Friday, March 30, 2007

SHAKING WIRES/SAVING LIVES

What's up everybody? Despite my never-ending requests for written comments on the blog, I haven't received many. I have enjoyed it when people come up to me and say that they have read and enjoyed the blog. Keep coming to see me in person, but leave a note here also.

OK- Check out my two new links. Death Clock will actually brighten your day. DHMO is an ongoing threat to the world, and you can make your own assessment of what should be done.

Now for the new story. I wrote in the last post about my old friend Scott, whom I referred to as the greatest medic I have ever seen. I thought of two quick stories that illustrate just how much things have changed. Both of these mini-stories involve an obsolete communication device and one medic's manipulation of wires on the device to achieve his patient treatment goals. (N.B.: In my maturity, I have come to realize that some of this stuff was pure chutzpah/hubris/balls on the part of the medic, rather than medical magic or even sound medical practice, but these are cool stories anyway- You medics just keep quiet)

Quick poll among EMS providers: Who among you knows what a "bedside portable" is? Back in the day, this was a radio telemetry unit that allowed for communication with the hospital via a handy-talkie handset, and it also had a transmitter for ECG info. They were used for field communication with the hospital. It was about 12 inches wide, 5 inches high, and 2 feet long. These units have long been replaced by cell phones and other means for transmitting data. In the WWW, the bedside portable was always a dicey means of communication, and Scott used that to his full advantage...

Example Number 1 (1989): Called out for CPR in progress, I-95, on the shoulder, at about 0200. Arrived on scene to find a 40 Y.O. biker dude in full arrest, and an upset State Trooper taking his best stab at CPR. Down time is reported to be less than five minutes on our arrival. Scott and his partner, Lee (who may be the #2 or #3 medic ever- also a Navy Corpsman) go to work on the guy. They shock him. They get their lines going. They do some drugs. They look at the monitor and go "hmm." Cars whiz by. They keep saying that they ought to be able to save him. Time to call the hospital. They break out the bedside portable. Lee calls the hospital. The situation is explained over the radio. The hospital asks for telemetry of the ECG. Scott and Lee discuss the situation. They are both sure that they can get the victim back, but they have exhausted their defibrillation protocols. The monitor shows a flatline, and they want to shock him again. More shocks are contraindicated and beyond permitted protocol. Despite a total flatline, Scott winks at Lee, picks up the ECG wires and shakes them rapidly. Lee transmits the ECG, which the hospital interprets as "ventricular fibrillation". Scott asks for authorization to deliver more defibrillations, and that authorization is granted. The next set of defibrillation actually converts the guy. Biker dude gets to hospital with a pulse and survives. No shit, this actually happened. I have witnesses.

Example Number 2 (1989 0r 1990): Called out for auto accident with extrication. I-95 in the median, car into tree. Engine arrives first and finds the driver, crushed in the car and very gravely injured, but alive. Rather than wait for hydraulic rescue tools, our friend Billy uses what the kids call "retard strength" to pry the door off the car with a halligan bar and then drag the guy out. Our boy the victim is all fucked up. The short list of his injuries is: bilateral femurs, one open; bilateral wrists, both open; head injuries, open and closed evident; chest is visibly not right; jaw smashed. Prominent "U.S.M.C." tattoos all over his arms. "Scott the Doc" goes to work on him. Start with airway. Scott hands me a bag mask and has me go to work on breathing for the guy, whose respirations are trailing off. It is not easy going with the BVM, because of throat/neck/jaw trauma. Soon thereafter, the victim stops bleeding. He loses pulse. In a burst of EMS work like none I have seen (before or since), Scott gets two huge lines going, gets some drugs on, and gets a pulse back. The stuff coming out of the wounds starts to look like Kool-Aid. Not good. Not much blood left in there. Scott goes to intubate, but can't see anything because of too much trauma. Another medic breaks out the bedside portable and hands the handset to Scott. Scott quickly explains to our Operational Medical Director (yes, the boss of EMS) that he has a restart on the guy's heart, but in the absence of decent airway, he's going to die. They have some argument, of which I only hear Scott's side. Scott actively plays with the wire connection where the phone connects to the box. Scott tosses the handset to his partner, complaining that he can't spare the hand to talk on the phone, plus it's "all static anyway". Scott is looking down on his work while firmly and loudly telling his partner that he is not going to sit by and let the guy die because of no airway. His partner looks up from the phone handset and says: "The doctor says to do what you have to do to get an airway". Scott, a second's hesitation and without looking up from the victim's face, points to the ambulance and says: "Somebody get me an OB kit". Sure everyone was confused by this, but it came in a matter of seconds. Scott didn't want a bulb syringe or a chux, he wanted that big, fat, scalpel that was in the kit. He popped off the safety guard, felt around the victim's throat for a second, and deftly cut a big hole in the guy's neck. He put two fingers in the hole, felt around, said "OOOH RAH!", and then slid the endotracheal tube between his fingers into the guy's trachea. I was knocked out. A surgical chric in the field was (and is) so far off the protocol ranch that it is not to be believed. I slapped the BVM on the tube, and lo and behold, beautiful chest rise and effortless ventilation. Time to go to the hospital. (No helicopters, bad weather). By the time we get out of the ditch, on the cot and into the ambulance, the easy ventilation has ended, and the victim has clearly paradoxical breathing. He lived for a while, but ultimately died. One must have some red blood cells to transmit oxygen to tissue in order to survive. This guy was circulating Ringers Lactate or D5W or whatever. The massive breach of protocol was ultimately resolved in favor of Scott was a Corpsman, his duty is to treat Marines, and that is what he was doing when he cut the guy's throat. On that basis, our OMD was willing to overlook the entire incident. It was helpful that the procedure was perfectly done, despite adverse field conditions. Again, no shit. I have witnesses.

Two stories where Scott manipulated wires to cheat the system and actually preserved life. Don't try to trace this back, the names have been changed to protect the heroic.

Go to the links, leave a comment, come see me. Peace and be safe....

DTXMATT12

Saturday, March 24, 2007

FISHING WITH SCHMOES- The Best Day Ever, Part II

The quick among you will have noted that there has not been a "Part I" to this post. As I wrote before, I can't really tell the first part of this story just yet. I made the executive decision to write the second part first, just so I can get it on paper.

Last August, I was pulling a family-free weekend, and I had made arrangements to meet with my brother, whom we shall call "J", and our very good friend, whom we shall call "Larry" to go fishing on Saturday. I had also made arrangements to ride along with the narcotics team from my primary law enforcement agency on Friday night. Riding with the narcs turned into one of life's great adventures, which is "Part I" of the story. Suffice it to say, we saw a bunch of interesting stuff, made a couple of really cool tactical arrests, travelled many miles in a great hurry, watched a SWAT team (not ours) work, and found kilos of cocaine. A great night of law enforcement by any standard. But it took all night...

So I called J on his cell phone and told him that I had been up all night, that I wasn't going home, and that I would meet him at the pre-designated rally point at a convenience store on the way to the fishing grounds. J and Larry were already there when I got there, and they immediately started into breaking my chops over being late and being bleary-eyed. I relayed to them a story of great adventure, which had just happened. Larry used to be a cop, so he was seemingly impressed. J was more interested in getting to the fishing. I had to agree. We loaded up in our cars and headed out to the chosen spot.

J and I, being brothers, have fished together for our entire lives. Larry has been going with us for about 20 years. We used to go fishing almost every weekend. Back in the day, someone was always able to cook up some scheme to find the fish, and we would execute someones scheme on either Friday, Saturday, or Sunday. Maybe all three. We were WAY into fishing. Some might describe it as "pathology". We tied our own flies. We cast our own lead weight parts. We had our reels lined at the fishing store to get better spools. "Must See TV" meant 6 regularly scheduled fishing shows. Larry started pouring his own rubber worms. Fishing occupied most of our free time, if not literally, then in time spent thinking about fishing or doing things in support of fishing.

These things having been said, we are not now, and have never been, those fancy-schmancy types of fishermen. To describe our style of fishing, we coined the term "Fishing Schmoes". A schmoe is to be contrasted with the guy on a speckle-painted bass boat (you know, red with sparkles, 275hp motor precariously hanging on the back, live wells, 50 poles, etc.). We were always the opposite of that. To understand our fishing, you have to know our prey.

After a very short time in our fishing careers, we decided that the best thing to fish for is the smallmouth bass. The smallmouth bass has been called "the gamest fish that swims". If you have never seen one of our bronzeback buddies, please take a moment to Google "smallmouth bass" now. OK, so it is a beautiful fish. They fight hard. They take some skill to catch. In Virginia, they live in rivers. We are very lucky, no, blessed, to have within easy reach four of the best smallmouth rivers in the world. Optimal conditions for smallmouth fishing are a cool, not cold river, which runs 4 to 8 feet per second, 1 to 5 feet deep, over a rocky bottom with some boulders or larger rocks to provide some cover. Around here, we have that in spades. We can get to the western sides (i.e., above the fall line) of the Potomac River, the Shenandoah River, the Rappahannock River, and the James River, all in two hours or less.

The preferred schmoe method for catching fish is to wade into the river, walk around, and cast for fish. This is different from what is seen on TV, where gentrified anglers use every technical advantage to get some fish. In our world, there are no fancy waders; just sneakers. No fancy vest; just a fanny pack stuffed with gear and slung across your chest. No creel; if you catch something you want to keep, you can tie a stringer to your pants. Big-brim hats. Sunscreen. It seems simple, but walking around in chest-deep class 1 rapids is less than easy. It leads to various problems. The rocks are usually slick, and the footing accordingly bad. There are always rocks that you can (and will) smash your shins into. The weather plays into the game too. A change from sun to clouds can leave you freezing cold in the middle of summer. The river can rise quickly, leaving you stuck on an island or on the other side. Getting out into the river is the only real way to catch those fish. The current and bottom conditions make boating difficult, though not impossible. In short, we look terrible, but get good results. We thought that it would be a good idea to do a TV show of our own, called "Fishing With Schmoes", where we could show regular folks, with a budget (both for money and time), how to have a good time fishing without the $100,000.00 investment. We would talk about little scenes or how to get shots of something funny.

I have always favored walking in the rivers. I feel like it washes my soul clean.

For years we fished like that. That's not to say that we didn't do other stuff. We fished from boats on the Chesapeake. We did float trips down our rivers. We fished ponds and impoundments from boats. It always came back to walking around in the river. We just figured that part of being a schmoe was suffering, whether it be from weather, pain, or other trauma. It was the cost of fishing glory.

Fishing glory has been hard to come by of late. In recent years, Larry, J and I have been forced to grow up. We all have grown-up lives to lead. Our Saturdays don't belong to us anymore. The concept of being able to fish twice in any weekend is laughable. Getting all three of us together at one time for anything has even been trouble. When this past August rolled around, we hadn't been fishing together in years. It was going to be a very happy day.

We arrived at our chosen spot. Our entry point would be a boat ramp on the Rapidan River. The Rapidan is a major tributary of the Rappahannock River, and this spot is very near the confluence of the rivers. The water was very low. In our style of fishing, this is a very good sign. With less water in the river, it is easier to get around because the water is generally shallower. With shallower water, the fish concentrate in the deeper spots. It is a formula for success.

Larry threw out a cast before any of us had our feet wet. He caught a fish on that first cast. We all smiled. We got into the river and walked out, heading upstream. We all had fish in hand within a few minutes. It was one of those days where everything worked. Whatever bait you had, that's fine, just throw it out there. We were fishing three radically different techniques with equal success, and having some fun. We cracked jokes on each other. We talked about other trips. We looked at animal tracks and at some birds. It was great. By lunchtime, we had caught about a hundred fish.

In contrast to our regular routine of eating damp sandwiches out of those triangular plastic boxes that you get from 7-11, J brought his travel grill and we had a hot lunch of hot dogs and sausages, along with all the fixings. I was soaking wet, I had sand in my shoes, a thumb with visible wear marks from unhooking fish, and a hot sandwich in hand. It was pretty much Nirvana.

After we ate, we stood around talking for a long time. Thinking back on it, we were catching up on each other. This was strange, because I never go more than a week or two without seeing these guys. There was something about being out there, in our goofy ghetto-fishing attire, out in the sun, having some fun. The sad part is, I think that we were all suffering from a giant case of the "nostalgias", and thinking things along the line of "you can never go home again".

Larry had to go home. J and I decided to stay. The fishing had been so good, I wanted to spend the afternoon using my fly rod. Catching smallmouth bass on a fly rod is one of my top five things to do in the world. I tied on a fly that I had made myself. It was several years old, but it looked good, and wasn't falling apart. J stayed with a little technique that he has developed for fishing soft plastics in a current. We went back out and slayed them.

I caught a bunch of fish. J caught not less than two-to-one on me. A couple of times, I caught myself just watching him fish. He has good eyes for spots and good feel for bait presentation. He "thinks like a fish", and is generally amazing that way. We walked downstream during the afternoon session, which is usually a faux pas, except that the river was so low, there would be no question of our ability to get back. Did I mention how cool it is to catch smallmouth on a fly rod? Yeah, well it's even better when you do in on stuff you made yourself. I basically achieved total fishing satisfaction that day.

We will never get back to the old days. I think that I finally realized this fact on that day. I also learned that we can still have a meaningful and enjoyable time, even with years in between fishing opportunities. In eight or ten years, my kids will be old enough to go out into the river on foot. I think that with Uncle J around, our best fishing days may still lie ahead. I will be especially happy if the kids want to take their old man out slipping and sliding on the rocks every weekend.

We got out of the river. I was dog-assed tired, having been awake for something like 40 hours straight. I came home and slept the sweet sleep of the dead, until I was finished. Where sleep is concerned, this is a very rare luxury any more. I woke up sometime in the late morning on Sunday, my great day having ended and a new one begun.

So in the final analysis, the best day ever took something more than two calendar days to complete. Oh well, when you have as many kick ass adventures and moments of poignancy as I did on that day, 24 hours can't hope to contain you.

Get out there and kick some ass, whatever it is that you do! I'll be back soon. Perhaps with a shorter post. Peace to all...Leave a comment.

DTXMATT12

Friday, March 16, 2007

KICKIN' IT OLD SCHOOL- Survival Breakfast

OK, readers. I know that I promised a couple of pounds of cocaine and some smallmouth bass at the end of the last post. With regard to the cocaine, the case is still pending, so I have thought better of cutting loose with what I know until later. Sorry.

Earlier this week, I was reminded by a friend that I had once gotten drunk in her apartment one morning while tagging along with the guy who was supposed to be house-sitting for her. At the time, I didn't really know her. We had a little laugh, and I got to thinking about the events that led to that glorious morning of Budweiser and Mickey's Big Mouth. For me, this was one of my first big-time experiences with a well-known firehouse phenomenon that I call "survival breakfast".

So, there I was.... in 1988. It was early fall, I was pretty close to two years in the fire department, and I was a live-in firefighter at my original station in North Woodbridge. We had a great crew of guys back in that day. There were no duty crews assigned to cover the overnight portion of the day, so after the duty crews left at 2400, it was live-ins from 2400 to 0700 every day of the week. Needless to say, we got to run a bunch of calls and we were very close. The call that led to the drinking in a stranger's-now-friend's apartment was a little fire in an outbuilding next to a fleabag motel, but the story started back in the summer.

It was a hot day, most likely a Saturday. As I recall, the uniform for the day would have been: 1. some sort of shorts, whether they be camos, sweats, running shorts or whatever; 2. some sort of tee-shirt, hopefully from a fire department somewhere, usually with no sleeves; and 3. some sort of baseball hat. On a Saturday, there would have been no actual duty crew, just a cobbled-together group of live-ins and people hanging around. Our leader was a guy named Harry, who at the time was a sergeant, aged about 24 and a superstar fireman like none who has been seen since. He had a girlfriend that he kept secret. It was a terribly kept secret. He would deny the relationship while making goofs like driving around in her car alone for no reason. He was driving her car this day. We all watched as he walked across the front ramp of the firehouse, jumped into the car and sped off to we-all-knew-where with a little "toot-toot" of the horn as if to say "See ya!". For my part, I was content to keep working on my car, smoking a few cigarettes, and enjoying the sunshine. About ten minutes after he left, I heard the squealing of tires, the massive over revving of a too-small engine, the squeal again, and then here comes Harry, driving way too hard for that car in particular and any car that wasn't his in general. He skids to a stop on the ramp and yells: "Load up! We're going to an auto fire". I think to myself, "Big fucking whoop. Why the crazy driving?" It turned out that while driving to his girlfriend's house, Harry had seen the fire, and came back to the firehouse. I pulled on my trusty camouflage pants and my three-quarter boots, and climbed onto the side of the engine. It would have been a guy named Ron driving, Harry was the boss, myself, my buddy Gordo and a dude named Billy. (Watch Billy carefully here, because this will be important for later) Thanks to Harry's driving (remember- this was pre-cellphones), we got a massive head start on the other engine that was eventually dispatched to this call. Like a five or eight minute jump. We got to the scene, the shoulder of an interstate highway, and find a 1970's era station wagon fully involved and a total loss. There is a small crowd of people standing around. Gordo and I pulled a line and quickly knocked the fire down, being careful to conserve water on our non-hydranted interstate. We ultimately gave up the line to Billy, as he was the senior man, and he wanted to get some nozzle time. Whatever. I lit up a smoke and went over to see why a crowd had gathered. Turns out that there had been fifteen (no shit, 15) people in the car, and the "crowd" were the occupants of the car. Wow. So, there was Billy finishing up the final extinguishment of the car. Harry told him to get up under the dash and make sure all of the fire was out. Billy promptly jumped into the front seat and, of note, made no bones about rubbing the back of his coat all over the burnt out front bench seat. He would grind right to lie down, grind left to sit back up, and grind right again so he could lie down again. Ostensibly, this was to get position to put the hoseline where he needed it. Really, these moves were made to get his coat as dirty as possible. Back in the day it was cool to get your gear as dirty as possible, and Billy was certainly taking care of business. When he got done, the back of his coat was a mess. Dirty was cool, but dirty like that was lame. It was like intentionally rubbing your gloves on your face to look "smoked up" after a fire. So we left what turned out to be a memorable call and went back to the house.

Fast forward to the fall. It had been a couple of months since the car fire. It would have been a weeknight. At about 0330, we are dispatched along with two other engines to a structure fire at the aforementioned fleabag motel on U.S. 1, right on the line between our first due and the first due of my current firehouse. Our crew is a guy named Jim who is driving, Harry was again the boss, Billy was the lead fireman, myself, a rookie named Robby, and a guy named Scott. Scott was a Navy Corpsman, and the best medic I have ever seen, bar none, but he was just starting as a firefighter, and was not certified. It turned out that the fire wasn't in the hotel, but in an outbuilding next to the hotel. The location of the fire is difficult, because the hydrants on that stretch of U.S. 1 are not well placed, and to get a water supply, a "split lay" is required. For the uninitiated, a split lay is where the attack pumper drops its supply hose someplace (usually an intersection) and goes to the fire, and a second pumper drops where the first one dropped and lays out to a hydrant. Water supply is achieved by hooking the second pumper's supply line to the hydrant, connecting the middle, and then the first pumper connects to its pump. This is a common fire department tactic, especially for us in this particular area. We were first there, and were going to be the attack pumper. Given the status of our crew, Harry told me to get off with Robby to drop the split lay and make sure that the connection was made. It would have been my assignment if we didn't have Robby and Scott with us. I watched as Robby pulled the line, and I helped him to get ready to receive the line from the second pumper, which was now coming up to us. Once I was satisfied that he would be able to finish the job himself, I ran up to where the building was on fire. Harry and Billy had already pulled an attack line and gone into the building. I put on an airpack and got ready to go in, but I didn't have another firefighter, so I walked up to the front door and stood with Scott, who was watching from outside. The building was 20' x 20' square, wood frame, looked like two rooms separated by an entrance hallway. Fire was blowing out of the front window on the left. Before I could do anything, stuff started to happen. The hoseline jumped, indicating that they had opened the nozzle inside, and I sighed, thinking that I was going to miss the good stuff. The fire didn't go down right away. It didn't go down at all. The line jumped again, indicating that the nozzle had been slammed shut. Weird. Billy appeared at the front door, with smoke cranking out from behind him. When he reached the door, he fell to his knees just past the threshold. I looked at his face, and his wide eyes seemed to fill the entire lens of his mask. He fell to his belly, and I saw that his entire back and his shoulders were on fire. Oh, shit! Before I could do anything, Harry's helmet came rolling out the door. Holy shit! I was getting close to Billy, who was rolling around on fire, when Harry came flying out the door at about waist-height, Superman-style, and pounced on Billy. Harry commenced to smother and beat out the flames on Billy. Billy seemed to be OK. Harry was pissed off and otherwise very agitated. And then up went the mighty cry: FUMBLE!!!! Scott took Billy away, and I grabbed the line, which Billy had dropped. Harry and I went into the building, this time with me on the nozzle. To get to the fire, it was ten feet in, turn left at the door, and hit it. We got pretty close. In 1988, our gear would not let us go where we go now, so we hit the fire we could see blowing out the door to the fire room, but didn't make much progress. Harry tapped me on the shoulder, said something like "Fuck this.", and then kicked at the wall on our left. I saw his plan right away, and we both kicked at the wall until we had a hole big enough to stick the nozzle through. I aimed the nozzle into the hole, opened up, and knocked the fire in the room down in a few seconds. Once fire wasn't shooting out the door, we got up from the hole in the wall and went into the room to finish up. We then worked on the inevitable fire in the attic for a few minutes before we got relieved. We went to check on Billy.

Billy was fine. All of the soot and other shit that he intentionally put on his coat during the car fire a few months ago had left him with a plasticized crust on his back and on his shoulders. Harry tells this part of the story much better than I do, and it works better in person with hand gestures, but it goes like this: Harry and Billy go in with a charged line. When you go into a fire, you are supposed to open the line for a second or two before you go in, so that any air trapped at the end of the line is released. Every time one charges a hoseline, some air is released before the water comes out. It was no different this time, except that Billy didn't open the line before he went in. Harry tells it this way: "He turned to face the door, opened the line and there was this hissing of air, and then the fire just said 'ARRRGH, FUCK YOU' and (arms making a grasping embrace) totally ate him alive.", which in English means that when he blew a bunch of fresh air on the fire, a big fireball shot out at him. This fireball set his coat on fire.

Sooo, we were happy Billy wasn't hurt, and we had a little laugh about how Harry jumped on him like SuperFly Snooka of the WWF, but after a while we all realized that we were pretty freaked out. We got back to the house at about 0700, turned the pumper over to our paidmen, and sat around looking at each other with that shared look of "wow, we almost got hurt there." Billy had to go to work. Scott too. Robby was leaving town. Harry suggested that he and I should go get drunk. I couldn't have agreed more. Without having showered, we walked down to the 7-11 on our block and bought about thirty beers. 18 Budweisers and 12 Mickey's as I recall. I was wondering where in the firehouse we were going to devastate that beer, when Harry said, "hey man, let's go to Sue's apartment and drink up there." At the time, I didn't know Sue very well, but once Harry explained that he was house-sitting for her, I was happy just to have someplace to go that was not the firehouse.

So we loaded up in my car and went to Sue's apartment, which was too-nicely-decorated for two dirty-assed firemen who were looking to get their drink on. We started drinking. We talked about what had happened. We laughed the laugh that you get to laugh when you know that you have been close to (and perhaps over) the edge and pulled it back in. I call this "survival breakfast". Survival breakfast is not necessarily a meal, and is not necessarily breakfast. It works whether it is beer in the morning, or is actual breakfast in the firehouse, or is a cigarette in the parking lot of a convenience store. It is a little moment where you realize that you have seen something bad, but you are glad to be alive. That feeling of being alive is a feeling of being not just alive, but very much alive. The probably-too-occasional opportunity to to these things is one of the best things about being in the fire department. Because of the location, this one was a little wierd. Once we were all drunked up, we went out on foot and had a little adventure in the Lake Ridge Giant, but that is for another post. Events like this were powerful learning experiences in my youth. It is amazing how well you can sleep with a dozen beers on board after fighting fire all night.

For the love of God, if you have read this far, please leave a comment. More to come soon, but until then, peace.

DTXMATT12