RIC – You Spin me (Right Round)

One of our Division Chiefs has seen more fire than a line cook at Outback Steakhouse and loves to ask odd questions in the heat of a situation.  Some think he’s just picking on people while others see it as a way to really think about the situation we’re in.

On other occasions this Chief likes to play with the RIC or Rapid Intervention Company.  This is the 4th due engine at a working fire and is tasked with standing by to rescue firefighters should the need arise.  Many Departments staff this position differently, but most will tell you they don’t like standing in the street while everyone else gets to work.

The RIC is responsible to size up the building, soften the exterior by removing hazards before they are an issue and knowing what operations are going on in and around the fire building.

It seems like a no brainer, but as the RIC team gets itchy to freelance, the Chief will turn to them and make them turn around to face him in the street at the command post.

From here he asks a very simple question:

“Describe the fire building.”

Each of the 4 members often have a slightly different interpretation of the building, from number of floors, to color, to where ladders are placed.

Ever since I saw him do it, I’ve always paid closer attention to the building as the RIC team.  And that was his intention.

Scrub a dub dub

While washing the HM Mobile this morning (which recently crested the 100,000 mile mark TYVM!) I was amazed at how dirty it had gotten over the holiday season.  All the trash from the kids’ snack wrappers, pretzel crumbs, paperwork from work, scattered uniform bits and other such regalia were taken out so I could vacuum and clean.

At one point I told myself, jokingly, “You wash your gear more often than this car.”

And it’s true.  I wash my turnouts once a month and after every fire.  I clean out and wash my car far less frequently.  But then again, there are few chances my dirty car will lead to my premature death.

The reason we wear our SCBAs into fires is because of the smoke, right?  What is smoke if not particles of non-complete combustion?  Where does that smoke land while our lungs are protected by fresh air?  On our gear.  We get back from a worker and clean our hose, hooks, axes and engine so that they are ready for the next alarm.  We shower and change into a fresh uniform, or at least a new pair of shorts and a T-shirt.

But how often are you cleaning your turnouts?

They likely sit neglected on the floor of the bay, covered in soot, drywall, insulation and whatever else was in that fire, signaling to the next crew that you are the man.  You caught a fire and you are one bad ass.  Your jacket is just as filthy, as is your helmet, but I bring up the boots for a special reason.  Would you sleep in that fire building that night after the fire is out?

Then why do you but your dirty, dangerous boots RIGHT NEXT to your bed later that night up in the dorm?

Fires are still killing us and that is disturbing all on it’s own, but what is more disturbing is the growing list of firefighters contracting rare, and not so rare, forms of cancer.  Bladder, kidney, lung… all cancers we open ourselves to when we fail to clean our protective gear after a fire.

The glory days of the Fire Service of Old are long gone fellas.  Smoke Eaters did this job when houses were made of wood and cloth.  Now there are metals, chemical carpet stain blockers, plastics and a host of other things that we recognize as dangerous and mask up.

But remember that along for the ride was your coat.  And your helmet.  And your boots.

Don’t have time to clean them?  Find another excuse.

It’s not that bad? Find another excuse.

Or keep doing what you’re doing but don’t be surprised when the doctor tells you you won’t be able to enjoy that retirement you earned.

The Crossover Podcast Episode 8

Another installment of the blabbling on that is the World’s only crosspolinated podcast is back from the holiday break (we decide when those are, Sparky) and discuss scene safety versus a scene being secure and use the shooting in Tucson as a backdrop.

We also answer a listener question that was phoned in at 313-451-HMMC, which was our all requests oldies hot line, but is now just a drunk dial number for public safety folks to vent (when off duty of course).

So have a listen and let us know what you think about Medics carrying handcuff keys.

Episode 8 – It took you long enough

You Make the Call – Hotel Rooms – What Happened

This scenario was patched together from a few here at home and from around the community.  My service recently ran a call for nausea that included multiple persons in stacked rooms and handled it well.  But identifying the cause or possible causes of the illness can be difficult when multiple possibilities present themselves.

ICS focuses on being the first in and building from the cold zone forward.  This call would be so much easier if we were donning our Medical Group Supervisor vest and carrying the command kit into the lobby control.

Ah, if only life worked that way.  Most MCIs and Haz Mats evolve quickly and rarely come in reported as what we find.

I added the element of the unknown upstairs to make us think about what ELSE could be happening besides the seemingly straight forward CO poisoning call which, had this been contained to two adjacent rooms, is easy to include in our plan.

Medic 88 responded above us, called for a haz mat response and went off the air.  We got neither a status update on their condition or why they called for the haz mat activation so we must assume the worst: They are compromised.

On the 4th floor we have 3 or 4 patients directly needing our assistance with an unknown number possibly dead, dying or completely oblivious to the situation.  The first instinct is to evacuate the building, but scattering our unknown illness may prove more costly than not, so we need to evacuate to a place of safe refuge.

The enclosed nature of hotel rooms gives us the unique option of being able to stage our evacuation from the rooms to the hallway, establishing a warm zone.  Of course identifying those experiencing symptoms will be difficult so we need a way to identify them easily.  The MCI and triage kits are downstairs in the rig, so we’ll need to improvise.  Advise the persons you have already contacted to put on the hotel white robe (if they’re there) or drape a large white towel over their heads.  Asking them to also bring a clean washcloth to cover their coughs will help contain any airborne illness should it be present.  The 2 masks we carry are on us and we are considered contaminated until proven otherwise.

Now we have our original patients easily identifiable and a method to separate them based on signs and symptoms of illness.

This information now needs to be relayed to the other responding units.  Using clear text is key in this situation.  Identify your unit, establish command, list threats and give your status.  If Medic 88 is unreachable upstairs we must include them as victims until we hear otherwise.

For the time being we should stay on the 4th floor, triaging all the rooms who will answer the door.  Symptoms get a white towel/robe and washcloth, non symptomatic get moved the the other end of the hallway from our rooms.

This is no place to establish a command post or begin to orchestrate the response of additional units.  In most communities the first units on scene will be engine companies with basic gear and SCBA, and until we know what is going on upstairs, they should not enter the 4th or 5th floor.

Haz Mat Specialists can speak in more detail as to how they may approach this situation, but leaving what Medic 88 found unknown, I think makes us think in different ways, determining a solution for each possible situation.

Think about the following changes to the scenario:

Medic 88 reports a faulty pilot light on the water heater common to 403, 405, 503 and 505 and that symptoms clear in the hallway.

Medic 88 reports fumes of unknown origin seen coming from room 505, two patients are down inside that room.

Medic 88 calls a mayday and reports they are trapped on the 5th floor in heavy smoke, no SCBA.

Medic 88 stumbles from the stairway with blisters on their faces and arms, excessive snot from their noses and mouths, begging for help.

A hotel employee approaches you stating the hotel has received a bomb threat.

These are all exotic situations we may never see in out careers, but could actually happen when we are already set up for a different event.  Responding to any of these situations allows us to think ahead, set perimeters and stay back from the nasty stuff, but with dispatch systems keen on getting us out the door ASAP, most times without finishing the coding of the call, a simple code 2 sick call can become a dangerous unknown situation.

Think on your feet, use what is around you to your advantage and don’t forget that in this situation, YOU’RE a victim too.  At least until the heroes in the yellow suits say otherwise.

If you said “Slow down and think this through” you made the right call.

You Make the Call – Hotel Rooms

Dispatch has rung you out for a reported sick/altered mental status at a local hotel.  No, not the one all the addicts live in when they cash their checks, the one where all the conferences are held.  Confidence is high that this might actually be a call for a sick person.

Halfway to the scene you hear another rig toned out for the same complaint at the same hotel, different room.  Double checking your screen you are going to a Mr Brown in Room 403, Medic 88 is responding for a Mrs Gutierrez in room 503.

Arriving at the scene you are met by the manager who asks you to park around back so as not to frighten the patrons.  Ignoring him you take the elevator up to 403 and find Mr Brown doubled over the toilet, vomiting.  It is then the door to room 405, the room next door, opens and a young woman asks you to take a look at her mother, who is dizzy and vomiting.

Something is bothering you about this, but you agree to stop in after checking on Mr Brown.  Mr Brown’s wife is also feeling dizzy and complaining of nausea.

From upstairs Medic 88 is asking radio for a full hazmat response and to shelter the hotel immediately, then goes off air.

What is your reaction?

You make the call.

Intruder Alert! Intruder Alert!

I was hoping this could be referenced by someone else first!

Statter911 is reporting an intruder at a San Francisco Firehouse HERE.  I will now comment on HIS story, not the actual event.

According to the report a man was found inside the firehouse wearing a uniform and watching TV, after having washed his shoes and gotten a bit of a workout in.  An anonymous commenter noted that a man wearing a female firefighter’s uniform was not out of the ordinary in San Francisco. Haha…hilarious!  Does your department issue different uniforms to females or are they simply a different cut?

All joking aside though, this is a perfect chance to discuss firehouse “security.”

Do you post a day watch?  Are your bay doors always closed?  Is the back door locked or wedged open for fresh air?

In San Francisco we do post day and night watches, but what happens when we run a call and pull away, only looking back briefly to tell the Officer “Door is coming down” as we head off to the call?

The only way to truly secure your quarters is to leave someone behind to double check the doors are closed and locked, windows fastened shut and no one ducks under the large doors while you drive away with your mind on other things.

The fact that this happened at a station I am very familiar with was only kind of a shock, since this is a double company, Engine and Truck, and with the staffing shortages we are experiencing, a large amount of unfamiliar faces come and go from house to house as staffing needs dictate.  Perhaps you have a smaller department where everyone knows everyone else, but with 43 engines, 19 trucks, 2 squads a scattering of specialty units, not to mention the dynamic ambulance staff and add to that a confusing 31 day tour schedule, I too have had to introduce myself to people at other housees that I have never met, and that’s almost 10 years on the job here.

I’m not making excuses for what happened but trying to make it a chance to talk to your co-workers about just how secure your quarters really are and learn from what could have been a dangerous situation.

Oh, and lock your lockers…you never know who’ll be trying on your uniform these days.

Stay safe,


Resolutions Schmesolutions

Each year it seems we are encouraged to write a list, a collection of sins or things about ourselves to improve.
Join a gym, eat healthier, don’t screw up, take a computer class etc etc.

But rarely do these things last more than a few weeks, 2 months tops.

It is important to take this time of year and just relax. The weather keeps us inside where our extended family resides most likely. What a great opportunity to learn the important things in life as opposed to listing your faults.
But we do love our lists. Some of the most popular blogs are about the top 5 Reasons you will die in a Zombie Apocalypse or the 11 foods rotting in your refrigerator.
Lists are clean, easy, numbered and we already know how long it will be from the title.
When most folks sit down to write their new year resolutions, it’s a blank sheet of paper or a new word document on the computer and it seems daunting. I’ve heard stories of folks searching online or asking around to others what their resolutions are and adopting them as their own.
I’ve done it here in this forum. Then a few weeks later they’re forgotten, as if just making the list in the first place is the important thing, on a list of things to do to end the official holiday season.

So for 2011 I’m going to keep doing what I’ve been doing, since it seems to be going pretty well so far.
Look back over 2010 and instead of finding your faults, make a list (see, sounds fun already right?) of three accomplishments, things you are proud of, events from the year you want to celebrate again…and do it.

Celebrate your year instead of setting your new year up for awkward glances at a list you made without knowing why.

#HM12DoC 6 Priapisms

On the 6th Day of Christmas Happy Medic gave to me…

6 Priapisms

5 Golden hours

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green

OK giggles, if you’re so ready to laugh at there being 6 of them, how about describing for me 6 causes of priapism, or general disconnect between the nervous system and the vascular system for that matter.

Yeah, I thought so.

As silly as this seems it does happen to females as well and can be a key indicator in many cases.  This is not in your primary survey, or secondary for that matter, on all patients, but should be noted if found, then a possible cause considered.

For example:

Ever wonder why all those commercials say that if their result lasts more than four hours the customer should call a doctor?  Because that is the official definition of priapism, an engorging of the sexual member without physical or psycological stimulation and a lack of the member returning to it’s normal state after a period of four hours.

So why should EMTs and Paramedics care about this sign and how it effects their patient?

Trauma is only one.  Recall from school that if your GSW patient with two anterior holes and no exit woulds can not move his feet and has a priapism, there is a disconnect between the vascular and nervous system, likely caused by those bullets.  Your patient has HIGH suspicion of a severe spinal injury.

But Mr Johnson walking painfully to the window of your ambulance and not having taken some of the pharmaceutical aids, is in remarkable discomfort that could be from other causes.  It could be a Brazillian Wandering Spider bite (HAH! Now that’s funny!).  What about cocaine use?  Trazodone has also been noted to have a side effect like this.  It can also be considered an allergic reaction.  Think about it.  An allergic reaction that disrupts two body systems…where have we heard that before?

Point being that while a priapism is indeed a chuckle worthy topic here in front of the computer so close to Christmas (Same sentence…YES!) you need to be ready to interpret that sign and apply it to your differential diagnosis.  And don’t laugh, ladies, from the literature it sounds akin to childbirth according to women who have experienced it.

the Crossover Show – Episode 7 FSTs and the News

Another installment of my mother’s favorite podcast is up and live featuring myself and the ever talented Motorcop of Motorcopblog.com.

This week he discusses some of the news stories from the LEO perspective including blood draws for DUI and a man shot for pointing a hose nozzle at police. I mention the New Mexico EMT recovering from a head on collision on I-25 and how many ambulance accidents could be avoided entirely.

News of Scarlett Johannsen’s divorce makes the list, as do more listener questions.

Speaking of listener questions, did you know you can now CALL INTO the show? Well, not really, but admit it, you were excited for a second. Leave a voicemail at 313 451-HMMC and we’ll answer your question on the next show.
What will that topic be? Listen to episode 7 for details. We’ve actually planned a topic. GASP!

Episode 7

You can also subscribe to the show feed HERE

We have been busy little bees indeed.

#HM12DoC 4 Fibbing V-Fibbers

On the fourth Day of Christmas Happy Medic gave to me…

4 Fibbing V-Fibbers

3 Tripple Os

EMS 2.0

and a British Medic dressed in green

“Witnessed Arrest” is not as black and white as we would like.  Does that mean a person watched their EKG change from a somewhat normal or non fib rhythm to V-Fib?  Did they witness someone slump over, seemingly unconscious?  Perhaps their blood pressure tanked, or a CVA struck, but how does the person standing there in line at the market know when the heart of the woman behind the register went into fib?  By the time my engine makes it through the traffic and into the busy parking lot 3 minutes have passed since the call was received.

Arguably one of the better response times in the nation is nothing if the information given to us is not accurate and especially not if the only thing happening for our fibbing heart is a load of positive thought from the gathering crowd.

I can count on one hand the number of times I have arrived in a public place and seen CPR being performed on a person who needed it.  That observation includes my entire public safety experience, now at 18 years, not just time in my current system.

CPR can be very uncomfortable for the woman in the nursing home trying to fight off her would be rescuers (caretakers) and does little for the man decapitated in the motor vehicle collision.  But now that we’re taking away the yucky mouth to mouth component to traditional CPR, perhaps more folks will start to get involved when their fellow citizens fall unconscious.

But that still won’t solve the “witnessed arrest” issue will it?

Not until we have a wide spread Public AED program will the concept of a witnessed arrest make sense to me.  It is possible that if we have a well trained, well armed armada of first responders in waiting, then less arrests will be witnessed and we can change the term to witnessed conversion prior to EMS arrival.

Lofty dreams indeed, but if we can get them into airports, schools and shopping malls, how about Doctor’s offices, care homes, police cars, mail delivery vans, school buses, taxi cabs…need I go on?