Thursday, January 3, 2008  I am a full time firefighter/EMT for a moderately sized city (~125k population). At about 2am, I responded along with my partner on an ALS medic unit to a possible stabbing. We were advised upon dispatch that the patient had been stabbed in the abdomen. PD was already en route and we met on the road halfway there and he followed us in. The scene appeared secure and with the two PD officers watching over us, we went up to the house where the patient was. The patient was standing at the front door with nothing visible. We asked him if he had been stabbed and he said he had and pointed downwards. We told him we needed to see the wound whereas he pulled down his pants to show two lacerations to his genitals. This is not really all that pertinent but I am trying to set the scene a bit to explain where the "oh @#!&" comes in. He gave us a fabricated story of getting attacked by a group of guys on the street and somehow he got cut. Ok... now that being said, he agreed to transport after some dispute- he was under the impression we should stitch him right there in his living room. Needless to say THAT was not happening. Now while we were in the residence we never left the living room which was right inside the front door. The residence was completely quiet and as far as we (and PD) knew the residence was empty with the exception of this man, his adult son, and his grandson. After we moved the patient out of the house and into my MICU, the patient asked very politely that I check with his son to be sure he had his cell phone with him so he could be reached from the hospital. Not seeing any reason not to, I stepped out of the box and walked to the still open front door. As I climbed the steps, the PD officers drove off without a word to either me or my partner. Mistake #1. Now as I approached the door, the patient's son came around the corner and saw me. He looked a little startled and immediately ordered me not to take one more step. Naturally I stopped exactly where I was and explained what I was doing back on the front porch. Keep in mind that I am in a VERY poor and crime ridden area so my self preservation instincts are on full alert at this point. The patient's son tells me to stay where I am and he will check for his phone. While I am standing there (for all of 30-45seconds) I realize that there is a VERY inhospitable gentleman sitting on the couch just outside of my field of view holding the grandson and staring me down. That’s mystery guest #1 and he makes me extremely uneasy. I begin to start taking steps backwards and then I hear screams and a fight break out somewhere in the rear of this tiny house. I now hear 2 female voices for mystery guests 2 and 3. I start to pick up the pace of my retreat when a ghetto pit bull walks around the corner and charges me. Now when I say ghetto pit bull, I am referring to a pit bull that is obviously malnourished, its fur is all matted and gnarled up, and is deadly mean. Any of the readers who work in bad areas know exactly what kind of dog I am referring to. The dog charges across the porch as I take off at a dead sprint for my ambulance. I got lucky as the patient's son appeared just in time to snag the mutt before I became his new chew toy. I honestly don’t think I would have made it to the ambulance in time. I immediately called for PD back to the scene as I should have done as soon as they left and without waiting, transported my patient to the hospital. LESSONS LEARNED: Lessons learned: 1. Always keep in mind where you are and what you are responding to. I was in a particularly bad neighborhood of a particularly bad area... when even the gang bangers and crackheads avoid this neighborhood, its time you paid attention to it too. We don't have the luxury of avoiding it when we get a call but don't let yourself get complacent. 2. DO NOT EVER LET PD LEAVE YOU. I believed the scene to be secure and that the patient's son who I had spoken with earlier to be a non-hostile person. Wrong! He was only hospitable because PD was there... 3. When intimidating mystery guests pop up and you're alone without back-up, get the #$&@ out of there! A lousy cell phone was not worth my hide... I try to work with my patients but at 2am in that neighborhood without PD that was not a smart move on my part especially when I knew it to be an assault and most likely not the story given by the patient. 4. Retreat to your ambulance and/or to another area the absolute second you feel that the scene is not 100% safe. As soon as my instincts kicked in and said, "hey bud, look out something ain’t right" I should have turned around and walked away. I hope my experience here might help someone avoid this scare and especially avoid becoming some dog’s chew toy as I nearly did.  

Monday, November 26, 2007  ME10 arrived on scene of this TCEX to find a vehicle that had struck a pole. The incident was dispatched at 0136 on 11/23. The 3 high voltage lines and the pole were still intact, however, in the dark picture below you can see that all 3 lines were displaced from their insulators. One line dropped below the supports and contacted the pole itself. The alert crew observed smoke coming from the bottom of the pole and advised CHP bystanders and incoming units of the hazard. The excited PG  

Sunday, September 16, 2007  My son just got out of the hospital after a 3 day stay and being sick for a week before that due to a water rescue call. He responded to a drowning in Lake Michigan of Pleasant Prairie Wisconsin. About 72 hour later he started having vomiting, diarrhea and severe stomach pain. They treated him with oral antibiotics after a check and tests in the ER. He seemed to be improving some, but on Monday evening he got much worse, went back to the ER where after more testing he was admitted with the Drs. doing a lot of head scratching. After more testing he was not improving until they started IV antibiotics that seemed to make the difference. The lesson to be learned here is to limit exposure time and have a decon shower set up to use when leaving the water. Do not let anyone eat or drink before being deconed. There were others on the call that did not get ill and some that did. The divers that did not get ill were all wearing full dry suits and rinsed when exiting the water. The others were not exposed as long.  

Friday, September 14, 2007  This past Sunday, My small local volunteer Department from LI New York responded to a call for an unresponsive male. The first arriving chief found a male about 30 years old laying on his bedroom floor. His family stated he had been drinking the night before and taken some prescription medications for pain. After examining the patient we made the desicion to bring the pt down from the second floor on a reeves strecher.As soon as the pt was moved over to the reeves but before he was tied down he caught everyone of gaurd when he became extremely violent. Thankfully two of the Counties finest were on the scene to help restrain the patient but this took 2 police officers and 4 firefighter/ems personnel. To make things worse the patient was kicking, punching and SPITTING the entire time and was covered from head to toe in poison sumac. LESSONS LEARNED: 1.Full PPE is not just for fire calls. Gloves, mask with face shield and even gowns should be readily available for all rescue crews. 2. Never get complascent. Even a typical type rescue call can turn violent in just a split second with prevocation.  

Monday, September 3, 2007  On Memorial Day of this past year I was working an overtime shift during the day at a station not far from my normal station. At about 730am we were alerted with the engine and EMS supervisor for a person shot at a nearby golf course. The comments advised that the caller had found a person that had been shot, and gave the caller's description, he was going to meet us top direct us to the patient. After a bit of confusion as to where on the course the person actually was, and what entrance to use, we proceeded up a small access road bordering the gold course with a police officer behind us. We came out of the woods into a small clearing with a small pond to my side of the ambulance. On the other side of the pond, about 30 ft away, I could see a person matching the caller's description waving to us. We go the ambulance turned around to be able to make for a quick exit, and since wwe would not be able to drive to the other side of the pond, I advised my partner to stay with the unit, and I would radio to her where the patient was supposed to be. As I got out of the ambulance I noticed the police officer had met up with the caller, but had stopped about 10 feet from him and was talking to him. The officer then took 2 slow steps back as he waved his hand in the air. I couldn't figure out why he was waving at the caller to back away. The officer then drew his weapon pointing at the caller. I then realized that the "caller" had a gun as well. I immediately told my partner the subject had a gun, and to come to my side of the ambulance (the "safe" side). I immediately advised dispatch to tell all units to stage where they were, that the police had the subject at gunpoint and we were taking shelter behind the medic unit. The came back about 3 minutes later advising all units enroute to the golf course that police had a subject at gun point and we should stage. We both spent about 30 mins huddled behind the rear tire of the medic (since the thin skin of the medic most likely wouldn't stop a bullet). The reality of the situation hit when there was one officer with his shotgun on the hood of the medic, and 2 other officers with M16s over their trunk behind the medic. The subject was talked into surrendering, and was taken into custody without incident. He was calm, his suicide note stated that he wanted the police to be there when he shot himself to recover his pistol so no one would find it and possibly get hurt. He had no magazine in the weapon, just one round in the chamber. He apparently called 911 using the ruse that he had found a subject shot to get the police there. LESSONS LEARNED: I let the facts of the call distract me: 730am, subject shot on the golf course. I figured maybe the victim had been shot earlier, and had just been found. LUCKILY a very alert officer was right with us, 2 minutes plus or minus and I would have been walking right with him. He saw the man put a hand behind his back and draw his weapon, and waved at us to back off as he drew his. Regardless of the details surrounding a call, never forget to keep your eyes and ears open and be suspicious of EVERYBODY. My first instinct was right, a shooting at 730 on the golf course was strange. Get your police dept to teach a few classes on situational awareness, and how to recognize people at risk for violence. EVERYBODY GOES HOME!!  

Sunday, August 5, 2007  Earlier this morning at 10:25, Medic Engine 75 responded to a medical call in Muscoy. Upon their arrival, CPR was being performed by family members and a deputy sheriff on a 54 year-old female hospice patient. Firefighters assumed CPR to no avail, and the victim was pronounced deceased. About 15 minutes later, the 19 year-old son arrived at to the residence. Upon learning of the death of his mother, the son attacked firefighters. The suspect began head butting and striking the Engineer. The Captain & Firefighter went to the rescue of their fellow firefighter. During the altercation, all four individuals were thrown against a window of the house. The deputy on the scene was able to tazer the subject, and with firefighter assistance, the suspect was taken into custody. The three firefighters were then transported to Loma Linda University Medical Center by AMR ambulance. The Captain received a laceration to his right inner arm (from window glass) nicking an artery which required stitches. Captain Schaefer is being released from the hospital. The Engineer received a large laceration to the top of his head requiring stitches from being head butted. He also received several facial lacerations. The Engineer will be staying at the hospital for further observation and treatment. The Firefighter received bruising to back of his head, and severe bruising to his back. The Firefighter has been released from the hospital. All three firefighters have expressed their appreciation for your concern and for your prayers. LESSONS LEARNED: This turned from a routine medical call to a life threatening event in a few seconds. Wish I could offer something more than be aware of what's happening around you.  

Thursday, July 26, 2007  Early morning our Engine and a paramedic were dispatched for the "unknown in a car" police on scene. it was 2.5 blocks from the firehouse and the driver mentioned he drove by there 20 minutes prior and the police were there then. We pulled up and got out, my side of the engine was closest to the car, I went to the vehicle and my partner went to get the EMS equiptment. As I approached the car the male was unresponsive but breathing and the medic units siren could be heard fast approaching. I asked the cop what was up he shook his head and mumbled with the I don't care body language. I began to arouse the patient with more agressive stimuli as the paramedic pulled up. I relayed it may be a diabetic and went to the passenger side of the car to get vitals and make room for the paramedic. The paramedic then gave odor stimulation to the patient as I was entering the passenger side of his car. The patient immediatly began to come to and motioned as to get out of the vehicle. He kept reaching for his right side coat pocket. As he pivoted his body out of the car he put his hand in his pocket, I noticed the but(clip & handle section) of a .45 cal semi auto. I yelled to the cop who had been there more than 30 min now and made the motion with my fingers (of a gun)and mouthed the word gun twice. Well the flat foot didn't move until it became a struggle inside the passenger compartment for the gun. End result the man was dissarmed. When the cop was shown the actual gun he decided to get involved and placed the man under arrest. "later findings" the man had fallen into an induced sleep awaiting a women who was the only wittness to him(yes our patient was out on bail) shooting another man. He was two doors down from her house and had a trial date later that month which would have put him under the "three strike rule". The police found a cache of weapons in the trunk. Lessons Learned: Always were rubber gloves on EMS calls. This was the only thing that got him convicted, no one elses prints on the weapon. AND it is a barrier for disease! * Situational awareness is PARAMOUNT!!! The first call or the 25th call of the day LOOK FOR SHIT....I've been on too many calls where the deck is stacked against us and the info doesn't come across of a past psyc history all calls are "SICK Person" according to the dispatcher and there is a carving knife on the table * Stay in shape the gun was taken away with force had the man been stronger, more awake or the fireman been weeker the next call would have been for 2-medics 4-fireman and 1-cop down. * Don't trust anyone to do their job completely. It's never DONE until it's over and we all go home or retire.  

Wednesday, July 25, 2007  Early morning our Engine and a paramedic were dispatched for the "unknown in a car" police on scene. it was 2.5 blocks from the firehouse and the driver mentioned he drove by there 20 minutes prior and the police were there then. We pulled up and got out, my side of the engine was closest to the car, I went to the vehicle and my partner went to get the EMS equiptment. As I approached the car the male was unresponsive but breathing and the medic units siren could be heard fast approaching. I asked the cop what was up he shook his head and mumbled with the I don't care body language. I began to arouse the patient with more agressive stimuli as the paramedic pulled up. I relayed it may be a diabetic and went to the passenger side of the car to get vitals and make room for the paramedic. The paramedic then gave odor stimulation to the patient as I was entering the passenger side of his car. The patient immediatly began to come to and motioned as to get out of the vehicle. He kept reaching for his right side coat pocket. As he pivoted his body out of the car he put his hand in his pocket, I noticed the but(clip & handle section) of a .45 cal semi auto. I yelled to the cop who had been there more than 30 min now and made the motion with my fingers (of a gun)and mouthed the word gun twice. Well the flat foot didn't move until it became a struggle inside the passenger compartment for the gun. End result the man was dissarmed. When the cop was shown the actual gun he decided to get involved and placed the man under arrest. "later findings" the man had fallen into an induced sleep awaiting a women who was the only wittness to him(yes our patient was out on bail) shooting another man. He was two doors down from her house and had a trial date later that month which would have put him under the "three strike rule". The police found a cache of weapons in the trunk. LESSONS LEARNED: *Always were rubber gloves on EMS calls. This was the only thing that got him convicted, no one elses prints on the weapon. AND it is a barrier for disease! * Situational awareness is PARAMOUNT!!! The first call or the 25th call of the day LOOK FOR SHIT....I've been on too many calls where the deck is stacked against us and the info doesn't come across of a past psyc history all calls are "SICK Person" according to the dispatcher and there is a carving knife on the table * Stay in shape the gun was taken away with force had the man been stronger, more awake or the fireman been weeker the next call would have been for 2-medics 4-fireman and 1-cop down. * Don't trust anyone to do their job completely. It's never DONE until it's over and we all go home or retire.  

Monday, April 9, 2007  My partner and I first responded on our truck for a person possibly in cardiac arrest. We noticed that we had been to this house before for bad domestic calls. We arrived the same time the police did and started cpr on our patient. Our ambulance arrived and we transported the patient to the local hospital. My driver went with the ambulance as a 3rd person for cpr. I stayed behind and finished cleaning up the scene. I went into the house to find the police and mother of the patient shouting at each other. Then I realized that the police had found multiple weapons hidden on the couch the patient was laying on.The guns were hidden within reach of the patient on the couch. Even the cops were surprised at what they found.All guns were registered and kept at the house. LESSONS LEARNED: DON'T GET COMPLACENT! Have the police do their job and keep the scene secure. Don't take threats for granted. Treat every call as the person is out to get you. There is that fine line on being friendly to the patient but cautious also.  

Saturday, March 31, 2007  We responded to a call for a male who was short of breath. We routinely have a district police car respond to all calls, and we "stage away" until cleared by police for calls suggesting violence, drunks, etc. In this case we arrived before the police officer and there was no information suggesting an "unsafe" scene. My partner and I went into the basement gameroom, as directed by dispatch. We found our patient sitting on a chair in his residential basement, using an Albuterol inhaler. He appeared to be in significant respiratory distress. We began our interview, listened to breath sounds, took his blood pressure.....then the officer walked in the door. As I waved him off stating we would be OK.....he looked at me and the patient with a quizzical expression and asked "why is he wearing a gun"? Strapped to his hip was a holstered 380 automatic pistol. The patient immediately stated he had a permit to carry, and he owns a jewelry shop, and is armed because he frequently makes bank drops of loads of cash as well as transporting lots of inventory. The police officer removed the weapon for the transport at the patient's request. What is really bad about this close call is that my partner and I missed a gun....a painfully obvious gun at that.... LESSONS LEARNED: 1. There is no such thing as a "routine" ambulance call! 2. Consider guns and other articles that can be used as weapons to be everywhere 3. Avoid tunnel vision...even though it turned out our patient did not mean us harm, and the gun was lawfully carried, we tunneled in on the respiratory distress and missed an obvious weapon.  

Friday, March 2, 2007  I was on a medic unit and got dispatched to a man not breathing under a mobile home. The first responders made scene about 4 minutes before we did. Two men were under the mobile home trying to get a male patient (about 250lbs and 70 years old) out from a confined space. He was in "full arrest". I crawled under and assisted. I used a simple bedroom knot on rescue rope to drag the patient out. While we were dragging the patient out a responder noticed a wire that the patient was laying on. The wire was not seen before this time. We noted it and continued to move out with the victim. When we reached the outside and began CPR, I noticed that he had two, what appeared to be electrical, burn marks on his arm. We checked the breakers that had been tripped. It appears he was under the house doing some electrical or plumbing work when he cut into a 220V wire and was shocked. We transported to the hospital where he was later pronounced dead. LESSONS LEARNED: When I arrived I did not consider the fact of a confined space or that the house may still have power. There were no obvious chemicals or animals (i.e. snakes). I also saw some first responders and ASSUMED that they had secured scene safety. The biggest lesson learned is scene safety is on-going and must be re-evaluated.  

Friday, January 12, 2007  At approximately 02:25 Hrs on January 1, 2007 Rescue 1 and Truck 3 responded to what is normally a routine call for a report of a stuck occupied elevator. I am the Lieutenant of Rescue 1 and was in charge of rescue operations. My crew consists of myself, my driver and two firefighters, Truck 3's crew consisted of a Lieutenant, a driver, and two firefighters. The following is a synopsis of the occurrences that took place and the actions that were taken by units operating: Both units arrived on the scene and investigated. Upon arrival units encountered several hundred intoxicated people in the lobby area, making operations difficult. Upon arriving at the stalled elevator car it, was found to be stuck between the first and second floor. Rescue 1 attempted to recall the adjacent elevator with Firemen's Service but the elevator car stopped at the designated floor opened approximately 8-12 inches and proceeded to the basement level where it became non-operational. Members could not get the car out of Firemen's Service or get it to move anywhere. This rendered both elevator cars out of service. During initial operations a large fight broke out in the lobby of the hotel, no FD members were involved, but this delayed operations for a short period of time. Rescue 1 requested PD to the scene, Code 2. PD arrived and dispersed most of the people in the hotel lobby area. Truck 3 proceeded to the elevator control room penthouse located on the roof to shut down power to the stalled car. Rescue 1 attempted to make contact with individuals inside elevator to determine if there was any medical emergency but was unable due to the noise from the large group of people both in the elevator and in the lobby. Rescue 1 requested EMS respond to the scene for a stand-by. One person in the elevator notified Rescue 1 there were no injuries in the elevator; EMS was told to respond with traffic at this time. Access to the elevator car was delayed due to there being no keyhole on the second floor. The decision was made to make entry by placing a ladder on top of the adjacent lower car and raising it to the top of the occupied stalled car and remove victims via the roof hatch. At this time Truck 3 shut down power to both elevator cars. A person inside the elevator car then stated there was an unconscious party inside the elevator, a pregnant female having difficulties, and a party having an asthma attack. Rescue 1 requested EMS to the second floor. Two firefighters from Rescue 1 entered the elevator shaft to affect rescue of these patients. The first firefighter on top of the cars initial action was to shut down the “run box” on top of the elevator car. Shortly after the two firefighters got on top of the elevator car the elevator car fell 2 stories to the basement level. The second firefighter on the car was able to jump from the top of the elevator car back into the lobby. The other firefighter rode the car down to the basement level where the car came to rest against the buffers. There were no injuries. FD personnel proceeded to the basement level and removed a semi-conscious party having an asthma attack from the elevator. No other patients were found. Approximately 16 people were removed from the elevator. EMS personnel responded to basement level as well. The patient’s mother was extremely distraught and would not allow access to the patient by FD or EMS personnel. The mother became combative when members attempted to treat the patient. The mother was a danger to both Fire personnel and the patient. Rescue 1 requested PD to the basement level. PD forcefully removed mother from the area. EMS assumed patient care. FD assisted with packaging the patient for transport. The elevator repair company arrived and stated they could not make repairs at this time and left the scene. Truck 3 locked-out/tagged-out both elevators. The hoist way door on the second floor left elevator was broken during rescue operations. Rescue 1 and Truck 3 were able to secure door to prevent any fall hazard. No further FD action taken. All units returned to service. The purpose of this memo is to make as many firefighters as possible aware of the potential for injury/death while operating at these incidents. What may initially appear to be a “routine” call can change very quickly and become a dangerous situation. The following were unique factors encountered that contributed to the complexity of this call: 1.The elevator car was overloaded. During initial operations FD personnel were unable to communicate clearly with those inside the elevator. Once the elevator was opened approximately 16 people were removed. When the additional weight of the firefighters was placed on top of the elevator car, one of two things happened. First the brakes may have failed allowing the car to fall to the lowest level. Secondly the cables which support the elevator may have pulled through the pulleys and allowed the car to drop. This building was under order from the State to repair the cables, as they were rusted and undersized for the elevator system. 2.The elevator operated with a battery back-up so even though the main power supply was shut down to the elevator motor, it was still receiving electricity from a battery back-up. 3.Due to the large fight and other suspicious activity FD personnel had to stay clear of certain areas of the building at times. 4.Due to the unusual circumstances encountered the number of tasks that needed to be performed exceeded the resources on scene. LESSONS LEARNED: 1.Try to determine the number of occupants as soon as possible by either observing yourself or from a credible person inside the elevator. 2.When shutting down power to the elevator, make sure ALL power has been turned off including the main shut off and any other back-up/auxiliary power supplies. 3.If the amount of tasks needed to get accomplished exceeds your resources on scene, call for more, whether it be for the Deputy Chief or another Engine or Truck Company. 4.Trained personnel must rig overloaded or compromised cars. If no FD personnel on scene are trained in this skill, crews must await the arrival of the elevator repair technician. Due to the factors listed above, what was encountered was a technical rescue, not just a routine elevator call. All personnel should be aware of what is out there and never feel that “this won’t happen to me”. Always heir on the side of caution and remember that OUR SAFETY COMES FIRST.  

Thursday, January 4, 2007  Over 5 years ago, I was injured on the job as a part-time medic. I was in the back of an ambulance, being driven by a volunteer, that was to be going to the hospital, priority 3 which in our case is no lights, no sirens, and obey traffic laws.(I later found out she had the lights on, but nothing else and was stopping at traffic lights and sitting in traffic)(it was a misunderstanding on her part of what priority 3 meant). While on a straight stretch of road my patient complained that the automatic blood pressure cuff was bothering her arm. I moved from the bench seat to the CPR seat, removed the cuff and placed it back on the counter. The patient was sitting on the cot with the back in a full upright position. Once I finished with the patient, I stood to walk back to the bench seat. Just as I stood to walk around the stretcher, I was twisted at the waist and thrown over the top of the stretcher, with my right arm coming down on the pillow behind the patients head. I took the top corner of the cot in my right lower abdomen and my right knee struck the upright for the head of the cot. I asked what happened and the driver said that she hit a bridge joint (never got the truth, too much force involved for a bridge joint). We continued transport and turn over of the patient. After I got back to the station, I realized how much my knee hurt. By the time I got home my knee was quite swollen. I was taken by ambulance to the hospital that night and released to see an orthopedic. Long story short, I suffered a blunt trauma to my right lower abdomen forcing the SI joint out of wack. I had surgery to put pins in my pelvis to hold it in place with a bone graft about 1 1/2 years after the injury. I continued to have problems and had exploratory orthoscopic surgery on my knee after two clean MRI's, to find out that I have a partially torn ACL (anterior cruxiate ligament). I had that surgery almost 4 years after the injury. I rarely wore a seat belt in the back of the unit. But after this incident ending my ability to be in the back on an ambulance, I have thought about alternative restraint systems that would allow patient care, including CPR compressions to be performed, while still protecting the EMS personnel. I have never put thought to paper though, an come up with a viable solution. I have been wanting to tell my story, more than just locally, because no one seems to notice the significance of the incident on EMS safety. I suffered a career ending injury in the back of an ambulance without it being involved in an automotive accident with a another vehicle or fixed object. It was purely driver error. I often wonder how many other people have suffered injuries from incidents such as this? You only hear about the crashes. LESSONS LEARNED: My lesson learned should have been to pick a seat and stay in it. However, if I had reached over the patient to take off the cuff, both the patient and myself could have been injuried.  

Saturday, December 2, 2006  One of the Lts on my shift called me to his scene because a FF was accidentally stuck by a needle from a mark-1 kit auto-injector. After 9-11, a lot of us have these "failsafe" kits on our units. Everyone needs to know that they can discharge accidentally - the syringe came loose and free of it's base; possibly from jostling in the truck. The kit outer case is made from soft foam and the FF's hand brushed against it in the compartment under the LT seat while getting chalk to mark an accident scene. We give those auto-injectors to people experiencing "sludgem" due to neurological agent release. The medicine dries them out, and stops the "sludgem" but on a "healthy" body, the med dries it out from the inside out. The "C" chemical auto-injector shot through his fingertip, apparently ricocheting off the bone. The needle bevel was bent and the needle itself was bent. The FF pulled the needle out as soon as he realized what happened. Thankfully, the FF and Paramedics on the scene "milked" the finger to get some product out before it could be circulated and absorbed. Additionally, since the tip of the finger was injected, only the wrist and hand seemed to be affected. The hand looked so dried out, it appeared frost-bitten. The tip of the finger took in 2ccs of fluid that is meant to be injected into a large muscle. It is a known fact that the agent causes severe pain at the injection site. The firefighter's finger was x-rayed for fracture, but none was found. He was kept overnight for observation because delayed effects of the medication include bronchospasm and muscle rigidity. He did well in that regard, but experience excruciating pain at the injection site and the finger remained bulbous for several days. No amount of pain medication seemed to ease his pain. He was discharged the next day and returned to full duty his next shift. This was a scary event due to the lack of knowledge by responders and emergency room personnel about the effects of this auto-injector on a healthy body. Every person (doctor) we called for assistance that morning expressed an "oh no" attitude. Thankfully, one of our medical directors is on a USAR team and was well versed in the side effects of the medication. Back at the fire department, we took immediate steps to secure all of the injection kits in rigid plastic containers. We also checked the discharged kit for defects and found that the syringe had come off of it's "safety" base, enabling discharge with any pressure to the end of the syringe. Once the emergent nature of the call calmed down, the department Chaplain was called to the hospital to help out the FF and his wife. Due to the many unknowns, this was an extremely stressful situation for both the affected FF and the crews that worked on him. LESSONS LEARNED: We all must absolutely know what we carry on our units, to include side-effects, antidotes, and proper handling procedures. Nothing had ever come out suggesting we couln't store the kit as it was, and we were convinced it was failsafe. Additionally, for something so volatile and obscure, we should have definitive guidelines on how to handle an accidental discharge. We also learned that neither poison control nor the emergency room personnel had any knowledge about this kit's medications. We are following-up with a written guideline for any similar incident that will be placed in the emergency room. Another lesson learned is that if you have received information from your medical director on the seriousness of the incident, and the hospital staff doesn't seem to take things as seriously as you would feel comfortable with, leave one or two paramedics in the ER with the injured FF until the critical time has passed. Chances are very high that a field paramedic on a special operations team (as both were)will know a lot more about these agents than an emergency room doctor or nurse, and they can be of valuable assistance. One more lesson is that a good working relationship with your medical director is essential and invaluable, as is a good relationship with your Chaplain.  

Sunday, November 19, 2006  While conducting a extrication training class and cutting relief cuts above the front tire/fender area to prepare for a dash roll. The student made a cut above the passenger side front fender on an older vehicle and cut through the hood pressurized cylinder causing the flood to release and spray onto the helmet shield which was down and protected the students eyes. Knowing this was a possibility on the drivers side we decided to attempt to pry the cylinder off of the hood using the spreader tips. While spreading between the side of the hood and the cylinder a loud pop ensued causing the cylinder to seperate and shoot the loose end off into the parking lot located next to the fire station and we were unable to locate it and have know idea how far it traveled. LESSONS LEARNED: 1. Always ensure your firefighters have all of their PPE on including eye protection. 2. Be very cautious working around pressurized cylinders whether on the hoods or hatchbacks of a vehicle.