Trial By Fire

This is the story of my scariest day as an EMT, so far.  I was about two months into second rider time, so I was still pretty nervous whenever those radio tones went off indicating a 911 call.  My partner and I were posted at the edge of town, just sitting in a parking lot in the morning sun trying to stay awake.  We were planning on a typical day, filled with transfers to and from dialysis, a few minor responses, and maybe a psych call or two.  Then the fire radio lit up like a christmas tree with a voice urgently calling at least 3 trucks (2 engines and a ladder) to a house fire on the edge of town, right down the street from us.  We started punching the address into the GPS, my partner muttering to himself that “it should be close by.”  Our truck was dispatched seconds later, and as we swung the ambulance around to face the street, we saw thick black smoke billowing from a house just around the corner directly across the street from us.  We swore in unison, hit the lights and sirens, and scrambled to respond to both radios at once, reporting that we were practically on scene now.

As we rounded the corner, we saw a three story house with the top two floors complete engulfed in smoke with many of the windows already blasted out.  We parked our truck just as the engines roared down the street and the firefighters poured out like clowns out of a clown car.  It seemed like seconds and they had the hoses going, with guys shouting to one another, and ordered chaos everywhere we looked. Inside I was freaking out, heart hammering, mind racing.   Training kicked in, and I grabbed all the bags: the portable oxygen, the first-in, the c-spine, the AED (automatic external defibrillator). My partner got the stretcher and our fire helmets, and we ran down to the fire command post, basically a spot between two of the engines where the most senior firefighters were shouting orders.

“What have you got for us?” my partner asked?  “Anyone inside?”
One firefighter comes over as he helps straighten out a hose, “Yeah, neighbors think at least two people are home.  We know one of the guys who lives here. He’s a regular. Not sure if they’re home, though. We’ve got guys looking for them now. Standby.”

An eternity passed in a minute, then two.  Shouts came from the back of the house, and a man in fire gear ran out of the smoke billowing out of the carport.  “Follow me!  We’ve got a live one here!”
I looked at my partner, as if to say “He’s crazy, right? I’m not running into an effing cloud of smoke!”  My partner hesitated, then asked, “Can’t you guys bring him out here? We’ve got the bed set to go.”
The soot-covered firefighter shook his head curtly. “Naw, we’ve got another one to get inside. The carport’s safe, we took him down the back stairs, he’s pretty big, screamin like hell, he’s not coming quietly. Follow me.”

We looked at each other uncertainly, then, as we saw the paramedics running down the hill towards us, my partner charged resolutely into the black smoke, looking over his shoulder at me, shouting “Come ON!”  Then came the longest moment I’ve had in EMS. I stood stock still as the world and the fire raged on around me in slow motion, and I questioned what the HELL I was doing in such a crazy situation. Didn’t I work in a cheerful, sunny office a few months ago?  Don’t I hate fire? Why the ___ was I standing here in the ice and snow, about to risk injury or worse, to violate the first rule of EMS (scene safety), for a complete stranger? A stranger who’s in pain, and probably badly burnt, in need of help…. aw crap.

So I ran, like an idiot, without a helmet (my parter had it), up the icy driveway, into a thick black plume of smoke, climbed over snowbanks, around a rusting car, and tumbled headlong into the carport.  I tossed the bags to the ground, gasping, and looked around.  Two firefighters were trying to subdue a half naked bear of a man who was flailing and screaming, blindly trying to claw his way back into his burning house.  As my partner was setting up the backboard, the medics arrived behind us and helped wrestle the man to the ground.  I ripped open a large burn sheet and spread it over the backboard, and we started to secure the patient to the board, which proved difficult.  He had ripped off the oxygen mask several times, and I finally had to lay on one half of him, and a firefighter on the other, to subdue him.  We were all coughing and gasping in the smoky air, and we worked as close to the ground as possible, where the air was slightly better. One of the firefighters was muttering about how “we should all be wearing respirators for this shit.”  As the medics were quickly examining the patient head to toe, my partner strapped him down.  Just as they finished, the patient went silent and limp.
“He’s coding!” shouted the lead medic, and we all swore loudly. I started “bagging” him, forcing pure oxygen into his lungs at regular intervals. The rest of the crew struggled to lift the backboarded patient around the car and over the snowbank, and water rained down on us from the upper floors as we came down the driveway now littered with broken glass, singed siding, and roof tiles.  We threw the patient onto the stretcher and ran best we could up the hill, all the while trying to do CPR.  I never thought we’d get to the medic’s truck, parked up the hill and around a corner to make room for all the fire trucks now on scene.

As we all piled on board, I was finally able to breathe freely and see the patient clearly.  He was overweight, dressed only in a shirt that we promptly cut off him. He was bright pink with patches of red that looked like a blistering sunburn around his face, and he had welts over his arms, legs, and torso.  Black ooze was coming out of his nose and mouth, signs of severe smoke inhalation burns.  The scariest thing, the thing that still keeps me up some nights, were his eyes.  I don’t think I’ll ever forget them, fixed open, eyelids burned white and red, soot caking everything.

We continued CPR as we hooked him up to the AED and the paramedics started IVs and pushed cardiac meds to attempt to restart his heart.  We all rotated doing compressions and bagging him, but I was the one doing CPR on him at the hospital when the doctor called time of death.  We all moved over to the other trauma bed where the second tenant was also coding, but they lost her a few minutes later, her burns being much more severe.

We were sent back to the scene to be fire standby for the rest of the day, in case anyone was injured, or they found anyone else inside, neither of which happened.  It gave me the opportunity to process what had happened, to deal with things immediately, while drinking hot chocolate and talking to the experienced firefighters on scene.  People in these professions really have to look out for one another, and I’m grateful to all the guys who talked to me that day.  While this wasn’t the first patient I had lost, nor was it the first time I had done CPR, this call marked a shift for me somehow.  The medics now treat me with more respect, and I don’t get that jolt of fear when I hear the 911 tones on the radio.  I know more about myself, I know I can trust my training, and I know that I won’t turn tail and run, no matter how much I may want to, as long as there’s a patient who needs help.

What’s been a turning point for you in your career?  Post a comment below with your story.

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