Having responded to violent incidents many times during my career, and writing about some of them here, I thought I should post the following well researched and presented information. When on the streets, and a potentially violent situation emerges instinct cannot take over, as people in harms way should know. I have no intention of not coming home from my shift. For some stupid reason, my instincts mislead me, often into harms way. That cannot continue to happen, not only for my own sake, but for my crew, and the people who will need us when the scene is secure as well.

My chances of coming home are greatly improved when I put my emotions on hold and engage my brain, and by asking these nine simple questions – some of them redundant, and management level, but at least they slow things down enough to make proper descisions, most of the time – I give myself time to sort things out, and let the incident unfold without escalating things.

For Immediate Release

Media Contact: Bob Shilling @ 443-823-1376

RESPONSE TO VIOLENT INCIDENTS: Nine Questions You Should Ask

Questions inspired by 2012 Violent Incident Summit with IAFC, CFSI, NFFF, NFPA & NVFC

Emmitsburg, MD – Do you know the nine questions you should ask that could help keep you and your firefighters out of harm’s way in a potentially violent situation? As the tragic events in Webster, NY showed, not every violent incident can be anticipated.  But fire, EMS, and law enforcement experts agree that being prepared can often make a difference.

The National Fallen Firefighters Foundation is joined by the IAFC, CFSI, NFPA, and NVFC in this new effort to get fire chiefs, company officers and firefighters to ask critical questions that will help evaluate a department’s ability to effectively deal with a violent situation. Nine Questions You Should Ask is the work of Chief John Oates of East Hartford, CT, based on the report from a focus group of fire, EMS and law enforcement leaders held last year in Baltimore. That report has identified 14 National Recommendations to identify potential risks and stay safe.  The full report is available here. www.lifesafetyinitiatives.com/12/FLSI12_FinalReport.pdf.

Chief Oates has also has written an article summarizing the efforts of these fire service organizations and leaders to develop tools for firefighters as part of Firefighter Life Safety Initiative #12, Violent Incident Response.

Below is a summary of Nine Questions You Should Ask. Detailed information on the questions and resource material, including the final report, are available at http://www.everyonegoeshome.com/news/2013/violentincidents_011113.html

Nine Questions You Should Ask

1. Do you use risk/benefit analysis for every call?

2. Do you have an effective relationship at all levels with the law enforcement agencies in your community?

3. How good is the information you get from your dispatcher?

4. Do you allow members to “first respond” directly to the scene?

5. Does your law enforcement agency use an incident management system?

6. When responding to a potentially violent incident, do you seek out a law enforcement officer when you arrive?

7. Have you told your fire officers/personnel that it is OK to leave the scene if things start to turn bad?

8. Is there a point where you don’t respond or limit your response to violent incidents?

9. Is your uniform easily mistaken for law enforcement?

Stories from the Streets: Ladies Night

Sometimes all we can do for our patients is make them feel better during transport

She spent hours at the gym, had her nails done, a pedicure, her hair was perfect, and she spent a few hours getting ready for a fun night out dancing in Providence with her friends. She was beautiful and looked fantastic, and people noticed, and she didn’t mind, as long as they weren’t creepy about it…

http://www.emsworld.com/article/10858816/stories-from-the-streets-ladies-night

So anyway, I'm on my knees, surrounded by naked and semi-naked men, preparing to sink the tube down a guy's throat. My partner is on the other side, pumping away. The only light is coming from a giant TV off in the distance, porn, I think, from the sound of things, but I don't hear any feminine moans, just grunts and the like.

The fire crew arrives, to the delight of the assembled audience, who find the firemen and EMT's doing CPR on one of their own more fascinating than whatever goes on in the private rooms at the bathouse, or the porn for that matter.

"Put on some clothes for Christ sake," shouts the Captain as we run the code.

The things we do, the things we see, the things we think about – whether we want to or not, find their way from my mind to this computer screen, sometimes onto paper, and sometimes even in book form. I wasn't a writer when I started writing this blog, but now, seven years later I have a real chance of turning a hobby into a full time job as a freelance writer.. The Maccoll Johnson Fellowship which is administered by The Rhode Island Foundation provides me the means to devote the time necessary to pursuing that goal, and a big chunk of change to make the transition a little less painful.

But I'm still a firefighter, and an EMT, and always will be.

http://www.rifoundation.org/News/NewsArticles/tabid/513/ArticleId/201/Foundation-awards-MacColl-Johnson-Fellowship-to-three-RI-writers.aspx

Thank you Robert and Margaret.

“Are you okay?”
“Yeah, why?”
“Because you just saw a dead lady.”
“I think I’m going to see a lot more.”
“Probably.”

“So, you ok?”
“Does it always smell so bad.”
“Not always.”
“She didn’t look peaceful, do they always look like that?”
“Nah, sometimes they just look like they’re asleep.”
“How long was she dead?”
“Couple days, I guess.”

“You’re going to see things other people can’t imagine. It isn’t easy. When it gets easy, its time to go.”
“I’ve seen dead people, but they were cleaned up and in a casket.”
“They’ll clean that lady up.”
“It’s weird, the way her mouth was wide open, like she was trying to scream.”
“That was probably rigor mortis, she died in her sleep, the body does weird things once the spirit leaves.”
“You think she had a spirit?”
“Of course I do, can’t figure why we’d be here if there’s no spirit.”
“Hmmm.”

“You okay?”
“Yeah, probably gonna see a lot more dead people.”
“It’s never easy.”
“When it gets easy its time to go?”
“Its one of the signs. You have to know when enough is enough.”

What’s better than giving good advice to a new guy?
Getting good advice when you’re a new guy.

It’s getting easier.

Thanks Woody.

I do a lot of reading, and lately a similar theme keeps rearing its ugly head: Arming firefighters and EMT's. I cringe whenever I see a headline, "Firefighters shot," EMS Crew stabbed," Paramedic assaulted," and every combination of those imaginable, and wonder what we can do to stop our people from getting hurt. Best I can figure is to stay alert, be aware of our surroundings and call for help before it's needed. Even then, sometimes everything we do isn't enough.

I do not want a gun. It's not that I don't like guns, because I do. They are fascinating, beautiful  tools, finely crafted, precise and a true marvel of engineering. Great things, really.

But carrying one at work? Quite simply, my effectiveness as an EMT, Firefighter, First Responder, Incident Commander, Haz-Mat Technician, Ice Rescue, Water Rescue, Stuck Between Building Rescue, Trench Rescue, Peacemaker, Communicator, Negotiator, Therapist, Father, Brother, Mother, Friend, or whatever the call brings with it will be compromised.

No matter how much it weighs, a gun is heavy. I'm already carrying just about all I can on a call, physically and mentally, the added weight of responsibility a gun carries is just too much to bear. My part in the Public Safety world is difficult enough, and a constant challenge. I need to trust that the other parts of the Public Safety puzzle are not overburdened. The police have the guns. They train with them, take care of them, bear the weight of responsibility that comes with them.

As with anything, there are exceptions. Fire/EMS crews in rural areas who are not responding to dozens of calls every shift, a large percentage of which involve violent people have the luxury of wearing two, or more hats, and wearing them well. I've read accounts of volunteer firefighters who are paid police officers. Or firefighters who are also deputies. They carry weapons because they are the law and the firefighters.

Good for them.

As for me? I'm no stranger to gunfire. I have wrestled my share of uncooperative people, been in fear for my life many times, certain I would die once, have seen partners attacked and disabled by combative patients and not once would carrying a firearm done any good.

I cannot begin to imagine the trouble that would have been caused if my sidearm were visible while doing CPR on a gunshot victim in front of his posse..

Guns themselves are okay, but on an EMS rig they are far more trouble than they are worth.

Uncle Mike here, with some free advice:

You are called to the projects for a man unconscious. Engine Co. 3 is dispatched along with you. Both companies arrive at approximately the same time, enter the uh…home, climb the obligatory three flights of stairs, secure the Pitbulls, interrogate the zombies that are congregated around a bong in the living room, follow their directions to a rear bedroom and find and unconscious male, naked, covered with vomit and feces which also covers the mattress that he has collapsed upon. He's breathing, but looks dead.

Being old, and the senior person on scene do you:

     a. Send the junior man in and have him drag the patient away from the contaminated area

     b.  Have the zombies drag the patient away from the contaminated area

     c.  Fill a few 5 ml syringes with Narcan and imagine the patient as a dart board and hope for a bullseye

     d.  Shout, "Hey! Wake up!" from a safe distance

Answer: None of the above.

You are the person in charge of the EMS unit. You glove up, and go in. Do it yourself, wade through the contaminated zone, assess the patient, administer the appropriate meds, wrap him up with sheets and towels and a tarp if one is available, and get to work.

The fire company is there to assist on EMS calls. Rank has its privileges, but common decency, and not delegating the dirty jobs makes all the difference.

The above scenario happened to me, years ago. I have not carried a patient while responding with Engine 3 since.

We have a choice, make our days difficult, or work together. Working together works, every time, as long as you don't expect other people to do the jobs that you won't.

I've been doing a lot of backward thinking lately. Before I started working for the Providence Fire Department life was good. The bills were paid, I owned a successful business, my wife and kids were happy and so was I.

I'm still happy, and so is my wife, and so are the kids. Only there is a difference-a big difference. Over the last twenty-two years I have been fortunate enough to experience more perfect moments than any person deserves. Prior to my fire department career the only times in my life that I can remember being perfectly in synch with my mind and body, where a nuclear bomb could go off and I wouldn't notice, when I felt truly alive, and powerful, and nearly invincible was while doing the very thing that makes us immortal; the act of procreation.

Being inside a burning building, heat nearly unbearable, Scott running low, deep, nothing but blackness outside my mask, nothing but a hundred feet of tangled, charged line behind me and nothing on my mind but the battle is the closest I've come to that. Or nearly every time I ran a code, whether the patient was a ninety year old lady from the nursing home, a kid shot a dozen times or some middle aged guy who totaled his car and blew out his aorta.

Those precious moments when time stands still, and nothing matters but the job at hand now mean much more to me than I ever realized. When I thought I would live forever, and fight a thousand fires, and save a thousand lives-or not, they were just part of my shift, and I took them for granted, never imagining that it might all end.

Well, the end is near. I've had more perfect moments than most people dare dream, and I've loved every second. I just wish it could go on forever.

a new training acadamy starts soon; somehow, The Providence fire Department will survive…

"Thousands of people will apply for your job when you leave, get over it, you are nothing special"

How many times have you heard that one? Too many is my guess. When a fire department needs people the usual path to finding qualified personnel is to advertise the position. Any good sized department will likely be bombarded with applications. Indeed, thousands will apply.

It's a little different "applying" for a job and actually doing the job you "applied" for. People with decades of experience; people who came to work, and "applied" themselves, every day, day after day leave the ranks when their time is done, making room for the next generation of firefighter. Thankfully, you and thousands do apply, because a big pool of applicants is needed to find the people who are truly ready to apply themselves.

Before I was hired as a firefighter I had a lot of jobs, and worked with all kinds of different people. A prevalent comment when the job at hand was difficult or hazardous or plain old nasty is "they don't pay me enough to do that,” and the job simply would not get done. And the guys that didn't get paid enough to do that job would quit, or get fired and "apply" for another job that they would work at, and do their time, and punch out at the end of the day never having applied themselves.

There isn't anything wrong with that. Some people are simply not that complicated, and find contentment just getting by, collecting their pay and leaving when their day is done. Many of these are the people who apply for the job of firefighter, and never finish the application process.

We seldom hear about the thousands that forget to show up for the entrance exam, fail the background check, fail the physical agility test or simple do not finish high enough on the list to get hired. A lot of people are willing to "take" our job, not many could "do" our job. A lot of good firefighters have retired from my department over the last year; they leave a giant hole in skill, leadership and personality. Thousands have applied to take their place; hopefully in those ranks will be people with the potential to fill the void.

Only a few of those who applied will be capable and willing and able to stand in front of a fully involved building, turn in their pack, mask up, force the door, find the fire and put it out. Or pull the bloody, barely breathing victim from the rubble, and wash off the blood when the job is done.

The few don't say, "They don't pay me enough." The few go in, and get dirty, and get the job done. The few will eventually fill the shoes of the ones who came before them, and follow their footsteps into places the rest would never go.

Here's to "The Few," coming, and especially to those going. There will always be those who could have, would have and should have done our jobs, and those people will relentlessly attack our position, pension, pay and benefits, even our time off. Don’t let the bastards get you down, because you know, and I know, and deep down inside, where what it takes to put on the uniform either remains buried, safe and sound, or struggles to the top, gets dressed and goes to work, that we are here because we earned it, and they did not.

Thanks for showing up.

If my last post, Florida didn't do the trick, this one from Fire Engineering might help warm things up. Stay safe and stay warm!

By the way, if somebody doesn't click the "Like" button, does that mean they don't "Like" the story? Or should there be varying degrees of "Like?" Or even a "Don't Like" which would make the lack of "Likes" a little easier to digest.

If you want to make somebody happy, visit here http://www.facebook.com/pages/Rescuing-Providence/273947562721391and click the darn thing already!

We're returning from the repair shop, driving through the West End on our way back to the North Main Street Fire Station. I'm in the tiller cab of Ladder 4, sitting on top of the world and watching it go by as we roll through the roughest neighborhood in Providence, Rhode Island.

Litter flies past us as we weave through the tight streets. Boarded-up houses, rats, abandoned cars, fire hydrants open and running on some street corners leaving pools in the dirty streets for the kids to play in. Coney Island whitefish float to the top of the puddles, and the kids kick them to the curb and keep on playing. It's hot in the tiller cab, ridiculously hot, the plastic bubble windows are behind me, slid to the open position so a little breeze blows by as the ladder truck roars by.

I've got a little speaker in the tiller cab, but it comes in loud and clear:

"Attention Engine 8, Engine 14, Engine 3, Tower Ladder 2, Ladder 6, Special Hazards and Battalion 2, a still box."… finish reading here http://www.fireengineering.com/articles/fire_life/articles/2013/january/flashove-flashback.html

…Ten kids were inside; some sleeping on bare mattresses that littered the floor, some on a couch, watching cable TV on a 42" flat-screen that dominated the room. Milk crates served as seats, cigarettes burned in two different ashtrays, themselves overflowing with butts.

"He's upstairs," said the matriarch, forty pounds overweight, greasy long hair, dirty gray hoodie and black stretch pants. Her feet were filthy.

"Are all these yours?" I asked, amazed. She was only about 35 herself.

"I take care of them."

"Really."

http://www.ems1.com/ems-advocacy/articles/1390246-Searching-for-hope/

I take for granted the things I do that make up most days; starting IV's, administering aspirin and nitro, assessing vital signs, stopping blood from leaving peoples bodies et al, but one of those mundane tasks I'll never think of as business as usual again.

Last night, while talking with a group of friends, a meeting if you will, one of the members of the group, who struggles with addiction spoke of his recent overdose, and subsequent revival and spiritual awakening.

"I know how much I can do, and how much I can't," he explained. "Trust me, people who OD don't do so by accident."

He is recovering, and has a chance to recover because some EMT somewhere did his or her job, didn't panic, got the right drugs administered and gave this man, a successful contractor by the way, a second chance. By doing so, ten people remain employed, three kids have a father and a group of like minded people have their friend.

I have revived hundreds of overdose victims. They are not "scum bags, shit heads, morons, idiots or  junkies." They are people who have been given a second chance at life. For some, that life is relentlessly squandered, and will end by needle point, but most battle their addiction, are sick and suffering and deserve a chance.

I've been known to say some pretty dumb things, "A monkey could have pushed the narcan that saved that guy," being among them. But if saving somebody's  life is monkey's work, then give me a banana and a tree and let me sit on a branch and be happy.

I've never been one of those medics who chastises people when the narcan takes the opiates out their system, rather I'm just happy I got the person back. We all hear stories of the addicts who rip IV's from their arms, or puke, or fight when revived, and I have had one or two of those over the years, but the vast majority, when welcomed back with kindness and understanding, and a dose of genuinely delivered advice rather than jokes, degradation and arrogance respond with gratitude.

Perhaps they even have a spiritual awakening along with their second, or third, or fourth chance.

Sure a monkey can push narcan, but it takes a special kind of monkey to follow through, and do the work that leads a person to the road to recovery.

After all of this time an an ALS ambulance you would think that I would have seen that it's not the drug that saves the lives, the drugs are simply the tool used to bring a person back from the brink. The true life saving happens from the moment the person rejoins the rest of us, and sees that people actually do care.

I'm still learning that I have a lot to learn. Thanks Bill W., for teaching me something last night. Yeah, I'm a work in progress alright, but it is most definitely one satisfying journey.

Today, as I sat in my office complaining about the people who call 911 for rides to the er because they have the flu, and marveling at the disregard some folks have when it comes to the health and well-being of others, this directive from THE EMS appeared. There are a lot of sick people out there who need us, and lots more who use us. I'm tired of being used by people who think nothing of stepping into my 4×6 space, laying on my nice clean stretcher, coughing without covering, talking on their phone while waving to their boyfriend out the rear window and squandering EMS services.

There, I said it. Screw the epidemic, I've had it.

10 Jan 13

Subject: Influenza Outbreak, 2013

To: All Field Operatives

Attention All:

The yearly Influenza outbreak is upon us. This year's strain, the medialahooplatisis (media-la-hoopla-tisis) is especially virulent. According to media sources, 34 states are inundated with influenza patients, with seven declaring medical emergencies and two under strict quarantine.

Press releases prompting the citizenry to seek medical treatment at sniffle onset has promulgated an increased need for Emergency Medical Services. The following procedures must be followed to ensure public safety.

     -Universal Precautions will be adhered to (see appendix A.)

     -Any and all patients who seek emergency transport to the proper facility for treatment of the flu while bypassing their own means of available transportation will be issued a summons to appear before the Director of The EMS, or surrogate once the acuity of symptoms has ended. Patient will immediately surrender self to "The Containment Cubicle," where he/she will spend fifteen minutes with infected members of The EMS. Infected EMS crews are instructed to cough in direction of patient, sneeze upon patient and dribble snot wherever prudent.

     -Persons with mild flu-like symptoms, as determined by field operatives will be issued a facial tissue with citation and fine imprinted on surface. Patient may blow nose with citation, however, fine must be paid in full within 30 (thirty) days or be held in "The Containment Cubicle" with two infected members of The EMS.

       -Old people and little people, whose parents or caretakers are deemed incompetent by The EMS shall be treated kindly and transported to the appropriate facility.

That is all,

The EMS Director

It's odd how they come in, droves of MVA's when a crash hasn't occurred in days, multiple difficulty breathings seemingly appearing from nowhere, as if a giant asthma cloud descends at once, which isn't altogether untrue, changes in atmospheric pressure, dew point, relative humidity and other meteorologist friendly terms contribute to mass illness. But its the surreal that intrigues me; the rash of stabbings, the series of shootings that plague the city following weeks of calm, the domestics that seem to come in packs-those are mysteries.

The full moon brings with it an increase in psych calls, I think. Maybe I'm effected by the lunar positioning and it only seems that way to me, but I don't think so. Folklore leans heavily on the mystique and allure of the heavenly cycle, and there is sometimes truth in folklore, just ask the lady who stopped to get gas and a deranged murderer snuck in her backseat, then murdered her and put her head on the roof of the car and cranked Boston's classic Don't Look Back as he drove through town, for three days before the police stopped him.

Flu-like symptoms seem to be the call du jour, and resources both on the transport and destination side of EMS are stretched thin. Contagious disease is possible, and taken for granted, why not contagious madness?

Ask the average citizen what he thinks about all of this and nine times out of ten you will be met with a blank stare, or ignored, or find yourself suddenly by yourself as the average citizen runs away from you. But ask a cop, or fireman, or doctor or nurse what they think of the cyclical nature of humanity and nine out of ten will tell you that there is something nutty in the air.

Before the new ER at Rhode island Hospital was finished, complete with a helicopter landing pad on the roof, we would be dispatched to a parking lot near the hospital and wait for the air ambulances to land. The pilot would give the signal and we would bring the stretcher to them. The crews were always locked in on the patient, seldom engaged us small talk, were a bit arrogant but always professional.

After a few years I actually started to like them. Years later I learned to not only like them, but admire what they did as well. They are the consummate professionals, looked the part, and lived the part. Nowhere in EMS have I seen such military-like precision concerning patient care.

We don't see the crews much anymore, we are out of the equation. The choppers land on the roof, the hospital staff takes it from there. The thing I miss most is the ride back to their ride, when they became regular people-if you got past the can-do rigidity they presented, and we would tell a few stories commiserate about our shifts and relax for a moment.

Thoughts and prayers to my brothers and sisters who lost their lives while doing what they truly love, and best wishes for a complete and speedy recovery to those injured.

http://www.emsworld.com/news/10847986/three-killed-in-iowa-medevac-chopper-crash

http://www.jems.com/video/news/four-hurt-medical-helicopter-crash-oklah

The next time a person or persons places an I-Phone, Razor Rhone, Tracphone, I pad, I ponder, I pee or any other “device” on the table, counter, dashboard, bar or any other flat surface as if it were a part of the conversation I am going to take a 22 oz Estwing framing hammer out of my pocket and smash it where it sits.

Thank you, that is all.