Saturday, September 29, 2012

The Demise of the "Hearse" Ambulance and Other Good Things

Anyone who ever watched Emergency when originally on network television or later in syndication understands how far EMS, among other things, has come in the fire service.  With few exceptions, medical responses have long ago taken the lead over fire calls.  Some contend the name fire department is no longer accurate.  While I understand these arguments, I’m not prepared to go that far—yet. However, if you’re a firefighter today, particularly a young one, you better learn to “like” EMS, or consider another profession, because it isn’t going away. 

The development of ALS while the most prominent and recognized improvement is far from the only change.  Ambulance services run by funeral directors with a red light tossed onto the roof of a hearse have, thankfully, gone the way of the horses.    Overall availability has improved as well. 
How much?  A lot.  When I was six or seven years old, some buddies and I were playing in the woods, jumping in piles of leaves and generally doing the things young boys did back then when no one had to be worried about us being kidnapped if we went ten minutes from the house.  One boy jumped into a pile over a bank and hit something hidden beneath the leaves, breaking his femur.  His screams of pain frightened the living hell out of the rest of us.  There was no thought of moving him, not because we knew not to, but because of fear.  Practically as one, we all started running for our respective homes for one thing; to get our mothers—it was the 60s, they were home. 
The group of mothers followed us back, and mine, being a nurse, promptly recognized the fracture for what it was.  An ambulance was called, but it wasn’t quite as simple as today.  The first due fire department where Dad was a member had no ambulance or any medical capabilities at all.  No help there.  The neighboring department had an ambulance, but they only responded outside of their first due area on nights and weekends.  Monday through Friday, eight to four, they didn’t leave the district.  In the next village over, the police department ran the ambulance.  They didn’t leave their town at all, regardless of time or day.  The only unit available was operated by the county Sheriff’s department.  The road patrol deputy had to respond to get the ambulance from wherever he happened to be, and then across half the county to where we were waiting.    This wasn’t a rural area either; the suburban town had a population in the tens of thousands. 
Almost an hour later, it arrived to transport the boy.  Luckily the break hadn’t hit the artery or he’d have been dead long before the unit arrived.  After an extended convalescence; most of a school year, he recovered. 
Good?  No, but normal back then, so yes, things other than just ALS have changed a lot.  As much as almost no one wants to be on the ambulance every shift,  I think everyone would agree things are better now.   

Wednesday, September 19, 2012

A Challenging Mantra

Former quarterback Jon Kitna isn’t living the life of leisure in his retirement.  He’s teaching high school algebra and coaching football, and most importantly teaching life lessons.  The acronym he uses for the values he tries to impart is REAL.  

·         Reject passivity

·         Empathize with others

·         Accept responsibility

·         Lead courageously

The parallels are clear.  If underprivileged high school students can absorb this cultural challenge and change, hopefully so can our young firefighters—if we teach it. 

Sunday, September 16, 2012

Pizza Pie and Electrocution: The Strange Things That Bring Back Memories

Leaving a great pizza place in Endicott (Consols—originally Duffs—the same recipe for well over fifty years, but that’s another story) where Mike and I had stuffed ourselves with Dad, we drove by the old IBM plant and I pointed out a utility substation where I had one of my first serious calls as a youngster.
It was a summer day shift, and we got hit for an injured male.  This wasn’t our usual first due area but the ALS rig that normally covered it was on another call.  That the dispatcher or caller left out a little bit of information became rather evident when we pulled up on scene. 
There was a black male standing by the open gate of the substation with his arms extended out from his side.  Getting out of the front seat of the ambulance, I noted my observation had been wrong.  He wasn’t black—he was burned.  We got him onto a sheet on the stretcher and began carefully removing clothing where we could, and pouring sterile water onto his burns, trying to keep him talking to us. 
“They told us it was okay to dig there,” he kept repeating.  He and his partner had struck a high voltage underground line and it had blown them from the hole they’d been working in.  His buddy appeared to be less seriously injured than him but it’s sometimes hard to tell with electrical shock.  I called for another rig, and the cop that arrived along with some first responders from the plant helped with the second victim until a couple of our other members arrived on scene.  With victim two stable, and the second rig on the way, I decided to load and go with our patient.  I was worried about his airway, cardiac status; pretty much everything.  The ALS rig wasn’t available, and by the time we could get a medic to the scene POV, if one was even around, we could be at the emergency room. 
It was a wild and wooly ride as the far expanses of Chevrolet horsepower were explored by the driver.  We kept the victim talking all the way, the best tool we had available to keep him out of deepening shock, using every drop of distilled water in the cabinets on him as well.  I was ready to see it pour out the rear door when we backed into the ER ramp. 
Both made a full recovery and then, a few months afterward, filed a lawsuit against the utility that had let them dig there.  Yours truly received his first, but certainly not last, subpoena for deposition.  I was seventeen years old……

Monday, September 3, 2012

"Quarterback" Size-up. Interesting Analogies

The start of football season brings out the talking heads and sports commentators who spend an inordinate amount of time talking about the mental skillset necessary to play the position of quarterback at a high level; making it sound like the most difficult job on earth.  While admittedly I have no desire to stand in front of a snarling 350 pound lineman trying to make my body intimate friends with the grass, I do think that the situational awareness necessary for rapid decision making under center presents some interesting parallels to fire scene size-up.  With a pass play called, quarterbacks go to the line of scrimmage and see a defensive formation that may give an accurate representation of the opposition’s intentions or may be deceptive.  At the snap, he has a few short seconds to read the scene and hopefully be able to locate and connect with his primary receiver.  If covered, he then has to check down and look for his secondary or tertiary outlet.  He has to avoid getting tunnel vision as the defense converges and move, bob, and weave while continuing to look down field; big picture and small, refining his tactics based on what he sees. 
The first arriving fire officer on a residential structure fire faces similar challenges.  What “formation” is the fire showing and is it deceptive or obvious.  In just a few seconds, the officer needs to evaluate the construction, occupancy, exposures; read the smoke and extent of the fire conditions present on all those.  He can then audible his strategy and the associated tactics.  The firefighters under him have a similar complex job to do looking at primary and secondary escape routes and continually evaluating the effect that the fire is having on the structural integrity of the building so they too can check down and adjust their attack and team actions if necessary. 
The similarities are obvious although the salary levels are not.  The stakes on the correct decision making on the fire side are a little higher than a sack, incomplete pass or interception.