9 Years

This month marks nine years in emergency services for me. I started nine years ago as a volunteer firefighter with Seaside. I still remember my first call—a drunk outside one of the bars downtown. It was the same night I’d first been issued my gear. My dad drove the rescue to the scene, me in one of the rear seats, feeling very out of place.

I remember a lot about that first year: structure fires, cardiac arrests, and car wrecks. I joined the department to fulfill my Senior community service project (called a “Pacifica Project) and didn’t have much intention of sticking with it long term. Nevertheless, I started the First Responder class a few months before graduation. Within a year, I knew where I wanted to go with my life.

A couple of weeks ago, I had to do the ambulance stand-by at the home high school football game. I watched the crowd just as much as I did the game: young men with the faces painted in red and columbia blue, young women with glittered ribbons tied into the hair. Parents were wrapped up into their kids’ letterman jackets, fathers in red Seaside ball caps, mothers in red Seaside hoodies. The Friday night lights were bright, shining onto the white-striped field. The band played fight songs and the cheerleaders lead the crowd in chants of “LET'S GET FIRED UP!” It was a beautiful slice of Americana—and it made me feel a sense of sickly nostalgia.

When I think that I’ve been out of high school for nine years, my 10-year reunion coming up next year, I have the undesired feeling of being old… or perhaps just older. But when I think of nine years in emergency services, I have a feeling that my career is just getting started and that I’m starting to develop the kind of experience that will make me an experienced and respected care provider.

It makes me wonder why I have such contradictory feelings about the passage of nine years. My wife likes to tell me that sometimes I’m still stuck in high school, and maybe there’s some truth in that. I miss a lot of the friendships, the experience, of being in the crowd, instead of functioning on the sidelines. But I’m excited about where I’m going, that I’m married, own a home, have a career, and a stable lifestyle.

Sometimes nine years can feel like a like time and sometimes like no time at all.

The Parapup and the Potato Chip

I was having a conversation with one of my firefighters about the topic of professionalism—what’s appropriate and what’s not in certain situations. We were talking specifically about an incident at a recent out-of-district training event and how bad it made out local volunteers look. As we talked, it reminded me of a few different “professionalism” moments. I thought I’d share.

***

Professionalism with your Superiors

It’s often been said in my company that they supervisors don’t get any respect because they work as regular crewmembers. There’s some truth to this as we all joke around together and the supervisors like to be friends to everyone. What develops from this though, is a lack of professional courtesy, something that is often passed on unwittingly to our new hires and our paramedic interns.

As a paramedic intern, when you arrive for you internship, you should be like an obedient puppy dog. Eager to learn, eager to run calls, but with an understanding that you are not a regular crewmember and that your rights and privileges are not the same.

I’m doing a fill-in shift and precepting a paramedic intern one spring day. I have a bag of chips and some salsa out on the counter. As a regular crewmember, it’s understood that to have a couple of chips here and there from someone else’s bag of Lays is okay. Partaking of the dip is acceptable. Just don’t empty the bag or drain the salsa bottle. Let me remind you of the point: interns are not regular crewmembers.

So when this wet nosed parapup reaches into my bag of Lays and withdraws friend potato wafer then places said chip in his mouth, you can imagine my reaction. “What the hell did you just do?”

The parapup look liked he had just piddled on the carpet.

“Did you just take a chip from my bag? Did someone tell you that you could have a chip from my bag? No? So who in the hell do you think you are?”

When is it taught to new paramedics that they need to have some respect and professional courtesy to those that are senior to them? At the very least, they should know how to act when they’re in someone else’s house.

***

Professionalism with our Peers

My brother is a firefighter for the City of Portland and arranged a training event at the Portland Training Tower for the Seaside and Gearhart volunteer fire departments. This was a rare opportunity for out departments to train together at a high-class training facility. We were able to use the live burn house then spent the afternoon in their high-rise building going over high-rise evolutions.

It was at the end of the day, as we were cleaning up, that one of the volunteer firefighters made his way over to one of the Portland firefighters that was observing. While I wasn’t within ear-shot to hear the conversation, the remark that was made quickly worked its way back to my brother and through the rest of the Clatsop County fire departments.

The remark from the volunteer firefighter went something like this: “I have all the same training and certifications that you do, and I have a real job.” (As a side note, this guy’s “real job” is working the counter at an auto parts store.)

It should go without saying that when you’re at someone else’s firehouse/training facility/whatever and there’s a crew on duty, you try not to bother them. In addition, you have to realize who you’re representing and do so in the highest manner possible. Let’s just stop and think for a moment what one firefighter’s comment did to the professional image of every volunteer firefighter there that day and all the one’s that we were representing back home.

***

Professionalism with Families

On shift on the ambulance one fine afternoon and my partner and I took a cardiac arrest. In my system, we transport all full arrests and don’t call them in the field after running a few rounds of ACLS. So, we start CPR, I place the ET tube, and have the patient on the monitor. Asystole all the way, but we load and go. As expected given the circumstances, the hospital called the code shortly after arrival and the patient didn’t survive.

Talking with the family about resuscitation efforts has always been a difficult thing for me. I don’t like being involved in a families grieving process, and even worse, I don’t like have to deliver the news that we had done all we could but their loved one was gone. In a certain morbid saving grave, when we transport the code to the hospital, I am spared having to notify the family. It’s left to the doctors.

As was the case here. I was gathering my paperwork and helping my partner to clean up the ambulance. The family had been called into the ER bay by the physician and spent a few minutes inside before coming out crying. My partner was making up the gurney a few feet away from the grieving family what he thought he would offer some words of comfort.

“Well, you can look at it this way: everyone has to make the trip upstairs at some point.”

I was stuck, rooted to the spot, and dumbfounded. The family was a mix of mortified, dumbfounded, angry, and in disbelief. I think that maybe for an instant, the family was so mad at my partner that they pushed the thought of their loved on passing aside. Then a nurse quickly escorted them to an empty ER bay, all the while the RN was giving my partner a death glare. My partner, for his part, had the what did I do? look on his face.

My first knee jerk reaction was to take him by the ear and drag him outside. Instead, after the RN had closed the door to the ER bay, I walked up to my partner and told him we needed to have a conversation outside. I had to have a conversation with him about appropriate interaction with family members, how we don’t impart our personal believes upon the grieving, and how saying anything more than “I’m sorry for you loss” is unacceptable.

After that, I then had a talk with the family that went something like this: “Hello folks. I’m sorry we didn’t get a chance to talk earlier. My name’s Jeramy and I’m the paramedic in charge. My partner—Jake—works under my direction. First of all, I want to say how deeply sorry I am for your loss. Secondly, my partner spoke out of turn and does not speak for the rest of the company. I want you to know how sorry I am about his remark. Here is my business card and the name of my supervisor. If you’d like to file a complaint, I completely understand.”

How do you make up for it when an off-the-cuff remark destroys your professionalism and credibility to the ones who matter most: the patients and their families.

***

Professionalism in the profession of EMS is all about how we act around the public and our peers. As I explained to my firefighter during our discussion, we can goof around all we want at the stations, play practical jokes and what have you, but we are health care professionals when the call comes in. The public and our peers should see us at our absolute best. I thought I’d share a couple of the professionalism moments above because I’m a firm believer in learning from other peoples’ mistakes. And while the parapup and the potato chips may not be the most poignant example, it sure makes for a funny story.

NOWS 2009

After rearranging my weekend schedule, I was able to participate in the Northwest Oregon Wildfire School at Camp Rilea. Every year, our county hosts a multi-agency, live fire, wildfire drill. This was my first year doing it and was looking forward to working with the other departments, the ODF crews, and the helicopters. However, due to rain, we couldn't even get a burn out completed on our safety zone Saturday. Yestereday was a total bust with thunder and lighting storms. Looking forward to next year, though.

2972, the Gearhart FD Unimog. My truck for the weekend.


Putting down a wet line.

Digging hand line.

The rest of the crew on the line.

Attempting to burn out the safety zone.

Lots of smoke, but very little fire.

An ODF lookout, keeping an eye on the (attempted) burnout operation.

With Little Fanfare

At the beginning of the month, I posted about how I'd be moving to a 12-hour day car. However, my little ambulance company is feeling the pinch of the economic downturn and we've had to cut a whole shift, as well as cut dispatchers and wheelie drivers. Because of seniority and our new shift bid process, my move to the 12-hour car was preempted by another employee, so I'll remain on 24s for the foreseeable future. As much as I was starting to look forward to the 12-hour days (sleeping in my own bed, no more midnight transfers, seven shifts per paycheck), I'm trying to find the bright side to remaining on 24s. I really like my current partner, I've started rotating through all the stations again, and everyday is a Friday (more time for golf).

Little of interest has happened in this last month, and I admit, I do feel neglectful of my blog. So I thought I'd post something juicy. Last year, I started the EMS Cyclist Program at my fire department and while it was a rocky start, I've had continued and increased interest this summer. My volunteers EMS providers are more willing to step up and the program has received a lot of positive support from local business owners and event organizers. The EMS Cyclist Program was also one of the reasons why I was awarded Firefighter of the Year for my department.

Based on this EMS Cyclist Program, my fire chief deemed it appropriate to submit my name to the Oregon Volunteer Firefighter Association for consideration of Volunteer Firefighter of the Year. Today, my wife and I just returned from Medford where last night I received my award plaque for 2009 Volunteer Firefighter of the Year.
I didn't get a chance to say thank you at the awards dinner last night, so I thought I put down a few of my thoughts here. I know that I've been recognized frequently in these last few years, and while my wife and family say it's because I work hard and deserve it, I can't help but feel so completely humbled and underserving of the praise. I feel this recognition needs to be shared with my fellow volunteers and my coworkers. I wouldn't be as lucky or successful today without them. The EMS Cyclist Program wouldn't be successful without the outstanding performance of the team members. Nothing that I do for the fire department (or my job on the ambulance) is an individual effort and I want to ensure that the efforts that I put forth benefit my organizations, not just me. So thank you to all of my fellow volunteers, fire, and EMS professionals.

As seen on CNN

After reading a short article on CNN.com, this was the "Ads by Google" that I saw at the bottom:

I have one thought about this: Fucking bottom feeders. God forbid we try to educate ourselves about the H1N1 virus, or that we talk about proper hand washing and prevention techniques. No. We have to put up with vendors trying to sell $179.95 (plus free shipping!) 5+ Person Flu Pandemic Kits. This "amazing" kit, a $279 dollar value, includes:

• Box of 35 N95 Masks (Latex Free): N95 Masks are the respiratory masks that are rated the best for preventing the spread of contagions (N95 masks are also good for chemical spills, wild fire, etc.)
  
• Box of 100 Exam Gloves (Latex Free, Powder Free)
  
• Box of 50 Disposable Isolation Gowns (Latex Free)
  
• Box of 100 Disposable Shoe Covers (Latex Free)
  
• Box of 100 Bouffant Cap Disposable Hair Covers (Latex Free)
  
• Five Pairs of Protective Safety Glasses (Latex Free)
  
• Five 4-oz Bottles of Epi Clenz Hand Sanitizer Gel

All this can be conveniently yours at a special discount price to make sure that your family is pandemic flu ready.

Gack! I think I've just thrown up a little in my mouth...

Occupational Hazards

Lt. Ray McCormack of the FDNY made a statement at the recent FDIC conference: the fire service needs a "culture of extinguishment not safety." Some of Lt. McCormack's remarks seem pretty inflammatory, but they're the same thoughts that I've occasionally had. Now, I'm just a volunteer firefighter on the Oregon coast, but if an FDNY lieutenant and a small town volunteer firefighter think the same thought, there must be a few people in the middle that feel the same.

I've been involved in the fire service for over 8 years and have worked as a full time EMT/Medic for 5. Even in that time, especially considering the post 9/11 period, emergency services are focusing more and more upon "ultimate" responder safety. As Lt. McCormack puts it:

"Attempting to make the job safer by teaching you to place yourself above those in need is wrong and goes against everything the fire service has ever stood for."

When I first started taking my fire service and EMT training, safety was a matter that was pressed upon us heavily. But it was always prefaced with a statement of: we're doing what no one else wants to do or can do. To put it another way: firefighters rush in while others are rushing out. What we do is inherently dangerous.

Police officers wear bullet proof vests and carry guns because they know they can be shot on any given shift. Firefighters wear turnouts and SCBAs because we know we're entering IDLH atmospheres. EMTs work and move around in the back of the moving ambulance because we know we have to taken care of our patients.

Safety has to be a concern of every emergency responder, but we all do our jobs understanding that there are certain, unavoidable occupational hazards. Even though a firefighter wears his turnouts and SCBA, he knows he may still die in a fire and even though an officer wears his vest, he knows he could die of a gunshot wound. As a medic, I know that when I'm not wearing my seatbelt in the back of the ambulance, that I could die if we get in an accident. My patient is restrained in the 5-point harness, but I take certain occupational risks to render care to my patient.

But I agree with Lt. McCormack that our evolving culture of safety is beginning to hinder our ability to do our jobs. As a medical professional, I attend conferences and read the professional journals. I'm aware of the crash helmets and restraint systems that are being advertised to the EMS community to make us "safer." Several months ago, my supervisors returned from a conference intent upon equipping us with crash helmets. It really just seems too much.

From the fire service, we're required to purchase SCBAs with PASS alarm devices that automatically engage and are engineered with Universal Air Connections (UACs) for the purpose of transfilling the tank. We are required to have RIT teams standing by, ready to spring into action at the first transmission of a "mayday." But in all the case studies the I've ready, I've yet to see a single one where these measures made the live-saving difference.

Lt. McCormack puts it this way: "If you put out the fire, safety is accomplished for everyone on the fireground." And he's right. Getting the job done quickly and efficiently keeps the situation from escalating too much, from becoming too complex, and as a reslut, will keep everyone safer. Our focus in emergency services needs to be on educating responders about a common sense approach to safety. And it also needs to be reinforcing the idea that what we do is dangerous and it is irresponsible to think that we can ever make our jobs 100% safe.

The Science Of It All

A few years ago we had a paramedic that worked for us that used to refer to himself as a “Purple Box Paramedic.” His idea of care was pretty simple—he saw bradycardia on the ECG, open a purple box. Asystole? Open the tan box. Low blood sugar? Open the big blue box. For him, patient care wasn’t about clinical assessments or diagnosing, it was a matter of looking at the monitor or vital signs and opening the appropriately colored box. Wash, rinse, and repeat.

Some would argue that that’s what we do. That’s what protocols dictate we do. Find the protocol that the patient fits into and open the appropriately colored boxes. I would argue that you’re not doing enough for your patient. After reading the article on JEMS that Peter Canning recommended (EMS 12-lead ECGs after ROSC?), I noticed a comment by an anonymous poster. I’ll paraphrase: “what’s the point? It won’t change our treatment.”

I don’t want to belabor the argument (and there was a big list of objections), but the first thing I thought of after reading the comment was: Purple Box Paramedic. 12-lead ECG didn’t fit into his/her protocol for post-arrest treatment, so why bother with it? Because, as the science is starting to show, it’s probably a good idea. And as a follow up commentator stated, “if it doesn't change what I do within the next 5 minutes then I guess it has no value at all, right?” (the sarcasm is implied). In addition to the science of it all, we have to be willing to think past the purple box and think about he long term continuation of care.

I like to browse JEMS and other literature and try to keep up to date on how EMS is evolving. In some ways, I know that I can be a little quick to jump on the bandwagon. I’ll sometimes read an article, think that’s it’s the greatest thing since sliced bread, and want to implement it the next day, regardless of how “new” or “unproven” the concept may be. But this comes from being aware of something about myself as medic: I like to know why I’m doing something. If I’m informed about the science behind it, I’m more likely to 1) perform the assessment/intervention/whatever, 2) have greater confidence in my ability to perform it, and 3) have greater confidence in the potential outcome.

As an example, I recently helped recertify our volunteer firefighters/first responders at Seaside on their CPR cards. In addition to the standard stuff (“push hard and fast; 100 times a minute; think of ‘Stayin’ Alive’”) I also gave them a brief lecture on coronary perfusion pressure and why it’s so important that we get our rate and ratios right. I kept it simple, not because they wouldn’t have understood a long lecture, but because the concept can be kept simple. And I could tell by looking at them that they were getting it, I could see the light bulbs turning on. In fact, I had numerous firefighters tell me that it was the first time that they every really “got it.” And this is the same stuff we’ve been teaching for almost 5 years now.

I’m a strong believer in the science of it all. I went to a subpar paramedic school and came out with a less-than-stellar education. I’ve done a lot of research and studying on my own and still try to learn new things every single shift.

Here’s another example. One of the headline articles on JEMS right now is The Disappearing Endotrachael Tube. Research nationwide is beginning to show that prehospital intubation by EMTs is a poorly performed skill with a significantly high (relatively) failure rate and an alarming trend towards higher rates of mortality. I read this and I think about how I want to be able to perform the skill proficiently with an eye towards long term patient survivability. Now I couple this with everything that I’ve learned about quantitative capnography, and I begin to think of intubation from a perspective of performing the skill when appropriate with an eye towards the overall patient outcome, and in turn, I have more confidence in my decision to intubate when determined appropriate.

So much of what we do in EMS is based upon habit, anecdotal evidence, and presumption. We need to be open minded about emerging research, changing trends, and evolving treatments. If we want to be taken more seriously as a profession, then we need to be willing to get behind the science of it all. It’s also so important for us to understand that we’re part of a greater health care team and that everything we do will have an effect, whether positive or negative, on the remainder of the patient’s care in hospital.

And as the NAEMT Code of Ethics for EMTs reads: “The Emergency Medical Technician shall maintain professional competence and demonstrate concern for the competence of other members of the Emergency Medical Services health care team.”

Something to ponder the next time the question is asked, “but will it change the way we treat them?"

Jaws Training

It's been 3 weeks since my last post and all for lack of anything exciting (or worth mentioning) happening. Yesterday though, I taught an MVA Trauma and Jaws class for the local EMT-Basic class. What's better than getting to cut up old cars with expensive, hydraulic tools?

Me and the Supervisor that I frequently write about. One of my best friends and the instructor for the EMT Class.
My good friend Mark, one of my fellow volunteers.

My older brother, Gordon, and the Supervisor.

A bit of good news--it looks like I'll be teaching the EMT Communications and Transportation class at the local community college next semester. My Supervisor recommended me for the job and I'm looking forward to injecting some fresh ideas into what has traditionally been a dull prerequisite class.

More to come soon, I promise.

JEMS State of the Science 2009

The Journal of Emergency Medical Services (JEMS) has a great supplement for download on their website. Called "State of the Science 2009," the 32-page insert has great articles on CPR, the changing roles of MS, lasix, and beta-blockers, the wide spread use of field 12-leads, research into hypothermic induction in a cardiac arrest, and other topics. You can find it on the JEMS website here. Look for the Download This Supplement link near the bottom of the page.

Vehicle Fire

Responded with my fire department to a vehicle fire last night. While I wasn't there early enough to get pictures of the pickup while it was fully involved, I did get a few good ones. Enjoy.

After the knock down

At the command post

That's my brother, Gordon, on the circular saw

In Service, Available

Medix 311 is back in service, available.

It's been a rough couple weeks since Christmas. While my little car accident didn't incapacitate me, it did make me surlier than usual. My wife and I have been down to one vehicle, which isn't so fun for her when she has to drive me to and from work on my 24s. Oh, I also got the damage estimate back on my car.

Drum roll please... $8000. That's right--8-K, 8-grand, 8-Gs.

$8000 on a car worth $1100. So needless to say, Allstate is going to total my car. Right now, my twisted wreckage of an automobile is somewhere in Central Oregon awaiting an Allstate service tech to verify the damage so they can cut me a check. Looks like I'll be new car shopping at the end of the month.

Additionally, I just had to drop $1000 today for a new washer and dryer as my current washer that is 20+ years old crapped out on me. My wife and I figured that it's better to replace them both at the same time.

My water heater has been acting up. I'm hoping it's because the washer was causing it trip its breaker. But who knows...

Oh, but I do have one piece of good news. Great news, really. Last night was my fire department's annual awards banquet and guess who was awarded Firefighter of the Year. That's right--me. Really, I'm honored and pretty humbled by it. My fire chief had so many nice things to say about me that I was a little embarrassed to receive the award.

That's it for now. Again, I promise I'll be back soon with Drunks 3, and it will be well worth the wait. Take care.

Why We Do

My brother’s little girl was born premature by 3 months. She had a lot of health problems in her first few years of life and today is mildly autistic. When she was born, my brother and his wife Tonya had moved to a little town outside of Portland and was working for a local utilities company. He was a volunteer firefighter in that town, the same as here in Seaside before he moved. He’s also a very proficient EMT.

One morning, Gordon’s wife was watching their little girl when she stopped breathing. It wasn’t unusual, and had happened a few times before. Tonya knew what to do and did the few stimulus activities that the NICU nurses had taught her… only this time they didn’t work. She cried for Gordon who came running into the room and saw his little girl turning blue and not breathing. He checked a pulse and not feeling one, started CPR.

***

I’ve asked myself and some of my coworkers over the years, “why do you enjoy being an EMT?” (or a firefighter, depending on who I’m asking). The answers are varied, of course. Most have some variation of “because I want to help people.” One of my fellow paramedics tells me he’s here because its less stressful than his lost job—he was cabinet maker before.

Many of my fellow EMTs tell me they’re here because its more interesting that what they did before. Whether it was surveying, delivering pizza, or drug running (seriously), they find working as an EMT more entertaining.

My supervisor was recently quoted in a local paper as saying “My favorite part is making a difference in someone’s life. Sometimes that means holding a patient’s hand and taking them to the hospital. Sometimes is means saving a life.”

For me, I’m not sure I have a simple answer to the question. I started in volunteering for the fire department my senior year of high school as my community service/graduation project. It was an easy way to get the hours and it let me spend time with my brother and dad. At the time, it was the era of the dotcom boom and all I wanted was a career in computers. Then the boom went flat and I was left looking for a new path. By the time I graduated, I enjoyed my time volunteering and moved into the fire station as a resident volunteer—but I still wasn’t sure it was what I really wanted.

I worked customer service, first as a floor manager at the local movie theatre, then as a front desk agent at a hotel before I started full time on the ambulance. But even as I became a full time, paid responder, I still wasn’t sure what I wanted. I was still testing for fire department jobs, but wasn’t thrilled about working 24-hour shifts, and neither was my wife.

This were different for my brother, though. He knew he wanted to be a fireman as soon as dad brought home his bunker boots when my brother and I were still little. Right out of high school he was applying for full time for jobs. He must have taken at least 50 in the last ten years and some times he’d get as close as the final chief’s interview before being cut. Time and again I saw him get cut down, only to get back up, dust himself off, and sign right back up for the test. If only I’d had that kind of dedication and drive.

Don’t get me wrong, I enjoy what I do. I love being a paramedic. I feel like I’m putting my skills and knowledge to use on a daily basis. I know that I’m helping people and most of the time that gets me through the shift. I’ve transported friends and family and known that I’ve made a difference for them. I have seen heartache and been on the calls that bring my family tragedy. I know that EMS is a team effort, but I know that because of my skills, there are a couple of people out there still alive and that makes me feel wonderful. Sometimes I think I’m here doing this because it’s what I’m comfortable doing—who wants to rock the boat, right? Right now, I can say for sure that I’m here because I have job security. With the economy as poor as it is, I know that I have a good paying job for my family that isn’t going to disappear. I just don’t know that I have a single, sum-it-all-up answer to “why do I do what I do?”

***

Gordon performed CPR on his little girls until the ambulance arrived. By that time, she was breathing on her own again and crying. She went in again for another stay in the NICU, my brother and his wife at her side.

Gordon once told me that if his whole purpose, his whole reason for taking all the fire classes, for becoming an EMT, for testing for all those fire jobs and getting shot down time and again, that if he was never meant to get a fire job—that his only reason for all of it was to save his daughter’s life that morning, it was all worth it.

I hope that someday I can have as noble an answer as my brother’s for why we do what we do.

Gordon is now a career firefighter/EMT for the Portland Fire Department.

Storm Ready

Today, I had to bring my newly packed Storm Readiness (as in I'm probably being overly paranoid) Bag to work. A wind storm is supposed to be blowing through the north Oregon coast over the next 2 or 3 days. This morning when I left the house, it was blowing rain sideways. Today, I'm thinking about trees coming down and as I told the ER nurses this morning: "the rain tends to bring out the crazies."

As for my overly paranoid Storm Readiness Bag, I now carry on the unit with me:

• A hard hat
• Rain pants
• Leather work gloves
• Headlamp
• Flashlight
• Safety goggles

At least if I get stuck on a highway this winter, I might feel a little safer while the wind is blowing and trees are falling down around me.

What did you do tonight?

I just got home from fighting a very large, fully involved structure fire.

Lots of flames, lots of hard work. I am very tired and I think I pulled a muscle in my left shoulder.

I'll write more later.

It was a good night.

Today

... I didn't forget.

Seven years ago, I was asleep in the upstairs loft of my parents place. I had just graduated high school a few months before and was sleeping in late until I had to work my shift at the movie theatre later that day. There was a knock on the door, then it opened. "Jeramy, wake up," it was my mother.

"What is it, mom?"

"Hun, you need to turn on your TV. Planes just flew into the World Trade Center."

"Hmmph. Okay." I started to roll out of bed as my mom closed the door. What the hell is the World Trade Center? I thought.

By the end of the day, I knew.

***

That day, I saw my father cry, after the realization struck that 9-11 was 911. My dad to me is a stoic guy, I'd never seen him cry before. As my family sat around the TV that evening, watching CNN, and the estimate of FDNY firemen lost went to over 300, I couldn't hold it in anymore. I sobbed, shoulders shaking and tears streaming my face. Dad got up from his chair, set a hand on my shoulder and said to me, "son, it's okay. We've all got to be strong, okay?"

***

Today, I didn't forget. Never once have I forgotten, not the 343 firefighters, 23 NYPD officers, 37 NY Port Authority Officers, and K9 Sirius, 8 private EMS workers, and the 2,564 civilians and military personnel killed at the Towers and the Pentagon.

I have to say how proud I am of my fellow blogging community for the 9/11 tributes that I've read today, they have truly lifted my heart.

Everyone, take care today and keep those that were lost in your hearts and thoughts.

Intermission

It's been over two weeks since my last post; an unexpected and unwanted hiatus. I've been working too many over time shifts at our slowest station. I'm stuck in Little Fishing Village just south of Little Beach Town with World's Longest Beach (allegedly) and I don't think they've ever heard of the internet. My company is working on getting us internet access into the station, but like all things, it will take time.

I thought that I would share some good news, though. My letter from Big Valley Fire Department arrived today and I will be advancing onto the physical ability round. I've heard through the grape vine that they've narrowed the hiring list down to 200 and are looking to hire a least half. We shall see.

As I've been stuck in Little Fishing Village, I don't have many interesting stories, but I promise I'll be back soon with some fresh material. I'm about to rotate down into the county for the next couple of weeks, so I'll have more opportunity to write and more to tell.

Angry Old Man

(Or, Why I Felt It Necessary To Break Down Your Door)

Several weeks back, I responded at three in the morning to a report of smoke coming from the roof of an apartment complex. This wasn’t anything too unusual, as this apartment complex still had several wood burning fireplaces. I took my time getting out of bed, then drove lazily into the fire station. I heard the Captain getting on the air and could hear the tiredness in his voice, trying to shake the sleep out of it.

I get about a mile from the station when the Captain gets on the air again, “3105 on scene. Heavy smoke showing, call a working fire!” He was awake now.

Oh boy! I’m thinking as my foot stomps into the gas pedal. (I keep it under control; I’m not one of those volunteers that wants to wreck his care because I was doing 90 to granny fell down. But this was a fire, and there was some quickness in my driving).

The ladder (really a quint in our case) is out the door while I’m still a few blocks from the station. I arrive and see my brother and another firefighter getting into their turnouts. I sprint into the station, clamber into my gear and make my way to the officer’s seat of the truck. The Captain has reported that there is not an all clear on the building, so we roll with the three of us.

Our assignment is to supply the ladder that arrived first. As we round the corner, our strobe lights, LEDs, and wigwags bouncing off neighboring homes and business, the entire apartment complex parking lot is obscured by smoke. We pull into the thick of it, spotting on the hydrant in the parking lot. My brother gets out to take the hydrant and set the pump, while I assist the other firefighter hand stretching supply line to the ladder across from us. We’re done in less than 2 minutes.

I can hear the sirens from the mutual aid engine in the distance. Local PD had showed up, their blue lights mixing with our red. The smoke, still rolling out from under the eaves of the roof, stings my eyes a little. The pumps and diesel engines on the trucks are spun up, providing pressure on the hose lines. The complex residents are out in the parking lot in their pajamas, wrapped up in blankets, watching us go to work. It’s this whole feeling that I love about being a firefighter.

My backup firefighter and I have pulled a second line from the ladder and we’re kneeling at the bottom of the stairs leading up to the fire apartment. A resident reports that the neighbor across from the fire apartment isn’t outside yet and the Captain has told us to conduct a search. I’ve checked the nozzle on my line, and I’ve taken my helmet off to put on my SCBA mask. I’m giving instructions to my backup firefighter when I see the crew from the mutual aid engine come barreling up—and I do mean barreling up. I have never seen a group of people scream volunteer firefighter more than these six firemen that had just bumped their way up to me.

And sure enough, as my partner and I pick up the hose line to advance up the stairs, the mutual aid company barrels their way right up them. There are now six 250-pound fireman standing on a narrow apartment stairwell, blocking my access to conduct a search. While I’m frustrated at these guys, I also have a morbid desire to see the steps collapse underneath them.

I watch as one of the firemen tries the door handle to the apartment I’m supposed to search. Finding it locked, he brings up his ax to give it a blow and knock it open. But he stops short. There seems to be a conversation going on at the top of the stairs, something animated, but I can’t make it out. The ax is passed off to another firefighter, and again I see him ready to knock open the door. Again, he hesitates, stops, and conversation ensues. What the hell? I’m thinking.

“Just get the hell out of the way!” I shout up to them.

Now, all six firemen from the mutual aid company pile into the fire apartment, mind your there’s already three other firefighters operating a hoseline in there from the first in ladder company. I signal to my partner and we make our way up the stairs. Again, checking the door knob and finding it locked, I get ready to take the door. I crouch a little, bring my shoulder in, and give the door a good solid hit.

Boom! The whole door swings violently in, splinters of the doorframe scatter across the entryway. Immediately I drop to my knees as my partner comes right up behind me. “Fire department!” I shout. There’s no smoke though, so I get to my feet, only to meet the now very angry resident of the apartment.

Here I am in full fire turnouts, plugged into my SCBA, hoseline in hand, standing next to a 70 year old man in pajamas and slippers, yelling at me for breaking down his door. “What the hell do you think you’re doing?”

Oh darn. “Get your ass downstairs!” I hear from behind me, “all of you!” The Captain the followed the first hose team in, was shouting at my partner, the mutual aid company, and me.

Oh double darn. See, I had been told by command to conduct a search of the second floor apartment, that there was a report of the resident still inside. But, unbeknownst to my partner and I, the ladder company Captain had already made contact with the resident and made sure that he was okay. The resident had gone back to bed when I decided it would be a good idea to bash his door in.

I’m sure that it looked quite comical to those observing: myself looking confused and abashed, while being yelled at by an angry old man and a fire Captain.

So, angry old man, I do sincerely apologize for bashing in your door and ruining your night. But feel comforted that I did it in an effort to protect your life and property. I was just trying to do my job.

Aftermath

I drove by the house this morning on the way in to work.

I’d driven by the house before, my wife and I had walked the dogs past it before, and I’d admired the landscaping before. I think I wanted a different memory than that of the house burning and those kids in the street. Scene tape is up all around and the investigation is still underway, but things are calm now. I don’t talk about that morning to people. My wife and I don’t talk about it to each other. Other people don’t understand. I took my wife to see her podiatrist yesterday. He knew we were from Gearhart and eventually he had to ask, “so that plane crash was right where you live, huh?”

“Yeah, I was there. I don’t want to talk about it.” That was it. I don’t want to be rude to people, but I don’t want to share details either.

I’ll write about it though. I think it’s because I’m doing it on my own terms, no one is asking the questions. I’m able to share the details that I want to share and no one is pressing for anything else. That’s comforting to me.

*****

There has been some criticism towards our local dispatch center following the plane crash and I want to stand up for them. Our south county dispatch center fields 911 calls for 3 police departments and 4 fire departments. At the time of the accident, only one dispatcher was on shift, as usual for that time of morning.

Several local people have had concerns about unanswered 911 calls after the crash, or calls that took too long to answer. The single dispatcher fielded 32 911 calls in 4 and a half minutes. The initial fire dispatch occurred 18 seconds after the second 911 call was received (the second call provided a rough location, the first apparently did not).

Per protocol, the dispatcher toned the fire department and dispatched the alarm before fielding the additional incoming 911 calls. During this 4 and a half minute time frame, the dispatcher also managed to contact her dispatch supervisor at home to request assistance in the dispatch center.

I think our dispatcher should be applauded and commended for handling such a difficult event so professionally and efficiently.

*****

Trauma counselors from the county and Red Cross have been in the area the last few days to counsel the firemen, family, and community members. I was invited (as all responders were) to the initial counseling session Monday afternoon and all following sessions. I’ve attended trauma counseling sessions before and they’ve helped, but I think doing what I’m doing right now, writing about how I feel, does so much more for me.

Seeing my brother firefighters that morning, the sadness and solemness in their eyes, I’m so grateful to know that they are getting the counseling they need. I left the scene before the body recovery began—I had a busy morning ahead of me on shift, they needed me in at work. I know the guys that carried those three kids out, most of them have families, young kids of their own. I can see in their faces and hear in their voices how this is hurting them right now. I’m grateful to know that we’re taking care of our own right now.

*****

After I got on shift that morning, I transported one of the survivors from the hospital to the airport to meet an air ambulance crew. She was going to the Oregon Burn Center for specialized care.

The tragic irony didn’t escape me, though. The helicopters couldn’t land at the hospital because the weather conditions were too poor. Now, this little girl whose life had been changed forever, was now going to fly to Portland in the same conditions that may have contributed to her tragedy.

I was so saddened and bothered by that notion, and I could only wonder how she felt. Or if she was even in a state to understand what had happened and what was happening to her right then.

But I felt a sense of fulfillment from being able to help her, even in the small way of transporting her from one place to another. I felt like I had done something good that morning.

*****

I wrote before how I wished I had been wearing my turnouts that morning and not my white button down. I’m not sure that’s really true. I don’t envy the firemen that were there.

I don’t envy any of us. I am exceptionally proud of every one of them though. Every fireman there (with the exception of a handful of paid chief officers) were volunteers. And every fireman that helped to carry the last three children out volunteered to do it—volunteers of the volunteers. No one deserves my respect more right now.

The house after the fire had been knocked down.

*****

As I drove by this morning, neighbors had set their trash cans and recycling out. Others were out walking their dogs, coffee cups in hand. Traffic on Marion had increased, as you would expect. The house is such a tragically awesome site and a large memorial has developed: flowers, candles, and balloons all along the long stone wall.

I guess it’s a sense of curiosity that brings people to the house, to leave their memorials, the same sense of curiosity that drives people to ask “what was it like?” Sometimes I feel guilty about how my emotions surround the accident. I was in the shower when the explosion occurred, I wasn’t even sure what had happened. I was only on scene for 45 minutes, didn’t taken part in suppression or recovery operations. I only assisted briefly in patient care, helping to get them packaged and transported.

Sometimes it feels like I didn’t do enough, like I didn’t have an opportunity to do enough.

Decimation and Shock

A plane crashed into a beachfront home 4 blocks from my house this morning.

I was in the shower, getting ready for work when I felt something shake the house. Initially, I thought that Boomer had knocked something over upstairs—we have thin floors and walls and little things often sound very big. But Meghan began knocking on the bathroom door when I turned the shower off and I knew something wasn’t right.

“Was there an earthquake?” she asks.

“No, I don’t think so.”

“Well, I heard a loud bang, the house shook, and then I heard a lot of sirens.”

“Probably just a bad car wreck, then, “ I reply. We’re only a couple blocks from the highway, and right behind the Gearhart fire station. “Let me get dressed and I’ll turn the radio on.”

Half dressed in my uniform, hair still wet, and plodding out of the bathroom in my crocs, I turn my portable radio on.

“… 3148 responding to Gearhart.”

“48 from Command, come straight in to the scene. We’re gonna need your elevated stream.”

I’m a little disappointed at hearing this, I’m missing another fire because of work. “Just a big fire,” I tell my wife. “Probably some type of construction accident.” We’ve had those before, explosions, BLEVEs, and the rare natural gas leak gone boom. I tell her it’s no big deal, to go back to bed.

But I dress a little quicker now, I’m thinking I’ll swing by the fire station on the way into work and see how things are going. I’m half listening to the radio as I button up my uniform shirt. I start to hear third alarm units going on the air, engine and ladder companies coming in from the other side of the county.

Then I hear it—

“…Medcomm, Medic 4. Fire reports three burn patients. Requesting a second ambulance.”

Shit. I’m at high speed now, grabbing my boots, cell phone, work vest, and ball hat. I kiss my wife quickly and tell her I’m going to head up to the scene and lend a hand until the second unit arrives.

I drive two blocks west and park on Marion, out of the way of incoming fire and police vehicles. Three blocks down, I see flames shooting above the trees, grey-brown smoke rolling upwards, and what remains of a house, laying on its foundation.

I grab my stethoscope and head off at a dead sprint up the road. All of town is out here to see what’s going on: couples in pajamas, or early risers out walking their dogs. Police haven’t even set up a perimeter yet. I jog up to the command officer as firefighters are pulling lines around me. The ladder from 3148 is up and they’re getting ready to flow water on the flaming pile of debris.

“Joey, where do you need me?” He points another half block up where the Medic unit is parked. I see three people lying on the ground, covered up to the necks with blankets, with bystanders all around them. I see one of our company EMTs. “Who’s in charge?”

It’s one of our new paramedics that he points to, and she looks a little overwhelmed. “Michelle, what can I do to help you?” Right away she starts giving instructions. She plans on taking the first two patients—children—and the next arriving Medic unit can take the mother. She needs my help to get them packaged and loaded, but first she wants me to find out if the Air Ambulance was activated from Portland.

I phone dispatch, letting them know I’m on scene, and then check on the air unit. The dispatcher, a little ruffled sounding, copies that I’m on scene, but tells me she doesn’t know if the chopper's in the air. I let Michelle know and we begin to load our first patient, a young boy. His hair is singed, his legs are blistered, and his feet are cut. He tells me he had to jump from the roof.

He looked like the pictures from the text book: covered with soot, with blackened hair, and lips that were just starting to puff. But he was amazingly calm. He followed our directions, said please when he asked us for something and followed that with thank you. He was concerned about his family and my heart was going out to him. I sat with him while the cot was readied. I introduced myself, talked to him a little bit, tried to offer a comforting, older brother kind of smile. And when we loaded him into the unit and I told him that Michelle would take care of him, he almost cried. “You’re not coming with me?”

“No, I can’t. There’s others I need to help. But Michelle will take good care of you, I promise.”

Behind me, and all around me, more fire units are arriving on scene. An additional ladder company from further south, additional engines from north county. Additional chief units are also arriving and they start coordinating defensive operations. The primary house is destroyed, collapsed to its foundation, with heavy fire rolling from the debris pile. The fire has partially engulfed the neighboring homes, and the chiefs set to work on the exposure protection.

Above all of this though, I hear a father yelling, “there’s still three kids inside!” He’s standing over Michelle and I and the young boy. He’s crying, tearing at his hair, hysterical, and I feel for him. He was staying in another house, further down the block when the explosion occurred. He has no idea what’s going on, he’s only concerned about his family.

The scene is a mess. Neighbors had been the ones to render first aid to the three patients, getting them to lie down then covering them with cool blankets and bath towels. The neighbors stayed with each patient until they were loaded into each of the ambulances.

Our second Medic unit arrived, as well as the OppsChief. The MCI protocol was activated, in some ways because he was expecting three more patients. I helped to get Michelle loaded with the second child, then gave them the best directions to get themselves out of the scene that was quickly bogging down with fire apparatus. The second medic unit had their patient loaded and was pulling around now, too. The OppsChief wanted me to stay on scene with him, at least until a third unit arrived to provide standby coverage.

Scene tape was going up now as the Sherrifs worked to control and move the crowds back. The OppsChief and I turned our backs to them and walked towards the command post. I took the time now to really study the scene. Something big had happened here, enough to literally blow the house apart. Glass had been blown into and across the street. The roof of the garage, still completely intact, had been blown up, then landed upright. Walls had been blown out, and debris piled the center of the house. The back side of the house was obscured by smoke and steam.

I watched the firefighters work hoselines through the debris pile. The ladder pipe was raining down a gentle fog. Steam was billowing out through the burned out home next door. I listed to the radio chatter as additional companies arrived and received assignments or were told to stage. Trauma Intervention Counselors were requested to the scene for the family members. I was watching all of this, wishing I was in my fire turnouts, not by white button down, when I heard the OppsChief ask, “so the plane came in from the west?”

I interrupt. “Wait, what plane?”

The command officer looks at me, dumbfounded like I should already know this. “A plane crashed right into the house.”

Holy shit. I was shocked and in disbelief. A plane? I couldn’t figure out how this was possible. It had come in from the west, over the beach, and that didn’t make any sense. This was the only house hit in the impact, and that didn’t make any sense either.

Bystanders had reported seeing the plane come in very low, strike a tree, then crash into the house. A secondary explosion, the one the shook my house, occurred just moments after the initial impact. Upon really inspecting the scene, a plane door was leaning against a tree in the front yard.

Oh my god. Three kids are dead, and three more are critical because a plane crashed into their house.

The house was decimated like nothing I’d ever seen before. And as I looked around at the firemen on scene, really looked at them, I could see the same look of shock, horror, frustration, and sadness that I knew was on my face. Three kids dead in an instant from a plane that had crashed into their house.

*****

I still had to go into work and the OppsChief cleared me from the scene as the third medic unit arrived. I went home, hugged and kissed my wife, cuddled my dog for a few minutes, then grabbed my day bag and headed out the door. It was going to be a busy morning.

My first assignment coming on shift was to transport one of the burn patients from the trauma hospital to the air station, and transfer them to an air ambulance crew for her trip to the burn center.

Both children had been taken to the same hospital and both were in relatively the same condition. They both had extensive first and second degree burns, both had been sedated and intubated in the ER (to protect their airways and provide for their comfort). My patient, whom I’d seen at the scene, looked far worse than when I’d last seen her. Blisters had formed all over her face, and her skin was starting to swell. Patches on her arms were sloughing off and we had to be careful as we moved her. She was transferred to my gurney, then quickly transported to the air station where the helicopter crew was waiting for us.

We turned the patient over, then returned to the ER where the nurses there told us what a fantastic job that our crews did. All the typical high-fiving and back slapping that goes on after a “good call.” But I can’t get the image of the kids’ faces out of my mind. I just can’t believe how destroyed this family is now, how such a freak accident has decimated their lives. All I want to do right now is go home and hug my wife.

*****

This was written the evening following these events (8/4/08), however I could not post this until today. Numerous news stations covered the accident and a report can be found here.

Back to Testing

I took the firefigher/paramedic test for Big Valley Fire Department yesterday and I'm feeling pretty good about it. It was the FireTEAM video test by ErgoMetrics which is a terrible test to take. Very long and very cheesy. I have been on a test-taking hiatus since I got my medic last year, so I'm a little rusty at the whole testing taking process. But I'm pretty hopeful as Big Valley is giving paramedic preference this year--a first for them. I've also taken the FireTEAM test before, so I knew what I was getting into. I'll find out in mid-August how I did. Fingers crossed.