Sunday, April 29, 2012  We hear it all the time. “WEAR YOUR PPE”, and “DON’T GET COMPLACENT”!!!! Fortunately for me, when I got complacent and did not wear my PPE, I got a close call instead of a surprise bacteria-filled human bite. At 13:00 the Communications Center received a call from a well-intentioned passerby for a man down. Upon arrival, he was difficult to find, so I had the crew wait in the engine while I looked for him on foot. Eventually, I found a transient sleeping peacefully under a tree. As the crew came over with the engine, I woke him up and started asking questions to confirm he was OK. As the Captain, I knew I was not going to have any physical contact with this person as the medics were right behind me. All I needed to do was stand back, document, and explain what was going on to the EMT ride along (in my T shirt, without gloves, EMS coat, or eye protection). His responses were bizarre and unrelated to the questions he was being asked. At first glance, he appeared to be a psych patient who was not under the influence. When it became apparent that he did not know what planet he was on (much less answer the orientation questions), we decided a trip to the hospital was in order. Because he was refusing transport, the police department was requested to issue a 5150 involuntary hold on him. Three officers arrived and after their attempts to convince him to go to the hospital were in vain, they decided to issue the involuntary hold and send him against his will. Three officers were not enough to subdue this scrappy, wiry man. Three officers, my two firefighters, and the two ambulance personnel were still not enough. He was prone and had both his hands under his chest. An officer was on his left arm, but nobody was on his right arm. I jumped in. I grabbed his right arm and pulled it out from underneath him. In the process, he bent his head down and attempted to bite my forearm. I felt his teeth graze across my skin as he got a mouth full of arm hair. Immediately, he made a loud slurping sound as if preparing to spit at me. My face was one foot from his and he had a clear shot. Fortunately, one of the officers immediately grabbed his jacket, put it over his face, and (gently) directed this gentlemen’s head into the dirt. Infection #2 averted.

Lessons: Often times, we learn the most by witnessing what not to do. That’s exactly what happened for the EMT student as I explained in detail the mistakes I made on the call. I told her don’t get complacent, and please, always wear your PPE”.
 

 

Friday, March 23, 2012  We responded to a call was for "welfare check" with PD. PD found the deceased occupant on third floor of townhome. The "odor of exhaust fumes" was prevalent to PD but was not relayed to FD. Several calls and days later CO readings were found in initial home and auto exceeding 200 PPM.



Monitor thoroughly and in adjacent apts. when there is a suspicious death.



 

Monday, March 12, 2012  On February 23'd, MCFRS had a "near-miss" event involving Eagle 1. This event underscores the hazards of helicopter med-evacs and the precautions necessary.

At the time of the incident, weather conditions were clear and cool with little wind. It was fully dark, but the amount of light from surrounding buildings and street lights provided some visibility to drivers and pedestrians.

At 1928 hours that night, units were dispatched to Georgia Ave and Connecticut Ave for a pedestrian struck. A705, PE721, PE718, and C705E responded and found a P1, Category "A" trauma. A helicopter was requested for med-evac to Baltimore Shock Trauma. Station 25 was identified as the landing zone and PE718 was designated as the landing zone unit.

Personnel from Station 25 and BC704 were in quarters at the time of the request. Leisure World security was contacted to shut down the gate from Leisure World onto southbound Connecticut Ave. An officer from 25 met with PE718 to advise of the situation, and recommended the landing zone on Connecticut Ave at the base of the apron.

The grassy hill behind the station was considered, but not chosen based on the historical practice of using the paved area in front of the station, and concerns about moving the patient up the hill.

The lanes of Connecticut Ave provide about 100' x 100' of paved area, and a slightly larger area that is free of utility poles. The grassy area is approximately 150' x 250', but requires loading a patient up a hill with about 20' of rise.

Prior to the arrival of Eagle 1, PE718, A705, and C705E had arrived at 25. C705E positioned at the intersection of Bel Pre and Connecticut to limit traffic from entering northbound Connecticut. Leisure World security was re-contacted to confirm that the gate was closed. When Eagle 1 announced that they were 2 minutes out, PE718 moved and parked perpendicularly to traffic. The two units then blocked all of the northbound lane, the southbound left turn lane, and part of the southbound through lane. Approximately one and half lanes of southbound Connecticut Ave were not protected by a vehicle. Once the Eagle was on final approach, PE718 turned off its emergency lights.

As Eagle 1 was touching down, (less than 5 feet off the ground) two privately-owned­ vehicles entered the intersection and proceeded north. Both vehicles crossed the double yellow line and two more lanes of traffic, went around PE718 and C705E. The first car drove under the rotor "disc" of Eagle 1 and the second car was stopped by the crew from PE718.

As soon as the pilot saw the first POV, he throttled up, but didn't gain any altitude until the car had driven by the helicopter. The Eagle then relocated to the high grassy hill behind Station 25, and A705 moved there to transfer the patient.

The image below shows the approximate position of apparatus and the yellow line indicates the route of travel that the POV's took:




Lessons Learned and Best Practices:


• Delays frequently occur during helicopter med-evac operations. The relocation to the grassy hill probably added 4 minutes to the patient transfer.

• Open areas (paved or unpaved) are almost always preferable to landing aircraft in traffic lanes.

• The minimum requirement for an LZ landing unit is an engine, truck, or squad with 3 personnel. This is usually adequate for a field, but is not enough for any roadway or most parking lots.

• The officer of the LZ unit should be designated as the "LZ Coordinator"

• Personnel must wear traffic vests, hearing, and eye protection.

• At least one crew member needs to be dedicated to being a "lookout" for changes to surroundings.

• Always expect drivers to behave irrationally. Build the LZ plan on the assumption that all drivers are under the influence, distracted and determined to get past
your incident.

• Pedestrians will also be drawn towards helicopters, and they must be kept at a safe distance.

• To prevent drivers from entering an area, there needs to be 100% closure of the road with a physical barrier (apparatus). If there is room for one car to maneuver through, it will.

• Even when a third party (like Leisure World Security) accepts responsibility to block traffic, we need to provide our own redundancies. We need to ensure that we build a safe work zone for our crews, aircrews, and our patients.





Additional Resources:

MIEMSS I MSP Aviation video on helicopter landing zones (requires log-in with EMT provider#)
http://emsonlinetraining.org/course/index.php

FRC Policy and Procedure 24-08 SOP for Helicopter Landings http://www.montgomerycountymd.gov/content/firerescue/swsj/policyprocedures/ops/frcops24-08.pdf



 

Sunday, February 26, 2012   On Monday (2-20) at approximately 0800 AM. A citizen summoned the fire station by means of the non-emergency line.  The man on the telephone was concerned about his father that has a long standing history of dementia.  He reported that his mother and father were home alone in a local retirement complex, and also that he is worried about his father’s sudden decline in mentation and change in personality.  The Owasso firefighters answered this extremely routine call for assistance quickly, responding both an ambulance and ladder truck.  Both crews totaling 5 personnel entered the residence as they would during any emergency scene.   When they walked into the entryway and proceeded into the living room, they noticed a woman standing next to a man that’s back was facing the crew at the kitchen counter.  The wife reported that this man was the patient that we were coming to assist.  Once she mentioned the presence of the crews, the man turned and looked at the firemen, then proceeded promptly to the back bedroom.  Upon seeing this odd behavior, the station officer asked the wife if there were any loaded “guns” that the patient had access to.  She stated that there were not any additional “guns” in the back bedroom.  She also stated that she had removed them earlier in the day.

The crews proceeded with no hesitation down the hallway to deliver care to the man.  When they made it into the hallway, the man came around the corner wielding a lever action rifle.  The man turned, saw the crews and actuated the lever of the rifle to place a shell into the firing chamber and pointed it at the fire crews.  The crews stated that the man had a large grin on his face.  

Immediately they dove for cover, and exited the residence.  Thankfully all the crewmembers made it out safely with no shots that were fired.   The man was disarmed shortly thereafter by the police department.  

This patient had been suffering from dementia for many years.  His mental decline was a natural part of his disease process.  In this man’s mind, he could have thought that his home was being invaded, and went back to his primal instinct to defend his family.  This call and one’s like it are responded to very frequently by fire and EMS professionals.  Fortunately, no one was injured.

 

Sunday, February 12, 2012  I was the 90% diver on an ice dive, using SSA as well as the safety diver. The primary diver (different dept) was using conventional SCUBA(80cf) with a pony bottle(19cf) bail out system on an Omni switch block. All divers are in dry suit and Divator FFM. The primary diver had some challenges with weight issues and equipment configuration. The tenders in this case are new and we are boat based in about 10ft of water with thin ice conditions. After a few attempts due to equipment issues the primary diver starts his dive. We allowed him to go only about 20 lateral ft due to the challenges he had. We had him on hard wire communication and after about 5 sweep patterns we advised him to start a slow ascent and we would due a lost diver drill with the safety diver. Suddenly and with out any communications or rope signals the primary diver started to pull himself in towards the boat. We noticed an emergency and told the safety diver to start towards the primary. The tender was told to pull the diver in also. The primary diver suddenly surfaced and removed his mask stating he had a mask failure. We had him exit the water and place his gear in the boat for examination. The primary diver suffered no injury. On inspection of the dive gear, he had 2500 psi in his 80cf cylinder. His octopus worked fine. His FFM did not have any air going to it. We checked the Omni switch block and noticed it was in the position for the pony bottle. I removed the regulator from the pony bottle and found it was empty. The diver was diving on his pony bottle system the entire time and sucked it dry. He did not attempt to switch the block position, he stated he would have removed his FFM and use his octopus, in ice water this is not as easy as it sounds. Later discussion found he had not been trained on the use, had no pool time, and was not aware of the operation of the switch block. We are fortunate the diver was limited to lateral distance of 20ft. If he was at a greater distance he may have had different results, not for the better.
Each diver must be trained and knowledgeable with their own gear. When the "domino" effect starts to take place, don't push on just to complete the dive. Gut feeling in this case limited the diver to only go out 20 lateral ft. Follow your gut! Each member of a division/county wide team must communicate with each other regarding gear issues. We don't all have the same stuff, but must be aware of each teams configurations. This diver learned the hard way to get into the pool first with new gear.



 

Friday, January 27, 2012  At 0521 hrs today, Geneva FD E208 and St. Charles Medic 153, on auto aid, responded for a medical alert alarm at a townhouse complex.  Upon arrival, companies were unable to gain entry due to locked exterior doors.  A family member down the block provided a key for access.  Upon entering the townhome, personnel including Geneva PD announced their presence multiple times without a response.  After searching the residence, a locked door with a simple push lock was found.  Personnel used a pen to pop the lock.  As the door opened, they were met by a dementia patient pointing a gun at them.  The PD officer drew his weapon and FD personnel withdrew from the line of fire.  The engine Lt. (also a police officer) contacted dispatch advising a man with a gun and called for backup.  The PD officer on scene was unable to get this transmission out due to need to concentrate on the immediate threat.  After lengthy standoff with police, the patient was tazed, dropped the weapon and was subdued.  Pt was subsequently transported to the local hospital.
 
We tend to be real complacent on calls of this nature which is a recurring theme on FFCC.  Had it not been for quick thinking and the training of all personnel involved, this incident could have escalated and become a multiple shooting very quickly. 



 

Monday, January 16, 2012 

On Friday January 6,2012 @ 07:15 hours. 15 minutes in to the start of my shift my company was dispatched for a mental distress patient. while enroute I asked the 911 dispatcher for patient conditions. They advised we were responding for a 76 year old male who was experiencing mental distress. I asked the dispatcher if the police were notified. they advised scene was safe and NO the police were not notified.they also advised NO weapons in house. My partner and I cut our sirens and lights. we arrived on location to find an elderly male standing on the porch. When crew approached the male he advised they had a gun in the house and they were trying to kill him. at the time i seen through a window that a younger male in army fatigues came in the view and had a gun in hand. crew left the sceneand called for police  

 

Be observant and do not panic in dangerous situations



 

Wednesday, January 11, 2012  On Monday January 9th at 20:00hrs Pittstown Fire and Ems were Dispatched for a Delta traffic accident on New York Rt 7 for multiple patients. Our Fire Crews arrived started treating patients and conducting hazard control as per our sop. Firefighters found a 20lb propane cylinder ejected from the car(not Leaking) 30 ft. from the car. as well as a mini gas powered motorcycle hanging out from the Suv. So under the guides of always look out you never know what you will find in a car, in an accident or on fire. 5 family members were transported for various injuries .

 

Saturday, January 7, 2012  While responding code 3 in our ambulance to a male pinned between a 500 ton counterweight and an I-Beam a hundred feet in the air on a crane at a refinery, my partner and I encountered a car attempting to keep pace in front of our ambulance. We were travelling approximately 50 miles per hour in the left lane of a 40 mph zone on a major street. We were approximately 500 feet behind the vehicle when the driver unexpectedly slammed on his brakes and brought his car to a complete stop. I was still far enough back with plenty of time to merge and pass him on the left (travelling on the wrong side of the road). As we got closer to the stopped vehicle the driver turned LEFT in front of us and stopped, blocking our path in a blatant attempt to cause an accident. I had slowed to 40 mph and had just enough clearance to go around him to the right to miss him by six or seven inches. We had all of our lights activated, our two sirens were on different modulations and we were sounding our air horn. It appeared this driver had his windows down.
While most drivers out there are simply ignorant of the legal requirement to pull all the way to the right and yield the entire width of the road to emergency vehicles, we must not forget there are some who are willing to endanger everyone around them in order to get money from insurance.
 

 

Monday, December 26, 2011  On December 23rd a local ambulance service, along with the local law enforcement agency responded to a call where one subject stated he had shot his significant other, who had been ill. The ambulance service arrived at the same time as law enforcement and staged about  ½ mile away, waiting for law enforcement to secure the scene. The chief of the ambulance service, who had a prior fire and law enforcement background established the Incident Command System and assumed the role as the I.C. The I.C. also functioned as a lookout for law enforcement. As the law enforcement officers approached the residence in their patrol vehicles, someone inside the residence fired a single shot, which struck a patrol officers vehicle. The patrol officers radioed for backup, retreated and established a perimeter. Additional law enforcement officers from the initial responding agency, as well as another local law enforcement agency arrived and reinforced the perimeter. Approximately 30 minutes into the incident at least 2 more shots were heard from within the residence, followed by a hissing sound which was followed within seconds by an explosion which lifted the roof of the residence. Within seconds this explosion was followed by a much larger explosion which threw debris up to 400 feet away. The concussion wave was felt by the I.C. and the ambulance crew which was located ½ mile away. Two law enforcement officers received minor injuries when they were thrown by the force of the explosion. This initially was thought to be a possible murder/suicide. Due to the unknown nature of what had caused the explosion and given the possibility of additional explosions, the I.C. made the decision to let the residence burn itself out. While the fire was burning itself out, multiple small explosions were heard which were later determined to be thousands of rounds of ammunition. After the fire died down, the local fire department moved in to extinguish hot spots, under the protection of a SWAT team, what appeared to be an Improvised Explosive Device was discovered. The fire department retreated and overhaul was suspended. Subsequent investigation revealed multiple satanic symbols which decorated  the inside of the residence as well as the back yard. The front of the residence looked normal from the driveway. A quick background check via the internet revealed the owner of the residence was a satan worshiper. Based on revealed information it was discovered that December 23rd is a significant holiday  for satan worshipers. It is theorized the occupants had intended to take the EMS crew hostage and then to ambush the remaining responders who would attempt a rescue. This theory was further reinforced by the fact that a man and woman could be heard conversing inside the residence before the explosion. This incident occurred in an area which has not seen this type of a scenario play out. Had the caller reported chest pain instead of stating that he had shot his wife, the EMS crew would have walked right inside without any indication of foul play, until it was too late.
Recommendations include staging your ambulance in a position which will tactically allow a rapid escape for the crew. Additionally, I do not recommend any crew member enter a building unless met at the door. This will allow the EMS crew to assess the persons body language, which may provide an indication that all is not well. Further, all responders should have a portable radio issued to them for the shift.
 

Wednesday, October 12, 2011  On Sunday Oct 9th 2011 I assisted a volunteer EMS agency with a trauma code. I performed cpr for about 20 minutes of a 40 minute transport. On the Thursday and Friday before, I had worked my normal job, then responded to a hazardous materials incident, which lasted 17 hours. About 2 to 3 hours post EMS assist, I started to experience severe chest pressure with radiation into my jaw,neck and both arms along with nausea and profuse sweating. I had no shortness of breath. I am a member of a all volunteer agency with no requirements for physical fitness or yearly physicals. There is no formal rehab requirements or SOP and some EMS providers are unaware of the need for them to perform rehab at fire scenes. I went to a local ER, where I was diagnosed as having an MI, and then flown to a hospital with cardiac cath. capabilities. During the cardiac cath it was found that I had a 95% blockage of the LAD which required a stent.

LESSONS LEARNED:

At the time of the close call I was 26 years of age.
No matter ones age, they are susceptible to cardiac health issues, and every person and department needs to take physical fitness and physicals serious. There is no reason for any department not to do so.
 

 

Tuesday, October 4, 2011  Crews responded to a male pt w/ a decreased LOC from a low blood sugar of 22. While crews were treating the pt one of them noticed he was holding a gun in his lap. The gun and the pt's hand were inside a 'beanie' wool cap. When the crews moved the pt's hand down alongside his lap, attempting to remove the gun, the gun discharged into the mattress. The gun was removed and LE responded for investigation. Once the pt regained consciousness he had no recollection or knowledge of the incident.

LESSONS LEARNED:
Dont take any 'routine' call for granted. Make sure the scene is safe, especially when dealing with a pt with an altered LOC.
 

 

Tuesday, September 27, 2011  At 2106 hours E61 was dispatched to the McDonalds Restaurant at 3323 North 24th Street for a fall injury. E61 found the patient, who was a McDonald’s employee, at the top of a stairwell that leads to the basement storage area. E61 began the regular line of questioning and treatment for what seemed to be a standard medical call. The patient was a 24 YOF who was pregnant. The patient stated that she was going into the basement to check on something and became lightheaded and fell. One of the other employees heard the fall and went to the stairwell to help the patient. Both employees exited the stairwell and called 911 to report the “fall injury”. As the Captain from E61 was questioning the patient and one FF was checking vitals, the other FF and the Engineer went into the basement to see if the patient had tripped or slipped on something. Shortly after entering the basement both members of E61 became lightheaded and exited the basement. Upon exiting the basement, the Engineer fell and both members reported dizziness and a bitter taste in their mouths. E61’s Captain immediately called for a Hazardous Assignment and evacuated everyone out of the building.

At 2117 hours the Haz Assignment was dispatched. One thing to note was that the PTI on the MCT still only had the info from the initial fall injury. I’m not sure how this could have been fixed, but updated PTI would have been helpful enroute. BC2 assumed command and assigned E4 to Haz Sector. E4 and Squad 8 made entry into the building in turnouts and SCBAs. The goal of the entry was to meter the basement for what was suspected to be a Co2 leak. The manager of the restaurant told the crews that they had just had the Co2 tank filled a couple of hours prior
to the call. The crews made entry with 2 CGI meters and 2 Gas Ranger meters. As the crews descended the basement stairwell they started to get decreased O2 readings and slightly increased VoC readings on the CGI meters. As the crews continued into the basement the O2 readings continued to decrease (the lowest reading was 17.5%). One of the many interesting things about this call was the readings the crews were getting on the Gas Rangers. The Rangers were reading 100% LEL. When switched to % gas the readings were 25%. The readings were obtained at ground level and at ceiling level. These reading prompted Haz Sector to exit the building and start to mitigate the potential hazards. They shut off the gas at the meter and attempted to shut down the power from the exterior.
It was determined that another entry was necessary to shut off the power to the building, and investigate the Co2 tank. Haz Sector made a second entry into the building and secured the power to the building while monitoring the air to assure there was no risk of a spark causing ignition. Haz Sector then re‐entered the basement to investigate the Co2 tank. They found a broken line on the tank and were able to shut down the tank to mitigate the hazard. After exiting the building, Haz Sector made a plan to ventilate the building. A confined space fan and flexible ducting were used off of SQ8. This method of ventilation was chosen due to the heavier than air gas in a below grade location. The ventilation was complete after about 30 minutes.
Haz Sector did a final entry and obtained Zero readings on all the meters.
A few things to note about this call:
‐ The 2 members off of E61 were transported to the hospital for further evaluation. This can truly be deemed a “near miss”
‐ Statistics say that the majority of fatalities in these situations are would be
rescuers
‐ Jeff Zientek will contact the manufacturer of our Gas Rangers to inquire about
the Co2 readings on what is supposed to be a natural gas specific meter
‐ Jeff will also check to see if we can use our Manning meters with the sensors
we have, and do a conversion for Co2
‐ The on-site Co2 monitors at the restaurant didn’t function
‐ Some McDonalds locations have basements
‐ The gas hot water heater was located in the basement so the potential for a gas
leak and source of ignition existed
‐ The ventilation profile was difficult because of a heavier than air gas in a
basement
‐ SWG initial responder had to be told more than once to exit the hot zone (hot
zone mgmt. is challenging on such a large scale scene)

The total FD response to the incident included:
E61, BC2, SQ8, E4, L4, HM4, L9, E9, R9, E5, E11, R11 C957N&S, SDC, NDC, PI3, C959, C99, R17,
and U29.
E61 did a great job of identifying the hazard, evacuating the building, and calling for the appropriate response. Crews did a great job of investigating and mitigating the hazard.
****Always suspect a potentially toxic environment when responding to any restaurant,
convenience store, or any structure that has these systems in place…especially in basement
areas.****

 

Sunday, September 25, 2011  While working for a private ambulance last weekend, I was in the back caring for a patient with a broken tibia/fibula as result of an MVC. Approximately 1 hour into a roughly 2.5 hour trip to the main truma center, the driver swevered off the road. Later she stated to me that she must have dosed off at the wheel (time of incident approx 4pm). At the time of the indident we were travelling approximately 70mph on a major us hwy. The rumble strips and other motion must have awakened her. Fortunately I had the patient strapped securely to the stretcher with the three seat belts provided and I was seated and belted on the bench seat. Had I been up tending to something at the moment I could have been tossed around the back of the ambulance or fallen into the patient causing further discomfort/injury. Had the patient not been properly belted, as he did ask if the belts were nescessary earlier in the trip, he likely would have fallen off the stretcher and likely caused further injury to himself.

Proper Seat Belt use prevented injury to myself and my partner while preventing further injury to the patient.
 

 

Thursday, September 22, 2011  Responded on a call for Code Blue (Cardiac Arrest) with Pipeline 52 and Medic 32. Arrived along with both companies. approached the 2nd floor duplex apartemnt to find patient in bedroom closet. FF/EMT from P52 was the first to approach the patient and attempted to locate a pulse. On closer inspection found that the patient had hung himself using a heavy duty extension cord wrapped several times around his neck. On closer inspection, and trailing the cord, we found that the extension cord was plugged into an electrical outlet equipped with a Gound fault circuit breaker. To our good fortune, the patient's girlfriend had already cut the cord with a thick plastic handled butcher's knife which by her account befgan exhibiting sparking. This evidently caused the ground fault outlet to trigger, therby shutting down electrical power to that outlet. The assessment of the patient was reinitiated , but sadly the patient was determined to be non viable. LESSONS LEARNED:
There is no subsitution for a thorough assessment of scene safety. While this call was a tragedy for the victim and his family, it could have been catastrophic for the firefighter, his crew and/or the paramedics who responded to this call.