Submit Your Close Call / Near Miss
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.
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.
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
‐ 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
‐ 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,
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
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.
Wednesday, September 21, 2011
A Fire Department based ambulance is nearly struck by a fast moving semi-tractor when attempting a U-turn to attend to a victim lying within close proximity of a major highway.
Many lessons learned:
1. Always utilize "emergency" overhaed lights when on-scene of an incident on-or-very near to a roadway
2. Always look--multiple times--to assure the U-turn will be done safely
3. Avoid U-turns on public roadways when possible
4. And, this is one of the most dangerous moves anyone can make on a roadway, don't take it lightly!
Monday, August 15, 2011
On the morning of October 5, 2010 I was assigned with a BLS crew to provide ALS for a patient being transported to Cleveland from West Virginia. We were approximately 1 1/2 hours from Cleveland we were sideswiped by a car, sending us crashing into a caron the shoulder of the road, then over a small embankment, striking a light pole and then ending by crashing head on into a hillside. I was seated in the patient compartment of the Ambualnce in the airway seat directly behind the stretcher. At the time we were struck I had stood up to adjust the oxygen and was then thrown into the floor of the patient compartment. Our two spare oxygen bottles were mounted to the wall of the walkthrough from the patient compartment to the cab of the truck. I landed directly in this passageway and when we struck the car on the shoulder this was the exact moment my shoulder, chest, and back struck the oxygen bottles. My head struck the corner of the wall and my back was slammed to the floor against the tracks that were made for the sliding door to seperate the patient compartment and the cab. As we went over the embankment I was slid towards the cab and once we crashed into the hillside I was then catapulted into the cab landing on my neck and upper back. Our driver sustained a head injury that later lead to a series of TIA's, the EMT in the back with me sustained internal injuries. Our patient, thankfuly, was basicly unharmed other than minor bruising.
There were many lessons learned in this event. The first being, shoulder straps on the stretcher WORK!!! They absolutely should always be used. Secondly, if you ever have the opportunity to wear your seatbelt in the patient compartment, it will save your life. I was unable to because of having to be mobile to provide patient care. My EMT partner in the back, fortunately did and that is what kept him from sustaining any further injury. Lastly, mounting the oxygen bottles in the pass through area is an incredibly bad idea. Many statistics show that this is a common area for a provider to end up in the event of a crash. Also, this shows that no matter what type of call you are assigned, wether it be a call dispatched by 911, a BLS transport, or an ALS Interfacility call, we all take risks whenever we climb in the truck each and every day. This event was featured on the Secret List on October 6, 2010 and I do want to thank you all for bringing awareness to the event. It helps to show that so many of us are injured in the course of our duties each day.
Tuesday, July 26, 2011
I too share your passion and absolute love for the job and the people that unselfishly serve our country from the ravages of death and destruction. I am 41 years old and have been a firefighter since I was 16 beginning my career as a volunteer. I'm still blown away that at 16 I was allowed to crawl into building fires with minimal training after riding the back step to get there! But we both know that the 80's were a different era in the fire service.
On November 10th of last year I suffered my own close call. I am a Lt. normally assigned as an engine company officer and during my day tour I went about our daily routine of fire and EMS calls without a problem. My shift commander was on vacation for the night tour and as the senior Lt. I was assigned to his position. This is the normal for our department and I have filled this role many times.
At approximately 1930, the men just began to order dinner due to the high call volume for early evening. We received a master box alarm for one of our rehab hospital a facility that has over 200 beds including 50 vent patients. We frequent this facility almost daily for EMS calls. Our normal box response for this facility is 2 Engines a Ladder and a ambulance, and we all turned out. En route I was updated by the dispatcher that he received a phone call now reporting a fire in the Kitchen.
I know this building well, having served a few years in fire prevention and doing monthly drills with the staff of each floor, I knew the exact location and best attack route to take. I arrived and established command, giving orders for my crews and was informed that the fire was small and mostly knocked down by the staff.
Once the Engine company made the fire area and extinguished any remaining hot spots the Engine Officer requested I come to the fire area to discuss the health and safety issues that this fire had presented to the hospital. I met the the Lt. and the Facility Manager, contact the health department and began to exit the building.
As I climbed the stairs to the 2nd floor and exited the building I began to feel palpitations and was having some back pain radiating across my shoulder blades. I recently had a nasty bout of bronchitis but was sucking it up to go to work. As I took my gear off, I could still feel the pitter patter of my heart. As a paramedic for over 20 years and paramedic instructor I knew something wasn't right.
During the call at the hospital I heard another crew get a EMS call and heard them call for the police for a violent patient. I didn't even get my turnout pants off and heard the radio come alive with report of a police cruiser crash and the officer requesting the ambulance with a push and the jaws of life. So I forgot my palpitations and began to respond. Upon arrival I took command of the extrication and didn't think about the earlier event.
We cleared the scene and I returned to the firehouse. Doing what every good firefighter/ paramedic would do, I denied that anything was really wrong. I went to the office and began the reports. I felt fine at that point but remember thinking I should do a 12 lead EKG just to see. So at 11pm when the crews had turned in, I went to the engine and grabbed the monitor. I sat on the back step and hooked my self up to the monitor and ran the 12 lead. This is the most hippocritical thing I have done, I teach my paramedic students not to do that!! Don't put yourself on the monitor and try to diagnosis yourself! Well it looked fine not showing any acute changes and no Q waves and I felt ok so I went to bed. The night was uneventful for me, although the crews did several EMS calls, I did not receive any calls for the rest of night.
The next morning I didn't feel right I was tired and as climb the stairs felt some palpitations again. I knew something was wrong, I made injury report and on my way home had made a appointment to see my doctor and called the Chief letting him know what had happen and that I was going to seek treatment.
I met with my doc and he sent me to cardiology with a worried look after hearing about my night. I was given a stress test and failed miserably as my heart rate climb to over 200 and I was in SVT (Supra Ventricular Tachycardia). I was sent for a cardiac cath and it was found that I had a single 99% blockage of my LAD (left anterior descending aorta) The blockage of this artery is referred to as the Widow Maker, because blocking this major vessel usually resulted in death. The cardiologist was excited as he could get to tell me I had a major blockage and it needed to be unblocked before I had a MI. But of course luck would have it that due to a study I had to be transferred to a Boston hospital for the badly needed stent!
The hospital I was at has their own ambulance service and I had been an employee there for 10 years. As the two paramedics (also career firefighters from other departments, moonlighting at the hospital) wheeled the stretcher in the cath lab they were blown away that it was me lying there! They began to move me over and in the fire department tradition began making me laugh and breaking my stones. I wouldn't have had it any other way!
After my ambulance ride and one single stent placement at Brigham and Women's hospital I was discharged with a note to return to full duty in 2 weeks. I was on a emotional roller coaster, my Chief had told my wife I was all done that I would not be able to return to work despite having that note from the discharging PA. This was a very depressing time for me and I wallowed in my pity for a few days but decided that I needed to pull it together for myself and my family and that I was alive that was the most important thing. I just survived the closest call I have ever had in the fire service.
Fast forward to now, I have done cardiac rehab lost a few pounds and need to make that higher priority, but I'm doing great. I have been to 3 separate cardiologist who tell me I'm one lucky guy that I suffered a plaque rupture and that's what caused my blockage, that all my other arteries are clean. I have just finished a battery of test including a full stress test to 102% of my max heart rate and I have cleared to return to full duty.
But!! in Massachusetts we have a heart bill that allows for firefighters like me to retire on disability (we do have an income cap on the disability retirement as well, which scares me). Several of my friends and coworkers have counseled me that I should retire due to the potential risks (despite the doctors telling me I'm fine) I am struggling with this decision in a huge way. I have a international training company that my wife and I own. I developed an Online Paramedic Program several years ago that is truly international we have a partnership with the University of Texas and students from around the country and the world. I love teaching, and I know you can appreciate that but my love of the job is stronger.
I have a supportive wife and three great kids, I want to live to see my children's, children and be there for them as they become adults. That being said being a firefighter is who I am and that is the part of me that is fighting to remain on the job. This has to be the toughest decision of my life because now the decision is truly mine. The department is willing to take me back to my original position as a company officer or I could retire and collect the disability (72% tax free)
I would like others to know of my story but I'm also looking for some advice. I'm not asking you what I should do, but maybe some guidance from a man that I admire and who has a better "Secrete" insight into firefighters that have returned to work with stents.
Monday, June 13, 2011
I was detailed to the BLS ambulance and responded just prior to the four wheel drive squad to the rural scene of a four wheeler rollover with injuries. We arrived and positioned in the driveway. The squad arrived and stopped in the dirt roadway. Due to several days without rain the roadway was now obscured by dust. As I exited the ambulance to talk to the squad crew another vehicle came through the dust cloud and ran into the rear of the squad. The second vehicle was totaled. The squad sustained heavy damage in the rear. The seat belted crew sustained no injuries and immediately provided care and extrication for the driver of the second vehicle. Additional EMS and fire units were dispatched to an accident involving an emergency vehicle with injuries. Cell phone service was not available and radio service was spotty. This heightened the stress for the secondary responders. The second ambulance transported the driver of the vehicle that hit the squad. No firefighters were injured. The two wheel drive ambulance was able to access the original off road scene and transported two patients.
You can never say with certainty what will happen next. Seat belts are always a great idea. Always try to safely position your vehicle on scene. Even with radio and cell difficulty relay to secondary responders that they must be aware of conditions and if there are or are not injuries to fire or EMS coworkers. Don't forget that the patients from the first 911 call need treatment too so call in as many units as you think that you might need.
Thursday, May 26, 2011
In 2001 I was working a one car MVC. I was first on scene and the only EMT. My patient was in critical condition and needed to be airlifted to the trauma center. the passenger seat was non-existant and all doors were locked. I had no access except for a small side window. By the time the chief arrived, he found didn't have a chain saw on the rescue to cut the tree off the top of the care (he was always moving stuff and not telling anyone and then would forgot about it). I was working as well as I could with my patient through the triangle side window of the new VW bugs. I was talking with the deputies when the chief called them over and asked them to help remove the rest of the tree off the car. While I was talking with the patient, the three of them threw a tree that was about 10' long and about 10" in diameter. It landed on my lower back. Even though they knew what had happened, they still wanted me to take care of the patient. I had to crawl over to her to oversee the packaging and thank-god the medic showed up. She was airlifted and I pretty much had to beg to go to the hospital for my injuries because the chief didn't want to fill out injury paperwork.
Be aware of what EVERY ONE is doing when they are working near you! When injured, you take care of yourself and pull yourself from the scene. You only injure yourself more and you can't take addequate care of your patient. When the chief is wrong...sometimes you have to tell him so!
Friday, March 4, 2011
February 24th, 2011 at approximately 2000 hours my department was dispatched for a single vehicle accident w/ unknown injuries or entrapment. Our rescue and an engine went in route within 2 minutes us being dispatched. we arrived on scene at the same time as the ambulance. Once on scene we found a single vehicle had run off the road, went airborne, hit a guide wire from a telephone pole, and the vehicle was resting in between 2 trees. the first problem we encountered was the guide wire that was hit actually was thrown in the air and had wrapped itself in the high tension lines above. All crews were informed of the issue. Once the vehicle was reached by our personnel, it was confirmed that the driver was entrapped. Crews from our rescue and engine worked to stabilize the vehicle and remove the roof. Once the roof was removed the patient was further stabilized, she was removed from the vehicle. While on scene the road we were working on was shut down by the local pd on one end and our squad had taken position at the other end of the road to divert traffic. In the middle of the rescue a second ambulance came into our scene at a high rate of speed and almost clipped our squad. The ambulance even ran over one of our cones that were up to shut the road down. Luckily our personnel were not in the way. The ambulance came with a driver only and had not called to our command for instructions so it was a surprise to us that it was coming.
We had learned multiple lessons from this call. We were informed from the electrical company that since the guide wire was made of metal; it could have caused the ground around the pole to be charred with electricity. Second lesson was that even knowing a road way is shut down; it doesn’t make it a safe zone from vehicles. The odd part of the whole call was that our station was holding a highway safety class at the time of dispatch.
Sunday, February 13, 2011
While I was working in the City of Philadelphia with an EMS transport company and I was sitting on our front bumper. There was a triple shooting no more than 30 feet from where I was standing I took cover behind our truck till a member of the PD said the scene was secured. At which time myself and my partner went over to render aid as we were getting ready to lift one of the victims on to our stretcher a witness to the shooting came over and started to stomp on our pts face no more them a foot from us.
No matter what the PD is saying if there is multiple victims and a lack of PD the scene is never safe. You need to keep your head on a swivel and communications from PD to EMS needs to be worked on.
Wednesday, February 9, 2011
Salina Kansas Fire Department crews where dispatched to a medical alarm for a report of a “male subject not breathing”. Upon their arrival crews were met by a female subject stating that she thought her boy friend was not breathing. The crew found a male subject seated in a recliner code blue. Crew members started patient care, and soon began feeling ill themselves. The crew exited the structure and collapsed outside. Additional units were dispatched to the scene, and Carbon Monoxide readings in excess of 800 ppm were detected inside the structure. In all 4 Fire Department personnel were treated and released for Carbon Monoxide exposure, 1 civilian died, and 1 civilian was admitted for further treatment.
Following post incident reviews the Department has place Carbon Monoxide detectors on the EMS initial response bags.
Fast forward 1 year.
Feb. 1st 2011 SFD crews were dispatched to a local vehicle dealership for a subject “Stumbling and sweating badly”. Upon their arrival crews entered the structure where they recognized the odor of vehicle exhaust, at basically the same time the Carbon Monoxide detector on their EMS response bag went into full alarm, the EMS crew quickly evacuated everyone from the structure and requested an Engine company for investigation. The engine company found Carbon Monoxide readings in excess of 500 ppm inside the structure. No Fire Department injuries occurred and all civilian patients recovered fully.
Take the proper protective equipment with you every time, even on the everyday medic run. You can not see deadly atmospheric conditions, a simple gas monitor can, and the cost vs. benefit is beyond comparison.
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