell me all the pertinent information, and smiled as he did so, occasionally grimacing. I wanted to administer some morphine, but we were at the hospital before I could get it out of the package. He didn't mind, said it wasn't too bad, and he and his daughter went in together, him on the stretcher, her holding his good hand.

I could see the skin oozing from the tips of his fingers, and blood seeped through the tar, yet still he smiled. They got him in a room, and started treating him, and gave some dilaudid, and only then did tears form behind his eyes. His son joined them, and soon after his wife.

As I walked out the ER door, the emotional combative suicidal female was walking in. She wasn't combative now, but just sad. She wore a summer dress, and sandals, and looked perfectly fine, but inside she was burning. I wanted to bring her into the trauma room with the family I had just left, and maybe some of the love and dignity that oozed from the little room would seep into her subconscious, and make her feel better. But things just don't work that way.

I returned an hour later, with a combative, intoxicated male. The girl was on a stretcher in the corner. They wheeled the intoxicated combative male, who had stopped being combative but was full of hate and misery next to her, where they will stay for hours, under the watchful eye of security.

And the family a few doors down will heal.

I want to feel it. Feel the thrill again, feel something.

I want to look forward to coming to work.

I want the people I work with to look forward to coming to work.

I want the people who work at four of the five hospitals I go to stop asking "why did you bring them here?"

I want the people who call to need us.

I want the people who send us to be able to say no to the people who don't need us.

I want to iron my uniform again, use a little starch, shine the Lieutenants bars, polish the shoes.

I want it to feel like it used to, when it all was new, and nothing bothered me.

I want to stop complaining.

I want to stop having things to complain about.

I want to find the good in the bad.I want this to be a proffession I can be proud of.

I want to stop ignoring the people in my truck.

I want to want to take every call.

I want nobody to call.

I don't know what I want.

What I really want is to remember posting this. I vaguely remember writing it, then nothing. Six after midnight last night, four already this morning, must have scheduled it for today, but I don't remember. I was going to delete it, I'm kind of sick of hearing myself complain, but it's out of the barn now, may as well roll with it.

Anybody wants to chime in, feel free, comments always welcome! And thank you, Hilinda.

I liked Amy Winehouse, thought she had a sultry, bluesy soul, troubled but ultimately good. Didn't think about her till she died. I don't think about the thousands of twenty year olds that die alone in bed either. I'd probably like them, too, if I got to know them. Amy is gone. A lot of other troubled souls are gone too.

"Most men lead lives of quiet desperation and go to the grave with the song still in them." Henry David Thoreau
 

Am I blessed or cursed for bearing witness to the bodies of the deceased whose song was never truly released? I know desperation. I've seen it, felt it, was nearly destroyed by it, but fortunately came to the realization that most of life is boring routine, punctuated by moments of sheer joy that make the mundane bearable. There are a lot of Amy Winehouses out there who never had the chance to figure that out, and make peace with it, and learn to live for those unplanned, unexpected moments that fill you with enough of life's magic to get them through the seemingly futile hours and days filled with nothingness.

Life on the rescue follows a similar path, days of routine things, simple people with simple problems, most of them decent folks struggling through life like the rest of us. We all struggle with this existence. I once wondered why some seem to float through the days and years without a worry in the world. I don't wonder anymore.

"Nobody here gets out alive." Jim Morrison

Nobody gets out without their share of hardship. Some of us are just able to bear it for longer, that's all. And for those unfortunate souls that drown in the ocean of self pity and destruction, I'm truly sorry they were not fortunate enough to break through.

I had a few minutes to kill between runs for phsyc patients last night so I sold Rescue 1 on Craigslist and liberated the Dumb and Dumber van from our Repair Shop. It's been sitting there gathering dust since the movie production company left, figured I'd put it to good use. Considering half of my patients are combative, emotional, aggressive, intoxicated or drug crazed, it just made sense to be proactive, I've tried to get somebody to listen to my protests concerning transporting psychiatric patients for years now, but my pleas have fallen on deaf ears. i suppose the powers that be think it prudent to put volatile patients into a big box full of sharp edges, glass and needles with an EMT who has no training in restraints, no legal power to restrain people even if he knew how, and two big doors for a crafty person to jump out of at high speeds, rather than putting them into a police car in a safe, caged environment, handcuffed if necessary.

I filled the inside with mattresses, fortified the doors and separated the front from the back with Moriarities Invisible Fence. My first patient attempted to elope, found the rear doors impenetrable and access to the front barricaded by an invisible force field. He threw himself into the invisible electric fence until finally losing consciousness.

Our second patient fell asleep, and the third started barking uncontrollably. All three were transported without injury to themselves or the EMS crew.

I haven't figured out what to do if a miracle happens and somebody calls who actually needs an ALS response, but the "Nut Truck" is a work in progress, and I'll have the bugs worked out by the end of the shift.

The young one had called 911 because the old one was talking in her sleep and felt dizzy. She had just arrived from The Dominican Republic. The middle one answered the door and led the crew upstairs to the bedroom. It was eighty degrees outside and one-hundred and fifty inside. The ladies were dressed accordingly. Vitals were assessed, a sea of breasts surrounded us as we performed our tasks. Our patients talked among themselves in Spanish, laughing and smiling at the Gringos. The heat made our movements slower, more methodical, more precise. The ladies decided that the old one needed some cooling off, and some ice cubes were brought to the bedside. Reluctantly, we left, with the promise that they would call us back if things got hotter. I do love Latin women in the summertime!

"Wow."

"That was weird."

"I'll say."

"It was disturbing, yet fascinating."

"Couldn't look away."

"Those were nice."

"Which ones?"

"You know."

"No I don't."

"All of them."

"But which were your favorites?"

"Which were yours?"

"All the same to me. I've been twenty, been forty and sixty ain't too far away."

"I'll take the young ones."

"Pervert, she was barely eighteen."

"How do you know?"

"Age and experience."

"Think they'll call us back?"

"I hope so."

"I hope it gets hotter."

"Me too."

"Rescue 1, in service."

It's Sunday at noonish. Rescue 1 in service. The other five are out. Three calls so far, will it stay quiet? Will something terrible happen? Will I care?

No matter what happens next I'm writing a 500 word story. Stay tuned if you dare….

1218 hrs.

Seizure, somewhere off of Broad Street. Somebody forgot to pass out the parental rule book in this area, five year old's walking around unsupervised on the sidewalks, kids without helmets riding bikes in the middle of the busy streets, teenagers on motorized scooters with no regard for  rules bopping in and out of traffic, onto sidewalks, scattering the unsupervised five year olds, clusters of men drinking from bottles wrapped in brown paper bags, and colorfully dressed African Immigrants leaving church give the place the only sign of hope. I'm not sure what they call these outfits, tunics I guess, but they are magnificent, look silken, and fresh, with matching hats and an air of holiness about them, making the person wearing them aware of divinity within themselves.

We arrive at the house somewhere off Broad Street. Directly in front are an empty trash can and two full recycling bins. One of the bins is supposed to be for bottles and cans, the other for paper. Somebody forgot to pass out the responsible citizen handbook and recycling guide, the bins are full of maggot covered chicken bones, take-out containers, and other junk. Engine 10 was first on scene and reports a man had a seizure, struck his head on a wall while shaking and is now walking down the stairs. he appears, cervical collar in place, looking like he just did ten rounds with Roy Jones Jr.

Another person sticks his head out of the door of the house, and tells me he woke up, didn't take his Dilantin and within a half hour had a seizure that lasted twenty minutes. That was a few hours ago, I'm told, but his face keeps swelling.

Swell. He offers little on the way to the ER, emits a bit of malovence, as if it were we who caused his seizure, and are now inconveniencing his day. That's one of the things I find tough to take here in Providence, the sense of entitlement many of the citizens show, and contempt toward us, as if we should grovel at their feet for having the opportunity to serve them.

We put him on a backboard, why I don't really know, he just walked down the stairs, but protocol is protocol, start an IV and get him to the ER, where they will do some blood work, and patch his face, and make sure if he seized again they will stop it.

Multiply this call by fifteen, change a word or location or complaint here and there and that just about sizes up the day. Is that 500 words? I hope so, cuz it's all I got.

What a waste. Great kids, good firefighters, good EMT's. They show up ready to put their skills to use. Most of them know their stuff, and are eager for the first call. It never takes long. From there it is a steady spiral into disillusionment.

Nothing can prepare a person for life on an ALS unit in Providence. Nobody would believe what goes on unless they actually do it. Sure, the stories give a small picture of what is about to happen, but it's not enough to stem the tide of frustration, anger and cynicism that is headed their way.

At first, the relentless calls for rides to the hospital are dealt with with humor, and resignation. It's not our fault the EMS system is a watered down version of what it was designed for, right? So, we put our training and knowledge in our back pockets, and leave the equipment on the shelves, and leave the stretcher empty and put the "patient" on the bench  and get a set of vitals not because we are looking for clues as to what ails them, rather because it is expected, and automatic. We use the lights and sirens, not because we need to, because we can, and nobody feels like being stuck in traffic when there is a way out, right?

So some people get out of their way, and some don't bother because they are too busy texting, and they get angry, and resentment builds, and a distaste for the general public begins to fester, both for those in front of them, refusing to yield and those behind them who insist on beating the system because it is there.

Weeks go by, no emergencies come their way, the boredom sets in, not borne from lack of activity, rather from routine: rides to the emergency room for non emergencies for people that can and do find rides for everything else. The pace is cool for a while, about a call every hour, twenty-four hours a day. It's a test of ones mettle, holding it together, thirty-eight hour shifts, keeping your cool, never letting anybody see you sweat.

It works for a while, but cracks start to develop, and the tenth drunk in fifteen hours tells them to shut up and do their job, well, things happen, things that shouldn't, and a sneer forms where a smile once was, and small character flaws develop, and grow as time progresses. Now and then emergencies come their way, and they perform, and save a life, or save a limb, of save some heart muscle, and the reason they are here in the first place envelops them with satisfaction, and the bad habits simmer down for a while, but never go away, they lay dormant until the next spell of inactivity, when emotion takes over, and training, patience and professionalism disappear.

Not many last here on the EMS side of things. They see in themselves things they do not want to face. They didn't become firefighters because they dislike humanity, rather the exact opposite. Being immersed into a pool of cynicism takes it's toll on the mind, body and spirit, and those smart enough to sense their values and ethics slipping away get off the truck, and get back on an engine or a ladder company, and let the new guys do the rescue stuff.

Problem is, the rescue stuff makes up 75% of the calls. And we're letting the new guys do most of the work, and feeding them to the lions, and they are coming out damaged, disillusioned and bitter.

It's no way to run an EMS Division, no way to run a Fire Department and no way to keep good EMT's where they belong, on the ambulance.

What a waste.

Somebody read my last post and asked, "why do you need to learn Spanish fast?"

Good question. I think I have a good answer. More than half of the people who call 911 in Providence speak limited English, and half of those none at all. Providence is the starting point for many immigrants from The Dominican Republic and Puerto Rico, as well as most Central American countries, Haiti, Africa and Eastern Europe, Cambodia, Laos, Vietnam and everywhere else. They start here. Some end here. Most assimilate into our country, learn our ways, retain their country of origin's flavor and become good American Citizens, adding to the character of our country.

I was watching the World Cup soccer game the other day, and couldn't help notice how cool the American team was, all different looks, hair color, skin tone, shapes and sizes as compared to the Japanese team. Nothing wrong with that, I rather enjoyed watching them, too. Americans are a bunch of different people working together trying to get it right, making mistakes along the way, but ultimately with the goal of life, liberty and the pursuit of happiness as the ultimate prize.

So, some people have landed in Providence, and they don't speak English too well-yet. What little they know goes out the window when the shit hits the fan. It's my job to stay cool when the shit hits the fan, not fire things up. So I reach into my bag of Sesame Street Spanish, and extract the key words needed to figure out how best to help these people, who are new here, and will eventually be a strong thread in the fabric of our people, and that thread will only be made stronger if those that came before them reinforce it, and make it stronger through example.

When those kids that stood by helplessly as their baby sister or cousin or whatever stopped breathing and seized witnessed their elders in a state of panic until the Fire Department showed up, and one of El Bombero's could communicate enough to figure things out and help, well, all the English lessons in the world wouldn't have taught them the value of one language, one people better than that.

So there you have it, my answer to why I try to learn Spanish. And sometimes fast.

As for the rest of the languages I come across? Maybe I should go to mime school.

"Rescue 1 and Engine 13, respond to 328 Calla St. for an infant not breathing."

Seconds seem like hours. Cars move like dinosaurs on the brink of extinction, sirens and lights ineffective. Gloves go on, mind racing, ghosts invade, I throw them out, the trucks move faster, picking up speed, three minutes pass. Before we stop I'm out the door, mother running,  baby in her arms, blue. I take her, she's stiff, burning with fever, rigid, then starts to seize.

Oxygen, assisted ventilations, family screaming, everybody tries to do something, I give out tasks, an IV, keep bagging, need a glucose test, find the history, learn Spanish quick, I need to know what's going on, get a temp, find out her weight, find a pulse, keep her safe, the seizing continues as if she were possessed.

Pulsox rises, seizing continues, can't get an IV, family hysterical, firefighters busy now, doing their job, Tylenol suppository administered, temp of 104, need a driver, call the hospital, tell them we're coming in with an eighteen month old, possible febrile seizure, eta one minute.

Give the crowd a thumbs up, look calm, reassuring, I hope, close the door and take the mother's hand, seat her next to the stretcher, let her know it will be okay, seizing slows down, the baby relaxes a little, the truck rolls, calm now, all we can do is done.

Trauma room ready, medical team takes over, struggle for a while with the IV but eventually get one, Broslow tape extended, dosages and medication ordered, bagging continues.

We clean and restock the truck, another child is having a seizure at the ball field, have to go. Twenty minutes, we're back, no seizure, just a kid who took a foul ball to the face, iced him down, brought him in and checked on the baby, breathing on her own, fever down, still bluish but okay, mother cries and hugs me.

Yeah, it's a good day.

http://www.jems.com/article/news/oregon-fire-ems-crews-try-save-five-murd

The article asks if six victims were pulled from a house fire would your department be over taxed. Last night at 0300 hrs. comes to mind.

Rescue 1 responds to a twenty-one year old male with police who had been punched in the face by acquaintance. No visible injury, he wanted to "be checked at the ER" and his injuries documented for the police report.

Rescue 2 responds to a twenty-four year old female, nine months pregnant who "thinks" she is having contractions. Her baby daddy follows in his Mercedes.

Rescue 3 responds for a fifty year old male having an anxiety attack.

Rescue 4 responds for an intoxicated combative male, with police.

Rescue 5 responds to a hi-rise for a male sleepwalking.

Rescue 6 responds to a thirty year old hearing voices.

Rescue 7…wait a minute, there is no rescue 7.

If one person were pulled from a house fire in Providence our department would be overwhelmed.

The Morse/Bracket campfire song extravaganza begins it's backyard tour in two weeks. I've been working on the set list:

One by U2

Rocky Raccoon by The Beatles

Ring of Fire by Johnny Cash, or Social Distortion depending on my mood

Can't You See by Marshall Tucker

Rockin in the Free World by Neil Young

Our first show is in my backyard, by my firepit. Sorry, it's by invitation only, and we only invited our wives.

Future Tour Dates will be announced, and tickets available through Ticketmaster only.

Most of our songs are three chord wonders, which is a good thing because I only know three chords. I've got a nifty little gizmo left over from a different life called a Pignose, and a battery operated distortion/overdrive  pedal, along with a twenty year old analog delay plugged into a 1976 Ibanez Les Paul Custom that when turned to ten turns me into the reincarnation of Angus Young on steroids.

Of course, I also use a Martin 000C-16GTE, and even a fumble fingered fool like me can sound good on that!

Coming soon to a backyard near you!

She made him a shake, kissed him goodbye and went to work. The operation was still a few weeks away, he had been trying to lose weight the conventional way to no avail. Four hundred and fifty pounds at twenty-three, sad, lonely and isolated, he spent most days a prisoner in his home, watching TV, eating and sleeping. It was no way to live.

She is an artist, her paintings framed and hanging on the walls of their home, portraits of her children, a few landscapes, and an abstract or two. It's a nice place, clean and comfortable. She left in the morning, and came home after her shift, and found her son in an odd position. She couldn't move him. She couldn't feel him breathing. She called us.

He was cold. His head rested on a night table that was next to his bed, his neck at an odd angle. His body was stiff, his eyes lifeless. There was no pulse, no breathing. His mother waited expectantly in the kitchen, waiting for us to tell her everything would be okay.

She was sitting at the kitchen table when I left her son's room. Her hands were folded in front of her. Her eyes; her eyes held hope, until they met mine, and without saying a word she burst into tears, then screamed.

"He's gone," I said. "I'm very sorry for your loss."

She sat back down at the kitchen table, stacks of protein shakes that will never be drunk, forms and questionnaires from the hospital that will never be completed, and looked at his door, which her son will soon be carried out of for the last time.

She wept. I filled out my paperwork as family members arrived, then I left them, a giant void where a giant once lived, and hoped to someday soon be like the rest of us.

Official Version of What Happened:

At 1833 hrs, 11 Jul 11 R-1 and E-13 were dispatched to 141 Moore Street for a child having a seizure. Upon arrival the members responding were confronted by three irate family members who demanded we move faster, and insinuated we were "on drugs." Upon entry to the home, shouting continued, a twenty-one year old male was lying in a hallway with another young man hovering over him demanding we "do something." Other family members echoed the demands. The young man who was the primary instigator demanded we leave and became increasingly aggressive. R-1 and E-13 exited the home and staged outside after calling for police back-up. Within ten minutes the tension had alleviated, the patient was brought out of the home, placed on a stretcher, treated for possible anxiety attack with possible syncope, and transported to RIH. Providence police met us at the ER, the situation was explained, no charges were filed, no injuries occurred and Rescue 1 and Engine 13 returned to service.

Division 1, DAC xxxxxx was notified of the situation by phone and EMS Chief xxxxxx was notified by phone message.

What Actually Happened:

Rescue 1 arrived on scene expecting to find a child having a seizure. Three women, girls really,  all holding babies stood outside a shack in a crummy neighborhood. While trying to figure out which of the three children was having a seizure a maniac charged out of the shack screaming like a banshee. "Why are you yelling at me," asked the Rescue Lieutenant, "And you had better stop," he continued as another screaming meanie charged out of the shack demanding we "do something."

Inside the shack a shirtless lunatic was screaming that the firemen were idiots and to get the "f" out of his house. The "idiot firemen" then found a twenty year old moron lying on the floor, tired and breathless after fighting with the shirtless lunatic. More banshees appeared, all screaming because the "idiot firemen" weren't doing anything, shirtless lunatic one started swinging and the "idiot firemen" bailed out, leaving the people who time forgot to fend for themselves until the police arrived and secured the scene.

Meantime, the herd inside the shack stashed the crack and heroin, came to their senses and brought shirtless lunatic outside, where we put him on the stretcher and separated him from the pack by bringing him to the ER for an evaluation. The police met us there, the shirtless lunatic's pack arrived shortly thereafter, made a scene at the hospital and  liberated their pack member and walked him home.

It is difficult for society to flourish when dragged down by generations of people who have no clue what it takes to be part of a civilized community. When I am ordained King, I will board up this house, and hundreds of similar ones scattered throughout the city and have all inhabitants over the age of ten placed into a basic civilized behavior boot camp, and won't let them out until they can prove they will stop acting like animals. I'll bring the kids under ten to my palace, put them into school and let them see for themselves the advantages of learning to behave like a civilized member of society.

Update: This from the same neighborhood.

http://newsblog.projo.com/2011/07/three-women-shot-in-providence.html

I close my eyes and sleep takes over. There's no tones, no engines roaring, gunshots outside my window. breaking bottles, radio chatter, nothing but crickets. Well, the crickets are in my head, actually, the real ones won't start for a few more weeks.

Point is, though I live seven minutes away from Rescue 1 quarters, it's a different world completely. Sometimes, when I'm at the station and all hell is breaking loose, I think of my home, a few miles away, quiet, peaceful and safe, and it gets me through.

It's a short trip from prosperity to skid row, physically and emotionally. I'm not the first, nor will I be the last to give pause, and wonder how fortunate some are, and unfortunate are others, and just how are those fortunes can rise or fall in the blink of an eye, or the fluttering of sleepy lids.

http://www.projo.com/news/bobkerr/kerr_column_15_07-15-11_52P68NQ_v14.35288.html

In the Providence Journal this morning. Thanks, Bob.

Pay no attention to the man fumbling with the rope, attempting a bowline, or clove hitch, or bow-tie, I'm not quite sure, what matters is he just rescued the pooch from the river!

Great job, Norfolk! Way to go, Tim (A New England native and Dropkick Murphys fan fighting fire and rescuing dogs in Norfolk, VA? Why not!)

The best part of the story, besides the dog being saved, is the dog and his owner stopping by the station a few days after the incident to say thanks.

http://www.wavy.com/dpp/news/local_news/norfolk/firefighters-save-dog-from-drowning

They come to the emergency rooms looking for help, or are brought there by EMS or the police because they need help but don't know it. When they arrive they are treated with kindness, respect and professionalism. They are fed, given a bed and a blanket, a kind word, competent medical care and a safe place to get better.

Why, then, is an emergency room one of the most dangerous places in America to work? And of all the people to bear the brunt of the assaults, why the nurses aids, or emergency room techs, as we call them. These are the unsung heroes of the EMS system, the ones with the most direct patient contact and care.

Firefighters, police officers and EMT's in the street get all the press about the dangers of our jobs. Let's face it, a TV screen full of fire, or crashed cars, or scary looking bank robbers looks a lot more interesting on the evening news or the headlines than a psych patient who spit in the eye of somebody who was trying to help them, or an intoxicated person who grabbed a nurse's hair and pulled so hard her head smashed on the bed rail, or the drug induced punches that land on the head and body of the people trying to restrain them. But those incidents are just as violent, and far more prevalent than anybody would believe. Anybody except for those of us who see it every day.

Stay safe in there, people, and thank you.

http://seattletimes.nwsource.com/html/localnews/2015584122_apwaworkplacesafety1stld.html

Thanks for the link, Rik!

www.scavo.net

We're told our report is all we have if we end up in court. If it isn't written, it didn't happen, I've been told. Our words are the official record of what did happen, often the only record of events that help explain the seemingly unexplainable.

I sat in the little room set aside for EMS crews, the hot summer sun amplified by two giant plate glass windows, must have been a hundred in there, but there was nowhere else to go where I could think clearly. The empty narrative section looked back at me, waiting for an explanation. A few hours ago, the chief presented me with a similar report, one I completed in March.

"What's this?" I asked.

"Fatality Report from the state. No big deal, they just need to clarify things for their records."

"Car accident?"

"Thurbers and Eddy."

"Nobody died on Thurbers and Edddy, at least not on my shift, you have the wrong guy."

He gave me his best sardonic look and handed the report over. There it was, in my own words, the explanation that family members must have read and re-read a hundred times, looking for clues concerning why their mother, grandmother, wife or sister was killed. I was unimpressed by my own narrative.

"Restrained female, front seat passenger, + air bag deployment, major/moderate damage to front end after collision with pick-up truck, windshield cracked, possibly from air-bag deployment @ approx 35 mrp, A&O x3 with stable vitals, board and collar applied, IV est, EKG NS, transported to RIH c/o neck and back pain."

I don't know how she died. Internal injuries I suppose. My report did nothing to shed any light on the incident. She lived in my neighborhood. I said "hey neighbor" when she told me her address, the day she died. I didn't think she would die, told her I'd stop by and say hello. In the weeks and months that followed, her once meticulously kept lawn and gardens started to look a little shabby.  Now, I knew why.

I started my latest record of events leading to the death of another person, somebody's neighbor, father, son and brother, knowing that this report would be read and re-read another hundred times, and there would be a lot of questions, and few answers.

When I was done, and re-read it it was just as stark as the rest.

I can record the facts, my thoughts are best kept to myself.

I actually tried to rationalize the reason dozens of people passed the dying man, never slowed down, didn't get out of their cars or even call 911.

"Grown men dropping are a common occurrence in the park, it just isn't unusual."

She looked at me like I was crazy, as cars continued to pass and a gathering of fifty or so people enjoyed the beautiful weather a hundred yards away, oblivious of everything but their own enjoyment.

"But he needs help," she said as we rolled the man onto a backboard, felt for pulses and lifted him off the street. People walked by, glanced our way, then looked away. A few stopped to watch the show.

"Ten a day drop, drunk, and wait for us to take them to the hospital."

She was incredulous, and watched horrified as we started CPR and loaded the dying man into the truck. He didn't appear intoxicated, perhaps he was simply just a man walking in the park.

"Is there anything I can do? she asked.

"Pray."

I closed the doors to the rescue and the resuscitation efforts began. They ended half an hour later, unsuccessfully. The man would have had a chance had somebody started CPR, or at least called us when they saw him drop, our station is three minutes away. Nobody did. He was down for about ten minutes before anything was done. A cell phone rang incessantly from his pocket, but I didn't have the time or the hands to answer it.

As we rolled toward the ER, calls continued to come over the radio, man down here, man down there, man down everywhere. Intoxicated males, the number one call of the day. Again. The same group of fifty or so, over and over. When one dies another joins the ranks and the dying continues, slowly, one day at a time.

The drunks who cry wolf killed a man today, just as surely as if they put a bullet in his head. When people drop on the side of the road in a crowded park, that should be cause for concern. Unfortunately, here in Providence, in the south side, it's business as usual. And nobody called until it was too late.

I'm taking over EMS. I'm turning it into a national organization, and renaming it The EMS. New uniforms will be issued, black shirts and trousers, with a big yellow EMS in capitol letters emblazoned on the back, an American Flag on the left shoulder, and a Department of EMS patch on the right. Each and every member of The EMS will be trained as a Paramedic.

All ambulances will be black, with a million flashing lights and reflective materials. In place of sirens Metallica's And Justice for All will play on a continuous loop. The interior will be comfortable, and each and every unit will be identical, and kept to the standards set forth by The Department of EMS, as directed by the director. Equipment will be state of the art and provided by the federal government, and distributed through the network of police and fire departments in each jurisdiction.

There will be no rank in the field, every crew member will be equally proficient in all areas of emergency medicine and transport. New members will be trained at CIA headquarters in Quantico, Maryland, in a newly designed EMS training facility. Only when a candidate successfully completes the training will he or she join the ranks in the streets.

When a person calls for The EMS, a response team will be sent, the emergency sized up following the newly developed 911 Emergency Call Directive, patients triaged and treated and the appropriate agencies notified. Fire and police departments will be under the direction of The EMS, and will carry out the commands of The EMS without delay. The EMS will be ultimately responsible for the patient that needs emergency care, as dictated by The EMS on scene. Those patients who called for The EMS and had no reason to do so other than to take advantage of the altruistic nature of our land will be issued a citation and fine. Those unable to pay the fine will be placed into a pool of candidates whose primary purpose will be to provide comfort to The EMS, and clean The EMS quarters and apparatus. When offender has successfully completed three (3) bodily fluid cleanups they will be released, and the next candidate will begin their sentence.

Applications are now being processed. Salary upon completion of the obligatory eight month indoctrinization program will begin at $85,000 annual salary, with full health care (15% co-share of policy) matching 401K, three weeks vacation time and four uniforms, which will be replaced at the rate of one every six months. Sick time will be allowable under similar criteria of the 911 callers directive.

Please send applications to me, at this address for consideration.

Thank you, that is all.

Kudos to The Leary Firefighters Foundation for their continuing support of the fire service.

"The Leary Firefighters Foundation was established in 2000 by actor Denis Leary in response to a tragic fire in Worcester, Massachusetts that claimed the lives of Denis’ cousin, a childhood friend, and four other firefighters. The Leary Firefighters Foundation’s mission is to provide funding and resources for Fire Departments to obtain the best available equipment, technology and training. We are dedicated to helping maintain the highest level of public safety in our communities."

http://www.learyfirefighters.org/

The Thinning the Herd Tour stopped at The Mohican Sun Resort and Casino last night, and the laughs were a plenty! I've been a fan of Denis's well before the Rescue Me era, always thought he was pretty funny, and the firefighter thing just adds to the package. Speaking of packages, without Donald Trump, Brett Farve and ex-congressman Weiner's packages being a "big" part of the show, I would have some far less troubling images stuck in my head today.

I'm not much of a gambler, but when in Rome…I put twenty bucks into one of the slot machines and a few minutes later $160.00 came out!

Lobster Fradiavlo is just better when paid for by the spoils of victory!

I've found a new reason to believe in a higher power. A dead person. Death is ugly, undignified, smells very badly and in no way, shape or form remotely resembles the person that occupied the body that lies on the floor, mouth open, dried vomit attracting hundreds of flies, and more bugs than I could imagine having a picnic on what is left.

When we die, the remains are just that, remains, for who and what we are, and what we made of ourselves leaves that old decaying thing, because there ain't no way the spirit that lived and loved and created things is connected to what is left behind.