ems

In-flight medical emergencies…

chosenbythemoment, ems, emt, firefighter, firefighting, jesserobbins, lessons, operations, stories

“You don’t choose the moment, the moment chooses you. You only get to choose how ready you will be when it does…”

I passed this Fire Academy lesson to my friend Ethan as I stepped onto a plane, returning home from vacation. I offered these words hoping he would find comfort, or at least company, while he wrote a letter to our many friends affected by the Blue House tragedy.

As the plane climbed out of San Jose I began writing down what I remembered from my crisis communication books, along with the great class taught by the King County Chaplains. Lost in sad thoughts, I almost missed the announcement the flight attendants were making: “May I have your attention. If there is a doctor or nurse onboard please ring your flight attendant call button.”

I rang mine and told the nervous looking flight attendant who came over that I was an EMT and happy to help. She asked me to come back where I found a 28 year old man, clutching his face in pain. The flight attendants said “He’s had eye surgery, and I guess he shouldn’t have flown.”

I began putting on my gloves, which I had instinctively grabbed from my bag as I left my seat. As I turned to face the patient a man abruptly stood up and said “I’m an eye surgeon”.

The doctor asked a few quick questions and then just as quickly… poked the patient in the eye. He stared intently for a moment, and told the flight attendants “This plane needs to come down, we need to reduce the pressure or this man will lose his vision in his only good eye”.

One of the flight attendants was communicating with the pilot and a medical dispatcher via a headset. I suggested that the doctor speak, and gave him the quick lesson in simplex communication. “Press, Pause, Speak, ‘Over'”.

While he did this, I asked for the medical bags and began inventorying them, suspecting that the kits were probably similar to an ambulance jump-kit without drugs or needles. I was happy to find that the aircraft “Enhanced Medical Kits” are really well stocked, and told the doctor what drugs and equipment were available to him.

A few minutes later the doctor was performing minor surgery on this man’s eye, with me holding a flashlight, setting up equipment, keeping a log, and whatever else needed to be done.

The pilots brought the plane down to 3,000 feet as the doctor finished de-pressurizing the man’s eye and saving his vision. I picked up the trash, asked the doctor if he wanted vitals or oxygen for the patient, and began writing a report.

In 2004 the FAA required commercial aircraft to carry an Enhanced Emergency Medical Kit, intended for use by medical professionals that might be on the plane. The flight-attendants can’t even open it, and most of the drugs are out of my scope-of-practice as an EMT. It’s a gift from those who have found themselves chosen by the moment… to those who are about to be.

-Jesse

(note: I migrated this post to here from my livejournal on September 22, 2007)

Christmas Gifts…

chosenbythemoment, ems, emt, firefighter, firefighting, jesserobbins, lessons, operations, stories

Christmas Eve in Palo Alto by my old fire station on Newell Road made me heartsick for firefighting. I spent most of the evening thinking at the coming expiration of my “5 year become a career firefighter plan” without having actually become a career firefighter.

I didn’t sleep well, and when my girlfriend Regina and I awoke (at 6AM) to drive to Fresno it was no farther from my mind. The drive was quiet, with me lost in thought and she lost in last-minute present wrapping.

The fog was dense on Pacheco Pass, and I was driving very carefully. I saw what looked like a serious accident and began to slow down even more. Several idiots swerved by me, nearly hitting a CHP officer who was setting out flares. Other than the cop, I didn’t see any emergency units on-scene and I could now see there were at least 6 blood covered patients huddled in the cold against the median.

I passed the accident, told Reg that I’d be stopping and found a safe spot to pull off. As I hustled toward the scene I was kicking myself for not carrying gloves on my keychain anymore. I found a guy who looked like an off-duty firefighter… crewcut, jeans, and a tattered CDF t-shirt, identified myself as an EMT and asked him if he needed a hand. He did.

Mr. CDF had already done the initial multi-casualty heavy lifiting by moving “walking wounded” patients to (relative) safety on the median, distributed basic bandages to put on minor wounds, and determined which patients would be the most critical. He must have been on scene for at least 10 minutes by himself.

We stole the first-aid kit from CHP officer’s car and began rifling through it for gloves (which was nearly impossible). This proved to be somewhat of a challenge, as it seems cops who primarily do traffic control don’t put a lot of thought into the utility of their jump-kits. They especially don’t seem to consider off duty and/or wannabe rescuers who might be rifling through their stuff. Regardless, I found a couple of glove kits, tossed one to the CDF guy and went to the car with patients he had identified as “criticals”.

The critical patients were a ~50 year old woman and her ~80 year old mother. I approached the car, introduced myself to the patients, and told them what was happening and what I was about to do.

“My name is J, I’m going to do some first aid until the fire department and ambulances arrive. There’s going to be a lot of commotion, and things will happen quickly, but everything we do is to help you…”

The daughter was pretty banged up with an obvious wrist fracture, some heavy bruising on her chest from where it looked like she had struck the steering wheel. She was complaining of severe pain in her wrist, was feeling dizzy, having difficulty breathing, and saying she felt like she was going to pass out. Grandma was looking much better, had no obvious trauma and was not having any trouble breathing. The Daughter was going to get treated first.

I had just started taking her vitals when the first Fire Engine arrived from about 10 miles away (They had to go through the same fog to get there so it took a while). I got the Captain’s attention, gave him the status for the two patients, and asked him for a better Stethoscope. (The CHP officer’s steth was missing the rubber earpieces, making it useless and uncomfortable) He tossed me a new one from their rig, and I got the vitals on the daughter just as the ambulances began to arrive.

I asked the Captain if he wanted me to start holding C-Spine on the patient, to which he responded “Yeah, if you’re up for being here a while”. I got behind her in the back seat of the car, told her that I was going to hold her head still and that it was important she move as little as possible and not shake her head to answer questions. I found a comfortable position, pulled the sleeves down on my jacket, and took control of her head.

(Almost every time I’ve held C-Spine for any extended duration I’ve managed to assume the most uncomfortable position possible, resulting in every limb going numb or cold. By the time we’re ready to move the patient onto the backboard, I have to be relieved because I’m a paralyzed and thoroughly frozen EMTsickle. After 5 years of doing this, I finally managed to get it right and was comfortable *before* I put my hands on the patient.)

The various responders began to assemble backboards and gurneys near the car as the Captain and one of the Firefighters began splinting the woman’s fractured wrist. Life-flight was on the way to a nearby parking lot (above the dense fog), we had her on high-flow oxygen, and things seemed to be going in the right direction.

I started talking to Grandma, who had insisted that I call her Grandma, and it was obvious that she was turn for the worse. She was starting to struggle a little for breath, and seemed like she was getting shocky. The paramedics had arrived and started treating her. She was going downhill pretty fast, and so a second helicopter was ordered.

We were able to move the daughter onto the backboard and get her transferred into the ambulance. I returned all the gear that I had absconded with and then asked if there was anything else I could do (there were now 3 fire engines on scene, 4 CHP units, 3 ambulances, two turtle doves, and a partridge in a pear tree). Mr. CDF and I were released and we scooted on our merry little way.

I suspect that Grandma had a hemothorax (blood in the lung cavity) and was probably in greater immediate peril than her daughter. I’ll never know how they fared at the hospital, but I did the best I could for both of them with the time and resources available. I hope they ended up with nothing more than a fractured arm for the daughter and rib for Grandma, that they were only a few hours late to open presents with their family, and are thankful for the gift that the accident wasn’t worse (it could have been much worse).

In that answering the call to help those in need I was given a gift too… An opportunity to write my next 5 year plan remembering why I wrote the first one. It was an unexpected gift, but one that I’m immensely grateful for.

Merry Christmas.

A day in the life…

ems, emt, firefighter, firefighting, jesserobbins, lessons, stories

(names changed)

So, seeing as how it is INCREDIBLY slow today, I thought I would tell you about a recent day in history… Monday June 5th, 2000. This email will

go into some medical detail. If you are not interested in reading about what we encounter on a call please dont read on.

I arrived at the station as per usual around 0730 and began my morning duties as I described in my last update. Checking out my gear, putting it on the rig, checking out the rig, the station etc.

0800 Capt Abrams Relieved Jones
Abrams, Sherman, Blackford
Intern Jesse
Information Exchange
Check Equipment

I should perhaps explain a few things about bells, alarms, dispatches, and the like…

Contrary to the way movies portray the fire service, going on a call is a
fairly simple event. Movies and television show us doing some kind of menial work, and when extremely loud bells or horns start ringing everyone makes a mad dash to get on the
engine which goes screaming out into traffic with very little regard for the motorists, who all (of course) yield perfectly to the lights and sirens.

Reality is somewhat different…

Typically, a citizen calls 911 and is routed to the Hightree Main Dispatch center located underneath city hall in a bunker of sorts. Dispatch receives the call and begins asking the caller a few basic questions, they then transmit a “pre-alert” to the stations over the radio. Normally (during the day) we have our station radio over the PA system. We hear a dispatch that goes something like this:

“Medical Call, 123 Lytton, for Engine 3 and Medic 2”

At which point we calmly put down our equipment, close and secure any open
doors at the station, and change into whatever gear is appropriate. Sometimes
this means just putting on a uniform shirt for a call, sometimes this means
taking off your uniform and putting on turnouts. For medical calls during
the day, we take put on uniform shirts.

This takes between 5-25 seconds. During this time the dispatcher is getting
more information from the caller and dispatches the units.

We hear:

*BEEEEEEP BEEEEEEP*
Followed by DTMF tones that activate our station bell and PA system (if
not already active)

The bell is a relatively quiet, simple note. It is accompanied by most
of the lights in the station coming on if they are not already on.

The dispatcher then gives us some more information… for instance:

“Engine 3 and Medic 2, patient is a 21 year old male. Reporting party
is advising that he fell through a plate glass window while urinating.
Has sustained facial lacerations and is reportably intoxicated”.

Normally, the Captain, Engineer, and Firefighter all go to the big map and
verify the location and route to be taken to the scene. I’m usually getting
on the rig at this time. As an intern, the engine should not have to wait
for me to get ready so it’s less of a rush if I just hop on before they do.

The captain presses the “Acknowledge” button on the console of our dispatch
system which tells the dispatches that we heard them, and are about to
head out of the station to the call. Sometimes the captain also presses the
“Light Preempt” button which gives oncoming traffic a red and clears the direction of traffic we wish to go in by giving them a green.

My seat is behind the Driver/Engineer. I climb aboard the rig, sit down
(facing aft), and put on my headset. Everybody else climbs aboard, the
engineer opens the garage doors, the firefighter and I both say “Set”.
The captain tells the dispatchers “Engine 3 Responding”

We pull out of the station and pray that the general public behaves as they
are supposed to and:

  1. Sees or hears the Fire Engine
  2. Does not immediately steer into the fire engine
  3. Does not immediately steer into another car
  4. Does not block us in by directly obstructing us
  5. Does not block us in by causing another car to get stuck in front of  us.
  6. Does not decide to follow us because we are clearing traffic
  7. Does not do some other totally moronic thing because they are talking on their cell phone, yelling at their children, reading some document, grooming or applying makeup, or some combination of the above
  8. Does not combine some or all of the above options resulting in death or serious injury to ourselves and the general public.

It’s extremely dangerous to be driving Code-3 (lights and sirens) for the
above reasons. Even though I am in an open cab, the rig weighs over 31,000
lbs dry and I sit 4 feet up. In an accident, we may be injured, but the
main problem will be for the citizens who are involved with the accident.
We try to avoid this, but at least once during any response somebody will try
to turn into us, will block someone else and cause them to turn into us, wont
see us until we are right behind them and then get totally startled when
they become aware of the rig. Code-3 driving is probably the biggest hazard
we face on a day to day basis.

Anyway, it’s just about 0800, I’m just finishing my checkout of the medical
equipment, the firefighter is going over the rig, and the captain and engineer
are getting cleaned up in the bathroom. The radio cracks to life, the
tones sound, and we are all caught just a little sooner than anyone is
prepared for.

It’s a bit hectic as we put everything back on the Rig and run on our first
call.

0803 Crescent, 31 yo female. Pain in LLQ, M1 to SUH

We arrive on scene to a large, sparsely decorated house. I get off the rig and get the Green Bag, the Suction unit, and the De-fib and follow the
Capt Abrams and Firefighter Blackford into the house. We are met by a frantic man. He is Asian and there is a slight language barrier. It appears
that his wife has recently had an ectopic pregnancy. She is experiencing extreme abdominal pain in her Lower Left Quadrant (LLQ), is vomiting, and
is not responding to us verbally. We later find out that she also speaks very little English.

I set up the suction unit in case she begins aspirating her vomit, Jeff checks her vitals and puts her on high-flow oxygen, the captain talks to the husband. Steve, the engineer, shuts down the rig and then comes inside. Steve was a longtime paramedic, so he takes over with the exam of the patient. Jeff backs out and I get her blood pressure. She begins to vomit after I get her Blood Pressure (which is very low), and so I go into the bathroom to get her trash can to use as a basin. Steve is asking her about any vaginal bleeding, which through translation we are told she does not have. When I look in the bathroom it is obvious that we are having a bit of a communication problem as the basket is full of bloody napkins. I take the trash bag out, set it on the floor, and bring it into the bedroom.

At this point the paramedics arrive and become the patient person. The captain passes all the information we have gotten along to them and I tell them about the discovery in the bathroom. We were all surprised when her husband told us she had not had any bleeding.

The medics put her on an EKG and start an IV to replace some of the fluids
she has lost. I take a second set of vitals. Things are improving.
We move her onto a gurney, and we all help the medics load her into the
ambulance. They go code 3 to Stanford.

I put everything back on the rig while the capt. finishes his report. Jeff
and Steve clean up the mess the medics left behind, and then we clear the
scene.

0930 Housework

I do the station duties with Jeff. It’s a less thorough job today because
we have a bunch of other projects to take care of. At about 1000 we leave
the station and go to Station #2 to fill up some SCBA bottles.

On our way back we stop by Peet’s and get some Coffee, then return to the
station for about a half an hour while I review some hose stuff.

At about 1130 we head out to go pick up our lunches at the Safeway on Middlefield by Oregon Expressway.
We all get sandwiches and head back to the station so
I can study hoses and the rest of the crew can study for their EMT recert.
Just as we are opening our lunches…

1201 – University Ave, 74 y/o female SOB m1 to SUH

This call is at one of Hightree’s many elderly care facilities. The
woman is having some trouble breathing, and has been for some time.
We arrive on scene, are taken to the top floor, and are greeted by her
RN. The RN is part of a pool that cares for many of the people in the
building.

The woman is unresponsive and drooling. Her respiratory problems are coming
largely from saliva that she is aspirating. I hook up the suction again,
Jeff takes vitals, I put her on oxygen. The RN begins giving the Captain
a list of meds that the woman is on, Jeff and I ask if she diabetic.
He insists that she is not, however there are needles everywhere and insulin
in her refrigerator. The RN decides that she might be. Managed Care at
it’s best…

Anyway, the medics arrive, start an IV with some glucose. We move her
to a gurney and then outside to the ambulance. She goes Code3 to Stanford.

Notice how unreliable people at the scene are?

We return to quarters at about 1245…

1246 – Middlefield Road. False alarm workers painting

This is a call at a school right next to the station. We change into
our turnouts and drive to the alarm panel. There is a large group of construction workers waiting for us as we drive up.
They forgot to disarm the panel before starting to work on a section and it set off the alarm. We return to quarters and sit down to start eating again…

1315 (1:15pm) – Highway 101 Metal into a vehicles windshield

Responding on the freeway is always a bit complicated:

  1. Fire Apparatus do not accelerate very quickly
  2. Vehicles slow/stop for accidents, creating traffic in the direction we need to go.
  3. Vehicles slow/stop when fire apparatus drive around code3 on the freeway to gawk creating traffic in the direction we need to go.
  4. Vehicles act erratically when they see a fire engine driving code3.
  5. They will block us, they will attempt to follow our wake through traffic, they will pull out in front of us. Most drivers are idiots.

God help the person that gets caught following an emergency vehicle
to get around traffic. People do it all the time, blocking off our
support units when they realize that those red lights BEHIND them
need to get by. Because my seat is not enclosed, I get to glare and
wave the person back into regular traffic…

Sometimes, to get around REALLY bad traffic, we will go down the freeway into
oncoming traffic. This is some scary shit. Normally CHP will block traffic
for us when this happens or dispatch units going in opposite directions to
find the crash.

This time getting to the scene is a bit easier. People are staying out
of our way, and the afternoon traffic hasn’t started to build up yet. We
roll up to the accident to see a Semi Tractor-Trailer and a 1990’s Corvette.
The corvette has a 2 foot piece of metal sticking out of the drivers-side
windshield. We see some people standing outside of the car.

CHP, Engine 4, and Medic 2 arrive at the same time from various directions.
The CHP officer blocks traffic, we go look at our patients, and Engine 4 is
released.

The metal in the drivers side is a piece of road debris that was thrown
by the semi. The it missed the very surprised driver by inches, embedding itself in his steering wheel. He and his companion were on their way to a funeral.
It was very close to being his own.

Amazing as it is, there are no injuries. All but CHP are released who stays
to get reports and wait for the corvette to be towed.

I snap a picture for posterity. Sorta fun.

To MSC to check for broken bolt from engine. Not from engine

Before returning to station, we decide to stop at the Municipal Service Center
to have a bolt checked out to see if it fell of the Engine. The mechanic
literally sniffs it and says “Nope, not from a fire engine”.

Then he backs this up with “You don’t have that color paint on your rig”. Suits
us, we all pile back in and head back to the station. The captain has some
other plans tho…

Ging road for Hose, Ladder, Forcible Entry

We take a familiar right turn onto Ging road. This means that I’m about to
be drilled on something. I begin getting my equipment set for when the capt
gives me my orders.

“Jesse, the small concrete building has smoke showing. I want you to make a
hydrant connection and return to the engine.”

I step off the engine and put on my coat, helmet, and gloves. Walking to the
back of the engine, I hop on the tail board and grab the red hose strap attached to our 5″ Large Diameter hose. I pull off maybe 25 feet on the first pull, enough to make it to they hydrant, put the hose strap around the base of the hydrant, and yell to the engineer “LAY LINE!!!”. The engineer drives toward the fire with the captain. I remove the hose strap from the hose along with a toolbag attached to the end of the hose. Taking the hydrant-wrench out of the bag I remove the cap from the hydrant, pull the hose between my legs gripping the 25 pounds or so worth of “brass” on the end of the hose with my knees so that I can thread the couplings on. I tighten the connection by hand and then open the hydrant.

Water fills the snaking hose out, filling it with over 100 gallon of water in about 8 seconds. The hose now weighs over 800lbs in it’s first length. I then run to the cab, meeting the captain who tells me that I have a fire in a small concrete structure to my right.

I pull the transverse inch and a half preconnected hose out 150 feet, and lay it in a series of “S” curves. I then stand ready at the door for the captain to
come over to me and give me my next instruction.

He comes over and asks me why I haven’t asked for water.
I told him I was waiting for him…

He tells me that I am supposed to have water already.

I call for water, and the engineer “charges” the line. I begin to mask up with my SCBA so I can fight the fire inside the building. The water hits the nozzle and starts to push. I have the nozzle placed under my foot, and pick it up  while wrapping a hose strap around it to keep it closer to my body. The captain
tells me to advance the hose and spray some bushes in the distance. I do so for about a minute when he  informs me that we are ready to make entry to the building.

Again I hesitate, waiting for instruction. Again, I get this puzzled look from Capt Abrams. I say, do you want me to just do it? He says, Umm… yeah… would you wait at a fire scene?

I tell him no, he says: “Right. Then come on, go.”.

I try the door for heat, down on my knees in a “duck walk” position.
Feeling with the back of my hand for heat, listening for the sounds of fire.
I try to open the door. It’s locked. The captain asks:

“It’s locked, what are you going to do?”

I stand and start trying all of the other doors on the building. All locked.

“What are you going to do?”

“Force Entry Captain…”

“Where?”

I decide that I would use a Halligan bar on the main door to pry the door through the jam.
The captain has me walk around again and suggests that I cut the padlocks off another exterior door to gain entry.
Some other options I consider are breaching the wall with a sledgehammer, and using the Hurst Spreaders on the door.

Capt. Abrams instructs me to go ladder the building with the 24 foot ladder
and get on the roof. I go back to the engine, take the roof and 24 foot ladders
off and go to the building with the 24. I plant it a little far away, and have
to walk it into the building.

“Take the hose on the ladder and spray the roof”.

Ever climbed a ladder before?
Try climbing it with a 70 lb object.
Then try pulling that object up with one hand,
Then lock onto the ladder and have that object push back on you with about
50 lbs of force.

Not fun. But manageable.

I’m sweating like a pig. That’s all the drilling for the day. We disconnect
and empty hoses, stow ladders, and get the rig ready to go.

We get back in quarters at about 1400 (2pm). Captain Abrams, Steve, and
Jeff finish lunch, I go shower and change into fresh clothes.
Clean again, I get back into uniform and go watch EMT recertification videos
with the rest of the crew.

1455 Cowper Street 8 Y/O Full arrest, canceled by E1 who took call

I end up listening to this call on the radio. The kid didn’t make it… sorta glad I didn’t have to go.

Engine 1 is taken out for CISD (Cumulative Incident Stress Debriefing) CISD is an opportunity for people on a hard
call to talk it through, to make sure that nobody is having any problems, and to let everyone know
that they did their best in spite of the loss. We can’t save everyone, even if we really want to.

1536 Cowper St, 53 y/o male “heart stopped beating” VA Hospital

Back to my good ‘ol cow palace days for this call. This is a halfway house
for veterans with relatively minor psychological problems. We are greeted by
an older gentleman living in a squalid room about the size of a handicapped
bathroom stall. It smells slightly worse than a public toilet. There are
cigarette butts everywhere, trash piled in corners, and generally that sort of disgusting feeling that people who don’t care for themselves exude.

Jeff asks: “Hello sir, what seems to be the problem”.
Patient: “Well, Sir, about an hour ago my Heart quit out on me.”
Captain: “Could we get you to put out that cigarette, we would like to
put you on some oxygen”
Jeff: “What is your name?”
Patient: “Corporal Williams, Number #3292304A4,
Steve: “What do you mean quite out on you?”
Patient: “Well Sir, I was watching TV and my heart just stopped beating…
“I followed the SOP and it’s tickin’ over again…”
Dispatch: “Medic 2 is unavailable, AMR is responding Code-3 from Mountain
View. Approx 20 minute ETA”

This means that ALS (Advanced Life Support) is about 20 minutes away from
the scene at best speed. Fortunately for our patient, he is not exactly
in need of ALS. Normally response times for an ambulance are around 6 minutes.
AMR does not serve our area, so we have a while to wait.

They arrive, walk our friend down to their rig, and head off to Stanford so
our patient can be evaluated.

I hope his heart troubles don’t come back. Good thing he was able to get
it tickin over again. 😉

We go back to the station for a bit, and then head back out to Hobee’s for dinner.
Our station kitchen is being repaired, so we have to eat at restaurants close by.
Dinner is a bit uneventful, other than some general complaining about
my recommendation of the house iced tea which everyone decides is way way way
too spicy.

We get back to the station and Jeff and I go work out for about an hour. Then
we all change into sweats and watch TV in the day room. I study at the table
and watch TV for the next few hours.

People head off to sleep around 0030 (12:30am). I’m last to bed, and shut
down the lights and make sure all the doors are locked. I share a dorm with
Jeff (the captain and engineer get their own dorms). I unroll my sleeping bag
on my bed, grab my pillow, and crash.

0057 Cowper Street, Good Intent Call Canceled by PD after staging.

The bells ring and the station lights come on. I pull on my socks and run down
the hall to hear the dispatch info as it comes off the radio. Everybody else
shows up several seconds later.

“Engine 3, Medic 2 respond on a possible domestic violence incident. Scene
is not safe, RP (reporting party) is screaming on the phone. Stage until
cleared by PD”

We roll out of the station. It’s cold and I’m groggy. Still, it’s kinda neat
to be pressed against the side of the engine for warmth as we speed toward
the call. Our lights are on, but are siren is largely off because there is
nobody driving around PA right now.

Dispatch keeps updating us, the scene keeps sounding uglier. We arrive
to find 3 or 4 squad cars outside of the residence we are dispatched to.
We wait for about 5 minutes outside and then a cop strolls outside.

“Apparently the girlfriend called because her boyfriend was drunk and she
was angry at him. He is fine, is refusing care, and there is no emergency”

We turn around, put the rig back into the station, and go home.

I wake up around 0645 and open the station, making sure coffee is made,
newspapers are laid out, and the morning shift rotation is ready to begin.

Relief arrives for some of the crew, others are held over for overtime.
I take my gear off the rig, hang it on my hooks, and head off to my
day job.

Thanks for reading.

That’s Firefigher-Intern Peon to you… (Part 1)

ems, emt, firefighter, firefighting, jesserobbins, stories

Date: Sun, 2 Jul 2000 21:26:33 -0700
From: Jesse Robbins
Subject: That’s Firefigher-Intern Peon to you… (Part 1)

I’ve told you all about my training, about the infamous Captain Roberts, about the members of my team, and about what it is like to stand 50 feet in the air on a freestanding ladder gin. I’ve told you about internships, and EMT training, and clinical time in the hospital… I’ve even suggested that I might tell you all about what going through an academy is like. The one thing that I haven’t told you about is what I do now that I’m an intern. This update will come in several sections…

My day begins on the day before the shift at around 11pm. Hours ago I realized that I needed to have all of my gear ready to go for the morning and then got caught up in reading and writing emails. At some point, the “oh shit” factor begins to click in my now tired head, grumbling as I start a load of laundry and begin ironing my shirt out. My pants are still dirty from the week before. At some point, the wash finishes and I put the wet clothes in the dryer. My uniform shirt is now hanging off the chin-up bar, and my pants are in the dryer along with my uniform T-shirts, shorts, and black boot socks.

I set the alarm for 6:30am, I set my other alarm for 6:31am, and I go to bed. I then get suffer some paranoia and get out of bed to check to make sure both alarm clocks are actually set properly. I have a terrible fear of oversleeping and being late for duty.

I wake up at 6:30 and get out of bed… starting the dryer again so that my clothes will be wrinkle free, grab a quick shower, get dressed, and then fold some of the clothes hot from the dryer and put them in my bag. I’m now wearing my Palo Alto internship uniform: Light brown shirt with patches, black “Sam Browne” belt, matching light brown pants, black socks, and polished zippered steel toe duty boots. On my belt I have a glove pouch, leatherman super-tool, radio belt clip, and my EMT shears ( EMT shears are the same as Paramedic shears but just work harder ;-). I take a brief look in the mirror to make sure that I am totally respectable, and then grab my bag, my sleeping roll (bag, pillow, down-comforter), my backpack with books and forms, and run to my truck.

I’m presently assigned to Engine 3. For those that know Palo Alto, Station #3 is located at Embarcadero and Newell, just before Middlefield Road. It is the oldest remaining station in Palo Alto. It is a single company station, housing one of the older open cab engines and the rescue boat. It’s 7:30 on the nose as I pull into the driveway and open the sliding gate. As an intern, I am supposed to arrive first in the morning and also get lowest priority in parking… so unless there are 4 spaces open, I park pressed to the fence by the gate. I leave the gate open for the shift change and walk in the door. The previous night’s crew is awake, coffee is usually brewing, and sometimes the newspapers are in. If not, I make the coffee and go outside to get the newspapers and lay them out neatly on the table.

By this point, I’ll probably speak with the firefighter on duty about their shift, find out if anything interesting happened, and if there is any special information that I need to know. Then it’s off to my hanger to get my helmet, turnouts (heavy protective clothing), and “red bag” containing my wildland firefighting equipment. It all must be checked to make sure that it is in proper working order, that nobody played any practical jokes and put weird things in it or hidden anything, that all the things I need are either in the pockets or otherwise attached to the jacket, suspenders, and pants. I carry a set of firefighting gloves, a NOMEX flash hood, straps to hold my gloves, heavy wire cutters, a hose-strap, earplugs, a few dollars in cash, and sometimes a small disposable camera. All this equipment gets stored on the engine or attached in various ways. Because the cab is open for the “tailboard” (rearward facing seats behind the driver and captain) getting all my equipment aboard is a bit tricky. I sit behind the driver/engineer on the left side of the engine. My helmet and coat go next to my seat on the motor compartment. My boots and red-bag get attached to the side of the engine on two separate folding foot holds. My box of latex gloves and at least one water bottle go to the right and left of the seat between the seatbelt equipment. Anything else gets crammed into whatever compartment I can find to fit it in where it is not in anyone way. The last thing I do is connect my headset to the engine’s communication system. It’s very noisy on the engine, especially sitting in an open cab with the engine running and the sirens on. The headset protects my hearing and allows the crew to communicate while we are driving around.

I’m now officially “on duty”. If there were an intern from the previous day on, I would relieve them by telling them that “I’ve got it from here”. As there is not yet an intern on every shift, it’s really mine from when I show up, but there is a certain feeling of the changing of the guard when I put on my equipment.

At this point I begin checking out the engine itself. I am responsible for each and every tool, hose, nozzle, radio, or medical supply on the engine. I start with the “green bag” containing all our basic first aid supplies and oxygen equipment as it is the most often used and abused tool on the rig. Sometimes things need to be restocked, recharged, or refilled, and almost always I have to rearrange the some of the gear so it’s how I like it. Much of my time on a medical call is spent grabbing things from the bag and giving them to whomever is the patient person so it’s extremely important that I can get at things when requested. Then I test out the defibrillator, suction unit, c-spine equipment, and burn kit to make sure everything is operational, stocked, and in good condition. I inventory the Self-Contained-Breathing-Apparatuses (SCBAs), spare air bottles, tools, ropes, lights, fire extinguishers, ladders, hoses, and hose appliances on the rig. At some point the firefighter shows up and begins his or her own check of the gear. It’s both of our responsibilities to make sure everything gets checked out. At 8:00am we run up the flags and shortly thereafter I finish checking out my equipment, the oncoming engineer and captain arrive and relieve their counterparts. We have a brief station meeting and then it’s time for the captain to do paperwork, the engineer to make sure the Engine is running properly, and for the firefighter and I to begin cleaning the station…

During this time, we are always ready to go on a call. Sometimes the bell rings and we are out for the rest of the day, but usually we make it at least to this point without screaming out of the station with sirens blaring and lights ablaze.

-Jesse

———————–
Jesse Robbins
San Jose, CA

Mission College Technical Rescue Team, or “what happened to my beard and hair”

ems, emt, Failure Happens, firefighter, firefighting, jesserobbins, lessons, stories

Date: August 25, 1999 10:04:50 PM PDT
From: Jesse Robbins
Subject: Mission College Technical Rescue Team, or “what happened to my beard and hair”

It seems that the little rescue group I was involved with has now officially evolved into the “Mission College Technical Rescue Team”. Complete with logos, patches, sponsors, jump-suits, and yes… even a secret handshake.

Some interesting personal changes have taken place since I last wrote. Most of which are a direct result of a 30 second encounter with the director of the Fire Science program. During the first indoor lecture of the class, he came into the room to discuss his pleasure with all the hard work we were doing, and explain his views of the future of the course.

He stopped for a second, stared at me, and said:
“But we won’t be representing the program with any Monkey-Faced-Little-Beards or girly little earrings now… will we…”

No, clearly we won’t. I am now regularly clean-shaven, with no earring to be seen, and definitely no “monkey faced little beard”. I am also now sporting a crew-cut and although my Breathing Apparatus makes a proper seal, I nowactually look my age… (scary thought)

The MCTRT has already done rescue demos for the City of San Jose and7 Chinese Generals who were visiting as part of some kind of Sister CityProgram. This included a confined-space-hazardous-materials rescue and the first public demonstration of our corporate sponsor SKEDCO’s new HAZMAT evacuation system. (All hail the sponsor!!!)

Most recently we have been working on the execution of the “Mid-air Pickoff”. This technique is for rescuing people stuck on a rope or on a ledge which allows us to transfer the patient from a failed rope system to our system and lower them to the ground.

We’ve been training at around 18 feet. Same level of difficulty, high degree of safety in case of a critical failure. It’s extremely technical rescue, and is easy to get yourself hung up… literally.

The biggest lessons learned so far are:

  • On Ropes:
    1. Your rope is your friend.
    2. Don’t step on your friend.
  • On Harnesses:
    • A bad harness is like a bad lover,
      Hang around together too long and both your legs fall asleep.
  • On Equipment:
    1. Your equipment is your friend.
    2. Don’t drop your friend.
  • On when equipment is dropped:
    1. Equipment will be dropped at the most critical time of the rescue.
    2. The captain will be filming you with a video camera.
    3. The captain will be zoomed in on your facial expression.
    4. The equipment will be expensive.
    5. The equipment will be marked with a yellow band.
    6. The yellow band will have special meaning.
    7. That meaning will not be “This equipment can be dropped”.
    8. That meaning will not be “This equipment can survive a drop”.
    9. That meaning will not be “This equipment is student loaner equipment, and is inexpensive”.
    10. That meaning will be “This equipment can’t be dropped.”
    11. That meaning will be “This equipment can’t survive a drop”.
    12. That meaning will be “This equipment is the captain’s PERSONAL in-service duty equipment, and is very expensive.”
    13. No matter how hard the person that dropped the equipment tries to apologize for the error and replace the equipment, no such remedy shall be accepted.
    14. The equipment, and a 8×10 glossy image will be displayed of the person who dropped the equipment at the exact moment the equipment was dropped. The face of the perpetrator will be one of grief and fear, having realized the error and trying desperately to grab the item before it bounces off the ground below.
    15. That display will be placed in a conspicuous location with the school.
    16. Ridicule for the drop will be administered immediately after the event occurs, and shall last no less than 1 week and no more than eternity.

More to come…

———————–
Jesse Robbins
San Jose, CA

Trauma: Jesse’s Life in the ER

ems, emt, firefighter, firefighting, jesserobbins, lessons, stories

Date: May 25, 1999 12:37:47 PM PDT
From: Jesse Robbins
Subject: Trauma: Jesse’s Life in the ER

In my last entry, I was describing the pride and confidence being in my EMT uniform inspired in me.  As I pulled into the parking area for the ER and passed 3 ambulances cleaning up after a call that confidence rather quickly changed to excitement and fear.  Over the past months of training we have been given a practical set of skills, most of which we have been told will be useless on a real patient until we get hands on experience.

What was quickly becoming apparent to me was that this was going to be when I get that experience.  Even if closely supervised, anybody that isn’t a little shaky when they realize that responsibility for the care of another human being is about to be placed in their inexperienced hands hasn’t quit grasped the fullness of the situation.  A lot of what-if’s and oh-shit’s go through your head, mostly questioning yourability to operate smoothly under stress.

I met with the charge nurse and another Mission college EMT just finishing up her rotation.  She had done 7am-3pm, I was set for 3pm-2am.  I got a quick rundown on her day, and then was sent off to triage in the ER.  Triage(French for “to sort”) is the process that you go through in the ER to determine treatment priority for walk-in patients.  If you arrive via ambulance you will be at least given a bed right away.  The nurse working triage that shift was a wonderful woman with an Irish accent.  After a quick acquaintance we let the first patient in.

Here’s what I learned in Triage:

  • About Infants:
    1. Unlike the plastic infants we train on, and unlike the books description and instructions for taking vital signs on infants, they do not hold still nor can the be bribed or otherwise convinced to stop. Palpating a brachial pulse on a wiggling infant is a joke.
      To get around this, I learned to use my stethoscope to simply listen to the heart and get a pulse that way.
    2. Using a stethoscope on a crying infant to get a pulse is harder than getting a brachial pulse on a wiggling infant.  Infants also, apparently, wiggle and wave their arms about when crying.  Sometimes they can be convinced not to cry by giving them some part of your person, clothing, or more importantly stethoscope to examine or play with.  This does not  stop the wiggling.  If you have given them the piece of equipment needed to perform the assessment in order to bribe them to stop crying, you have made an especially large mistake.
    3. Once an infant has hold of any part of your person, clothing, or stethoscope dangling off of your neck, it may be necessary to use a vehicle extrication tool such as the jaws-of-life to get them to release it.  21,000 PSI hurst spreaders are recommended.
    4. There is nothing more appealing to an infant than a stethoscope dangling from your neck.
    5. There is nothing less appealing to an infant than having some mean man in a uniform try to take away the shiny thing with blue tubes coming out of it.
    6. Once an infant grabs the head of your stethoscope in it’s clutches, it will soon have the head of the scope firmly in it’s mouth.
    7. Replacement diaphragms for Sprauge-style dual head steths come in the little box it came in.  There are 2.
  • About adults:
    1. The general level of calm exhibited by a patient with a feeding tube that has been unintentionally removed by a family member providing care is proportional to the level of hysteria exhibited by that family member.
    2. If at first your attempts at speaking Spanish to a patient fail, seek a translator.
    3. The term “Student” strikes fear into the souls of the ill and injured. Therefore:
      The proper way to answer the question: “Are you a doctor?” is “No, but I’m going to help you until a doctor can see you.” and NOT “No, I’m only an EMT student, but I can help you until a nurse or doctor can see you.”

I then did 8 hours in the actual ER.  Here’s what I learned…

  • About the airway:
    • A human being, unlike the airway model we use to learn suctioning,    has fluids, objects, and a movable, muscular tongue.  Also, unlike the model we use, things don’t always just fit or slide in.
    • Don’t look into the mouth without a face mask on.
    • DON’T look into the mouth without a face mask on.
    • DON’T LOOK INTO THE MOUTH WITHOUT A FACE MASK ON.
  • About humor:
    • Hard as it is, you must not laugh at or tease the drunk student with scalp lacerations who fell through a mirror while urinating.  Even when he asks you “You probably think I’m pretty stupid, Huh?”.
    • Nurses, on the other hand, can be as cruel to the patient as the situation warrants.
    • Hard as it is, you must not tell the friends/girlfriends/concerned frat-persons that despite the best efforts of the ER, their friend    will live.
  • About the Police:
    1. The number of times a patient will explain to you that he didn’t do anything is directly related to the number of police officers in     the room.
    2. Once the second ambulance arrives, and the victim of the first patient is put into the vicinity of the first patient, his assertion that he did nothing will become an exponential function of the number of cops in the room.
    3. Although a nearly infinite number of Police Officers can cram themselves into an ER, there will never be enough x-ray shields to fit them all behind.
    4. Once the police have positioned themselves in a room, the doctor will then arrive and not have enough space to get to the patient.
    5. Once a patient has been arrested, the number of times he will say    “Thats f***ed up” is twice the number of officers in the room.    Also, every time an officer enters the room, he will say it again.
  • About equipment:
    1. As a firefighter, we are trained to trust our equipment.  Hospital workers are trained not to trust their equipment.
    2. The more a patient is bleeding, the less time it will take to get a CT scan completed.
    3. The more critical the patient, the more likely the respirator will fail.
    4. I had a wonderful time in the ER.  I have a newfound respect for the people who work there every day.

Up next… How to remove the roof of a car in 2 minutes with only a hack-saw and a lift jack.
Hope this finds everyone well.

-jesse

Trauma: My life (leading up to) the ER

ems, emt, lessons, stories, Uncategorized

From: Jesse Robbins <jesse@worldcontrol.com>
Subject: Trauma: Jesse’s live in the ER (part one)
Date: May 19, 1999 1:13:58 PM PDT

-(*)- Trauma:  My life (leading up to) the ER -(*)-

In order to recieve my EMT-I certificate there are a few out of classroom requirements that must be met.  The most important one being the Clinical  Rotation.  A minimum of 10 hours worth of work with a fire department or emergency room, and a minimum of 3 patient contacts during that 10 hours.

Due to suspected hernia, I was bounced out of the San Jose Fire Dept (for now) and so I did my work in the San Jose General Hospital ER.

There is a lot of equipment and gear that you can buy for this (and any) public safety role.  Uniforms, boots, helmets, shears, knives, flashlights, bodyarmor.. it’s possible to spend a lot of money.  The goal of every fire-science student is to be “issued” equipment, but for now we are forced to go to summit uniform and gawk at the toys, credit cards itching to be maxed out…

So there I was, standing in Summit Uniform.  My task was simple: Obtain a pair of black uniform pants, and a light blue uniform shirt.

It took some effort, and one or two trips to the bathroom to splash water on my face, but I managed to walk out without a pair of newer, lighter, respose boots. I managed to depart the store without a full set of Threat-Level-III bodyarmor with front and back trauma plates.  I even managed to depart the store without the $170.00 Benchmade “automatic” response knife, probably because they wouldn’t let me touch it without a Fire Department ID card.  (Once you are a firefighter you can have a switchblade.  But you dont call them switchblades of course, you call them automatics.  Why, you ask, do firefighters need “automatics”?  For the same reason cops do… because they can.)

But I digress.  They tailored my uniform to fit me, and there I stood, in front of the mirror…  suddenly transformed from a geek wearing BDU’s and a t-shirt to a Public Safety Professional.  I proudly affixed my nametag over my right pocket which boldly read:
 Mission College EMT-I STUDENT
              Jesse Robbins

I draped my steth over my shoulders and put my penlight in my breast pocket.  At least I looked ready to save lives…

I *promise* pictures are forthcoming of everything I’ve done so far.  (Except the ER). I’ve been so busy lately that I’ve not had time to finish up my write up for my 14 hour rotation at San Jose Medical ER.

I’ll fill everyone in how that, and my finals, went in 2 weeks once it’s all over.

Hope this finds everyone well.

-jesse