WAR STORIES

NEW!

Here are the Good, the Bad, and the Ugly of Fire/Rescue and EMS.

You can submit your stories (credited to you or anonymous) to me at: webmaster@fyremedic.com

ENJOY!

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The Twinkie Lady

I was working for a large, BLS-level 911 provider in another state when this incident occurred. 

We were eating lunch one afternoon , when we were dispatched with our primary Medic unit to a report of respiratory distress.  The first-due ambulance and the medic unit arrived on scene and promptly requested a 2nd unit and the duty EMS Supervisor for manpower.  "Great, there goes lunch", I said to no one in particular. When we arrived at the location and entered the house, the first thing that caught my eye was a tipped-over wheelchair... the size of a LOVESEAT!  I then noticed the other crews standing at the entrance to the living room. I walked over to them and found our patient:

56 y/o female, grossly obese, in moderate to severe respiratory distress with audible wheezing, rales, and rhonchi heard over all lung fields.  Patient was severely hypertensive, with tachycardia, and tachypnea.  Patient was on oxygen via non-rebreather mask, and the Medics had applied the heart monitor, initiated an IV, and were preparing to initiate pharmacological support..

We tried to lift the patient to the stretcher without moving her one inch.  An engine company was requested, and arrived with the borough Assistant Chief in tow.  We now had 12 people on scene, and we STILL could not move the patient.  The Chief requested the Rescue for manpower.  When they arrived, we now had 17 personnel on scene.  We finally were able to log-roll the patient onto a pair of doubled-over salvage covers.  We then took the sides and corners of the tarps, dragging the patient across the floor to the front doors of the house.  Luckily, the house was an old Victorian with double front doors.  We then dragged the patient to the edge of the porch where the rail was broken, and we had backed up the unit.  We pulled the stretcher mounts and the stretcher and dragged the patient into the back of the unit.  The truck was a 4wd, 1-ton GMC Type I, and the patient bottomed the truck out!  The medic laid on the bench with his LP5, and our EMT stood in the side step well.

As we transported, scraping tires the entire way, worrying about setting something on fire every time we hit a bump, we presented a silly-looking parade of 2 ambulances, 2 fire trucks and 2 Suburbans, creeping along at 10mph.  When we arrived at the hospital, we had to take 3 lengths of rescue rope to lash 2 hospital gurneys together to accommodate the patient.  We placed her in a room, gave our respective reports, stepped away and searched frantically for the Advil.

The nurse was assessing the patient and setting up the monitors, when the patient asked "Could I please have something to eat, I haven't ate since this morning being stuck on the floor...".  The nurse advised her that she couldn't have any food until she was stable, and the Doctor said it was okay.  The patient seemed to agree, but every 5 minutes or so she'd ask the same question again.  Finally, after 15 or 20 minutes of the same exchange, the nurse blurted out: "FINE! You can have something to eat!"  The patient promptly thanked the nurse, moved what may have been a roll of fat (Breast?  Arm?), pulled out a flattened 2-pack of Twinkies, and devoured them with GUSTO!  This happened in 1989, and I haven't had a Twinkie since!

Author's name withheld by request

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An Inferno on Highway 290 West

(The following is one of my own worst calls)

We were dispatched to a major accident west of town. As we responded, we were informed it was a head-on with both vehicles fully involved in fire, and with people trapped. Upon arrival I established command, advised that the vehicles were burning, and began searching for patients. Two bystanders had pulled a 6-year-old male from one vehicle, who was being attended to by a nurse who had stopped. The car he was in had been pinned against the guardrail by a Suburban coming eastbound that had crossed the line without warning. The driver of the Suburban was pinned in the wreckage, dead in the burning vehicle. The parents of the boy, and his baby sister were trapped in the burning car, all of them also dead. the 2 men that saved the boy said nobody except the boy was moving when they got to the car. They tried to save to baby also, but were driven back by the increasing flames. The fire department arrived expeditiously, and knocked down the fire rapidly, but despite their heroic efforts it was too late for the victims.

I established contact with the patient, and found him to have large areas of second- and third degree burns to his face, arms, legs and chest. He was in considerable pain, but was able to speak and follow commands. We applied spinal stabilization, performed a thorough assessment, applied burn dressings, administered high-flow oxygen, initiated an IV infusion, and prepared the patient for transport. The patient was turned over to the StarFlight helicopter from Austin, and eventually ended up at the burn unit at Brooke Army Medical Center in San Antonio. The boy survived, and at last contact was doing well, adjusting to the loss of his family as best as could be expected.

It took nearly 3 hours to extricate the bodies of the deceased.

Barry E. McClung, EMT-P / Crew Chief, North Blanco County EMS

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Aircraft Down

(Note: This one may be a little unpleasant for the squeamish)

I work on small general aviation aircraft for a living when I'm not at the EMS station. I am a Private Pilot, Airframe & Power Plant Mechanic, and I hold an Inspector Authorization certificate through the FAA.

In April of 1999 a Cessna 182 went down in our territory. The plane went down in IFR weather conditions while being flown by a pilot who was not instrument rated. He apparently just flew the aircraft straight into the ground. I was on EMS duty the night of the crash, and I was one of the first people on the scene. It was the nastiest traumatic injury I had ever witnessed upon a human being. His body was lying about 10 feet from the main wreckage. His hips, knees, and ankles were all distorted, twisted, and obviously dislocated or fractured. He was a large man judging form the size of his torso, probably weighing 250lbs. But with all the trauma he now only looked about 4 feet tall. When we rolled him over to see his face, in order to see if we had anything to work with, he had a hole in his face large enough to put your fist through. The hole was where his left eye should have been, and his skull was virtually empty. The plane had hit a tree at full speed, 150mph by my guess, and skidded about 300 feet before it came to an abrupt stop in a 4 foot deep hole big enough to fit the entire fuselage in. When it slammed into the hole, the energy remaining hurled the Continental O-470 engine another 300 feet in a line straight from the fuselage. I found the motor within 30 minutes of the crash being called in, and it was still smoking hot! When the aircraft slammed to a stop in the pit, it exploded and a large mushroom cloud of fire filled the night sky. The body of the pilot was not burned. By judging the wreckage, I think he was sucked out the bottom of the plane and drug along most of the 300 feet. This would explain the massive extremity trauma. As for his face, I think he must have hit it on something like the instrument panel or the yoke to cause a fracture, and then being dragged and thrown would account for the evacuation of the cranial contents.

The ironic part of this story is that I worked on that particular airframe several months before the crash. I performed some routine radio maintenance on it... I just didn't realize it the night of the crash.

Mike Pippen, EMT-P / Crew Chief, Blanco Volunteer Ambulance Corps

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An Angel Goes Home

So many people take life for granted. We get up every morning, get ready for work or play, and never take time to tell our loved ones how much they mean to us. I'd like to share with you this 34-year-old EMT/Mom's Sunday off.

Telephone rings early Sunday morning, waking up the whole house. We've been invited to Granny's for a barbecue, great family fun. I'm a little tired, thinking about the eventful week with the EMS: several successful runs in three days makes you feel good inside. Later at Granny's, kids are eating, playing, fighting - you know, kid stuff.

We're all sitting around outside talking when a page for assistance comes over the radio: a possible drowning at the State park. "Oh my goodness!" is all we say. We all listen as the voice on the radio talks on. My heart is really racing by now; we know it is a 9-year-old girl. My heart goes out to the parents of this child. The ambulance is toned out along with everyone else. Divers are coming in from out of town to help search. I'm really getting antsy, thinking, "What can I do?"

So my sister and I leave our families behind at Granny's. As we pull out in traffic, we hear over the radio that they've found the little girl. EMS is working on her. Our hearts race, minds flying: please let her be okay. When we pull up to the park, people are standing around watching. We try to make our way in to help: "EMS personnel, please let us by." As the crowd parts way, there is the scene: mother sitting on the ground trying to reach in to touch her child. The father is looking on, watching over the medics working on his little girl.

Not a word is spoken as the medics work. Then the paramedic calls it: "It's too late." I reach down and ask the woman, "Are you the mother?" She turns to me and answers, "Yes, I am." The father cannot believe what he has just heard. He pushes his way to the ground and with loving hands picks up his little girl. Calling out her name, he begs God to please bring her back.

By this time, the EMS crew has stepped back. The mother has crawled to the side of her husband and little girl. Taking the child and weeping in silence, the mother cradles her lifeless little girl. I turn to the paramedic and ask if we can put them in the ambulance. He says they are getting the stretcher now. I take off toward the ambulance to see if I can help.

I get the stretcher ready. I look up to see my sister gently carrying this little girl, trying to make it to the stretcher. I'm on the other side, my arms reaching out to help. "Turn her around", I say. I take her in my arms, laying her down oh so easy, fixing her straight, covering her. The father runs over and refuses to cover his daughter's face, praying the whole time.

I crawl inside the ambulance, throw the side door open, and guide the stretcher in place. My sister asks what else she can do. The father looks up at her with tears in his eyes, "Please, could you get my vehicle and my other children and take care of them?" Off she goes, leaving me to do what I can.

The mother is sitting so quiet, trying to wipe off the mud and gravel from her daughter's face. I just stand there and watch in disbelief. I snap out of it, get a washcloth and some water and begin cleaning up the little girl's face. People come and pray over her and my heart hurts for them. I try very hard not to show any emotions, but it overcomes my professionalism. I am crying and asking God to please help this family. I know she is gone, but in my heart, there is still hope for a miracle.

The funeral home personnel arrive. I keep telling myself that I don't even know these people. The back doors of the ambulance open. I bend down and tell the mother, "It's time". The father becomes angry. "I'm sorry", is all I can say, wiping the tears from my face.

They pull the stretcher out of the ambulance, but I just cannot make myself let go. I try my best to help them load her onto the other stretcher. I turn quickly to get away, but find the EMS stretcher needs to be put back. I hurry along, wanting to leave. But I forget my radio back in the ambulance, so I have to go back.

My sister, seeing my condition, asks if I'm okay. I tell her I'm going to the car, and I try my best not to have a panic attack. I start to feel sick at my stomach. In the car, I start crying harder than I can ever remember crying. My sister comes to check on me. She tells the paramedic and he comes to give me comforting words. But my job is not finished. I have one more thing to do.

I pull myself together as best as I can. I get out of the car, make my way over to the family, and wait for the right time. The mother turns to thank me and I reach out and hug her. She is so grateful they found her daughter's body. I whisper in her ear, "She's an angel". She says, "Yes, she was". I say, "No, ma'am, she is".

Ruthie Weirich, EMT,  Blanco County, Texas

This article was previously published in the January/February 1998 issue of the Texas EMS Magazine.

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Squadrols - Precursor to Paramedics, But Hold on to Your Wallet .

"What has been is what will be, and what has been done is what will be done; and there is nothing new under the sun."  Ecclesiastes 1:9

Ambulances have always been an integral element in emergency medicine.  After all, they deliver most of the seriously injured and sick to the emergency room.  Ambulance crews are usually first on the scene at accidents, heart attacks, and other major medical emergencies and their actions can mean the difference between life and death.  The primary objective of ambulances has always been to transport the sick and injured as quickly and safely as possible to an emergency room to obtain higher-level treatment.

When I arrived at Cook County Hospital in 1965, I was surprised to learn that most trauma patients were not brought there by ambulances but in "squadrols."  The Chicago police operated these blue and white pickup trucks with camper bodies on the back.  Two gurneys (portable stretchers) in the back of each pickup, one on each side, provided a crude stretcher for carrying patients while the blue lights flashed overhead and the siren wailed.  I am not sure where the name came from, but imagine it had something to do with rescue squads or squadrons and the mission of "rolling" victims to the hospital.  It was essential that the county operate squadrols because private ambulances were in business for profit and very few patients brought to Cook County could afford to pay for transportation.  Squadrols were dispatched directly to accidents, stabbings, shootings, or anywhere a policeman found a sick or injured person.  They were stationed in most of the police precincts around the city, so they usually arrived quickly at emergency scenes.

Unlike today's paramedics, who take vital signs, start IV fluids, and apply braces and splints before transporting injured patients, the operational directive of the squadrol was "scoop and run."  The victim was quickly loaded onto the gurney, it was locked into the back of the squadrol, and the police officer then ran around to the front and drove as fast as he could to Cook County Hospital with his lights flashing and the siren blaring.  There was no one in the back with the patient.  The theory was, if the patient made it to Cook County Hospital alive, he or she had a good chance to survive.  If he died en route, he had a lethal injury or illness and could not have been saved anyway.  Anything delaying getting patients to Cook County jeopardized their chances for survival.  When victims arrived at the emergency entrance, hospital personnel grabbed them out of the back of the squadrol with the policeman's help, and in seconds a team of trauma experts would be all over them initiating treatment.

This system allowed patients to be transported to the hospital in the shortest time and gave our trauma personnel their best shot at saving their lives.  All squadrol patients were brought to Cook County Hospital, so there was no need to stabilize them at other hospitals and transfer them later to our facility.

One interesting phenomenon I soon noticed was that none of the unconscious patients ever arrived wearing rings, watches, or jewelry of any kind, nor did they usually carry wallets, which made it extremely difficult to identify them.  If they did have wallets, there wasn't any money in them.  Over the years, I systematically looked for exceptions to the vanishing-valuables phenomenon but never found any.  Patients who arrived semi-conscious related stories of wrestling with drivers trying to keep their rings, watches, and wallets.  During these "scoop and run" operations, the opportunistic county employees had enough time to strip patients of all of their possessions, taking full advantage of one of the fringe benefits of being a squadrol driver.  There was never a shortage of squadrol drivers, even though their job was dangerous.  They had to go into the worst neighborhoods in the worse conditions and often their patients were violent, drunk, high on drugs, and armed with knives and guns.  Many patients had to be handcuffed to gurneys before they could be transported.  Apparently, for Cook County's finest, the material benefits of driving a squadrol outweighed those risks.

In the late sixties, I witnessed the birth of the modern Emergency Medical Service (EMS) System.  Cook County's EMS grew out of a comprehensive plan to decrease the city's mortality rate from severe trauma.  It included a 24-hour-a-day trauma team that was standing by in the hospital as well as pre-hospital transportation.  The concept superseded the squadrols with large ambulances fully equipped like mobile intensive care units.

Instead of scooping the patient, throwing him in the back of a pickup truck and racing to the hospital, these ambulance crews were trained paramedics.  They were proficient in splinting fractures, starting intravenous fluids, stopping hemorrhages, and even intubating patients on the scene.  Since they were the first on the scene, the idea was that their treatment could often precede what was provided at Cook County by 10 to 20 minutes.

They could also carry out CPR (cardio-pulmonary resuscitation) with closed chest massage en route to the hospital, since there would always be a paramedic in back with the patient instead of just a driver, as in the case of the squadrols.  These paramedics were in radio contact with the hospital and could consult emergency doctors about treatment.  Trained paramedics and EMS units became extensions of the emergency room.

This pioneering effort in the late sixties included helicopter transport from scenes of accidents where heavy traffic might delay transporting patients to the emergency room.  Our heliport was right across from the hospital next to The Greek's.  This EMS operation, first used at Cook County and other large city hospitals, became so successful it was adopted nationwide under a standardized, federally funded EMS.  Most communities in the United States today benefit greatly from having EMS.

Even though the modern EMS with its paramedics seems to be a quantum leap from the squadrol, early studies cast some doubts on this advanced system and a new look is being taken at the once out-dated "scoop and run" squadrols.  The doubts arose from a physiological fact called "the Golden Hour."  From the moment serious trauma and massive blood loss begins, only about one hour can elapse before permanent damage occurs to various vital body systems and organs like the kidneys, liver, heart, brain, and so on.  If severely traumatized patients can be taken to surgery before the end of the Golden Hour, their bleeding arrested, fresh blood transfused, and repairs made, their chance of survival is greatly enhanced.

Unfortunately, paramedics with their advanced techniques and sophisticated equipment often spend 30 to 45 minutes at an accident scene taking blood pressure, applying splints, starting IVs, placing MAST trousers, and calling the hospital for instructions.  Consequently, by the time they reach the hospital, many EMS patients have passed the Golden Hour and cannot be saved.

Recent studies have shown that sometimes intravenous fluids started by the paramedics actually interfere with the body's ability to withstand shock by increasing blood pressure and blowing off clots that had previously sealed wounds, causing renewed hemorrhaging and a deterioration in the patient's condition.  As a result of these studies, ER doctors and other professionals who are the opinion-leaders in this specialty have recently given serious consideration to reinstating the old "scoop and run" technique popularized by squadrols of the fifties and sixties in Chicago in order to decrease mortality.  The squadrol philosophy of "throwing the patient in the back of the truck and driving like hell to the hospital because if we can get them there alive, they'll probably survive" turns out to have been a valid concept.

Of course, no rational person would advocate going back to policeman driving pickup trucks, but a combination of the modern ambulance (using simple splinting on the scene and stabilization en route) with the speed of the old squadrols appears to offer optimal results.  This is especially true if transport time from an accident site to the trauma center is under 30 minutes.  For longer trips, stabilization at the scene is still a better choice.

Larry Miller, MD / Medical Director, Blanco Volunteer Ambulance Corps

From His Book "Never Get Sick on the First of July ", By Larry Miller MD; Copyright 1992

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A LITTLE SHORT

Bear in mind that the only difference between an Fairy Tales and a War Story is that a fairy tale begins with "once upon a time...", and a War Story begins with: "Listen up, this is no $#&!..."

Anyway, some moons ago, when I was employed by a metropolitan county-wide EMS system, my partners and I responded to a one-vehicle collision out in the corner of the county.

'Twas the middle of the afternoon, broad daylight, on a weekday.  We arrived a good while after the volunteer first responder unit, since we had responded from the city.  The volunteers had everything under control pretty well:  single vehicle, restrained driver, no evidence of drug or alcohol use, adamantly refusing examination, treatment, and/or transportation.  Signed refusal.  Poor radio coverage in that particular area, so we were unable to hear their cancellation. Doo-Dah, Doo-Dah...

Well, since we were already here, we might as well investigate this incident a little (read:  rubberneck a little).

The driver was a 40-something lady who had dropped her soda while on a winding section of a rural Farm to Market Road.  She glanced away from the road for a moment to recover the drink, and while she wasn't looking, the road assumed a divergent path from her vehicle (a full-sized van). She left the road to the right, proceeded through a bar ditch, barbed-wire fence, up a hill (mowing down cedar trees the entire way), and curved back around toward the road.  Down the hill we go, through the fence again, crossing the same ditch, across all four lanes of the road (without hitting another car!), through the other bar ditch, barbed-wire fence, up the other hill, and finally came to a stop.

The damage to the vehicle was probably repaired with some rubbing compound, touch-up paint and elbow grease.

The patient was conscious and alert, skin warm, dry and pink, talking and making sense, no apparent trauma and ambulatory on scene after having self-extricated from the vehicle.

Her only compliant was that she "felt short".

Now, picture the scene:  A bunch of 6-foot-plus firefighters, paramedics, and cops wandering around the scene. One 4-foot-nothing signed-refusal patient who says she "feels short".  We're all looking at her, looking at each other, and each of us is thinking "Lady, you ARE short!".

Well, I'm getting evaluated on that call, so I decide to try to get this lady to go to the hospital with us.  I pointed out to her that the wrecker had not yet arrived, my ambulance is air conditioned, and it's 147 degrees out here; why don't you let us run you down to the hospital and get you checked out?  Nice, easy ride, no needles, talk to the Doc, husband meets you at the hospital, and you're on your way home in a couple of hours, having already been checked out by the Doc.  Your insurance will probably cover the whole affair.

"OK", says the short lady who feels short.  "That sounds like a good plan.  Let's do that."

Textbook standing takedown to a board with appropriately sized cervical collar, head blocks, tape, straps, appropriate padding around the voids (remember, I'm being evaluated on this patient...), and 10 minutes later we're off to the hospital, which is 45 minutes away.

On the way to the horse-pistol, she starts complaining of a little mid- to lower back pain.  I explain to her that it's not uncommon for our patients to have similar complaints, since we have her strapped to a sheet of plywood and our truck isn't the smoothest riding vehicle on the road.  Probably nothing to worry about.  She is placated.  Vital signs are stable and WNL, uneventful ride to the hospital with frequent timely patient reassessment, etc., and we drop her off.

A few hours later, we drop another patient off at the same hospital and we notice that the lady's name in still on the "leader board" in the ER.  My partner asked why she's still in the ER.

Compression fractures of 3 thoracic vertebrae.  Due in part to our superb pre-hospital medical skills, but mostly (in my humble opinion) due to blind luck, the patient suffered no lasting consequences from her injuries.

No wonder she "felt short".

Thus endeth the War Story.  I'll leave you to draw your own lessons from my experience.

Author's name withheld by request

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FLOOD!

Lots of flood stories from up here... this is my personal best. 

I could relay others from the heavy rescue crews in my department, but they just wouldn't have the same effect.

Of our in-service ambulances (including all ready reserve trucks), over half of them were assisting in evacuating critical patients from a flooding nursing home. We, on the other hand, were farthest away from that incident and started picking up all the 911 medical calls (not water evacuations, which were handled by engines and boosters).

Of those, we were sent (in the middle of the flooding) to an imminent birth call. We could not get off the main street, as it had 4" of water flowing across it, so we had to grab what gear we'd need (blue bag, OB kit, oxygen tote, monitor, extra gloves) and tread in on foot. Water in the subdivision streets was at chest depth (no current), and it was 3/8 mile back in the subdivision. The patient was in fact in labor (for the second time on her first child, pre-term by about 6 weeks). I spoke with her OB/GYN on the phone and discussed her labor vs. false labor, and her OB/GYN was of the belief that this could in fact be real as she fully expected the delivery to be pre-term from her other prenatal assessments. So, we knew it was coming, but probably not soon (at least an hour away, water hadn't broken, but might not if it was pre-term).

So, we went looking for options. Neighbors in the street were polled, and we obtained a queen size air mattress and 100 feet of small diameter rope. We rigged the air mattress with tie handles around the corners, secured it cross-wise under the mattress for stability (and to prevent the rope from slipping) and gathered two neighbors to assist us in floating the patient back to the ambulance. We placed her on the air mattress, began floating and waded back through the chest deep water to the unit (with our gear). Loaded her up, headed for the hospital (with lights for safety, but not able to do anything more than 15 miles an hour, pushing water 6-8" deep ahead of us in waves.

That's my story...

Michael W. Reed, LP

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SCOTTY'S INSIGHTS

The following are NOT war stories, but poems by a dear friend which are heartfelt and hit very close to the feelings many of us feel every time we don our uniforms.  Thanks, Scotty.

“Before My Eyes”

by Scotty Bolleter

 thoughts on patients who never said a word or had the opportunity to fly

I’ve seen life pass before my eyes

Not my own but others

Through unforgiving demise

This work I’ve done has changed me so

How much how deep

I’m not even sure I know

But there is one certainty

For which I pray you will find

It’s that you capture each moment

Don’t be frivolous with time

Nothing lasts forever

Least of all this life

But while you’re here make the most

Open your heart, choose right

You see I know what others wanted

Those who now cannot say

It was to love for one more minute

To fully live one last day

So take these words

Hold them close to your heart

Because when it matters most

It will be too late to start

"and under his wing you shall find refuge" Psalms 91:4

“Between”

by Scotty Bolleter

for all those who do this work and “feel the anger with no tears”

We stand between you and your fear

Making it possible for you to turn away

Continuing to work as you draw near

We walk between you and your pain

That which spills on the sidewalk

And even that which will never stain

We work between you and the unthinkable

The twisted metal and fractured minds

Nothing ever left to chance

No one here left behind

So make your way into this day or night

But understand it’s no game

We came here for life

You see, this work we do you can’t live without

But I’ve no real way to explain it

Until there is no doubt

But then you’ll know

Or perhaps you won’t

But in the end we’ll still be standing

Where others don’t

Scotty Bolleter is a veteran Flight Paramedic for San Antonio AirLife and an instructor.  He is a nationally recognized speaker, and he is constantly in demand to speak at events and conferences.  Scotty can be reached at: sbolleter@aol.com

These poems have been reprinted with permission of the author

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