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Firefighter Intern: Day 61 and 62
Feb. 9th, 2019 03:57 pmLife has many ways of testing a person's will, either by having nothing happen at all or by having everything happen all at once. - Paulo Coelho
I got to the station a bit early for some reason and got a breakfast burrito at a local coffee shop, because - somehow - I knew something was going to happen. Shortly after 8 am, we were toned out in Rescue 481 for a traffic accident but we were recalled before we got out of town.
Once we were back to the station, we had just a few minutes time for a few rig checks, and then we were toned out on Engine 481 for a pretty bad two-car accident. No one was seriously hurt, but there was a lot of me practicing traffic management and putting down absorbent and carrying Hurst extrication tools and taking vitals of the drivers and moving apparatus around the accident scene. Then we had a transport of a confused gentleman with some serious cellulitis to his leg, and we loaded him and made him comfortable. I took several sets of vitals, both with the monitor and by palpation, and managed his gurney while the paramedics gave report.
We responded after dinner for a public assist for a suspicious person who was reported to have passed out behind their vehicle, but they quickly woke up and drove away when we arrived. We suspect that they may have been using substances but we couldn't be sure, and they drove away before we could get a law enforcement unit to respond.
Then as we were getting ready for bed, and I was studying diabetes and altered mental status for my EMT midterm, we were toned out for what turned out to be a 70-year-old man with dementia who was missing and who may have fallen into the water. It was below freezing, dark, and colder in the water - so we ran Code 3, arriving in Medic 483 and Heavy Brush 481. I helped the water rescue firefighters get their gear ready and helped assemble the inflatable boat. The Deputies also at the call found the gentleman, and we went from a rescue situation to a recovery situation. After the Deputies and the Water rescue team retrieved the body in the Stokes Basket, we transported to a local mortuary. After the Deputy Medical Examiner completed his evaluation and also found a bottle of alcohol in his pocket, we transferred him to a body bag and helped the mortuary staff get him into their cooler. Once we got back, well after midnight, I hosed down the muddy and wet Stokes Basket and we got Medic 483 back in service.
Fortunately, we had no calls all night and we actually got a few hours of sleep. I was up on the extra bed upstairs, so I didn't get that good of quality of sleep. We got up for the 8 am meeting, most of which was a discussion of the weather patterns and the several inches of snow expected in the area by nightfall. We know that our traffic accident, medical, and rescue calls go up quickly so we set up our own EOC (Emergency Operations Center) to triage/prioritize calls coming in from C-COM, and spent the afternoon installing chains on Rescue 481, Medic 483, and Engines 481 and 488. We also sent out a couple of folks to the Delena Substation to get chains on Engine 486 and Medic 482. I pulled my turnouts off Medic 483 and racked them because I knew I could be responding in any of the apparatus, and having my turnouts more centrally located would buy me a few more seconds to prepare, and also allow them to dry out a bit.
And then it began. The snow started coming down hard before we finished getting Engine 481 up on the ramps so we could get the chains on the drive tires, and then the calls started coming in all over the county. We picked up three traffic accidents in a row, but fortunately, we didn't have to transport anyone. We took vitals and administered First Aid and depleted Medic 483 of bandaids, but all three of our calls refused transport. Our station has a state highway running through it, and we are responsible for a good chunk of that highway - and that's where our calls run.
We finally got to bed after midnight - but we were up at 4 am for a call in Engine 481 for a report of a woman trapped in her mobile home because her awning was full of snow and had collapsed. So, there we were, in full turnouts, in the dark, with the trash hook, clearing snow at a trailer park. *grin* We cleared off her awning, and her neighbor (who is well known to us), and cleared. By the time we got just gotten back to bed, we were toned out again for another 'regular' who was having trouble breathing, as well as some substance and mental health issues. Her caregiver was also having a 'vertigo attack', so we transported them both to the hospital. The paramedics took the difficulty breathing patient, and I took the caregiver to the hospital triage/lobby. After that, I met up with my crew, cleaned the gurney, loaded and restocked Medic 483 - and then it was far too late to get back to bed.
I went off shift and drove in the direction of home slowly, due to the snow and weather conditions. I, fortunately, got a homemade breakfast with Pepper on the way home, and more coffee, and made it home safely - where I took a three-hour nap. *smile*
A Stokes basket is a rescue stretcher. Created as a high-density polyethylene shell supported by a permanently attached heavy-duty aluminum frame, this rescue basket is ideal for moving a casualty or patient to safety in most types of rescue situations.
Reporting
1. Eye contact—When handing over patient care, responsibility and information, it is critical, especially during team-to-team transfers and when receiving clinicians are multitasking, to begin by making eye contact with the person to whom the patient is being transferred. This helps identify that the handoff is beginning, which individuals are reporting and receiving, and sends the message that “We are communicating now, you and I.”
2. Environment—Whenever possible try to minimize noise, interruptions and distractions. For example, momentarily turn down a radio, stop nonpriority activities or move to a quieter area to give your report.
3. Ensure the ABCs—If there’s priority critical care that must be initiated or continued, this must be immediately conveyed to and addressed by the receiving clinician or team. These include lifesaving interventions that are needed immediately (for example, placement of a chest tube) or must be continued (for example, CPR) for the patient’s survival. The receiving clinician should either direct the reporting provider’s team to continue care during the handoff report or direct the receiving team to take over the priority task. The receiving clinician must then continue to take the report in order to establish the mental model or “big picture.” If this is not done properly, the receiving team risks starting over from scratch, losing valuable patient care progress made by EMS or, worse, jumping from one critical issue to the next as they are discovered with little coordination and prioritization.
4. Structured report—There are numerous standardized report formats with countless variations, from the widely used SBAR to ATMIST, PACE, the 5 Ps, I-PASS and more. Mission-critical communications research has shown the use of a structured format greatly improves efficiency and reduces errors, but little evidence shows any one system is better than another. The important point is to pick a structured format and use it, preferably one familiar to both reporting and receiving providers.
5. Supply documentation—The verbal report should consist of the patient’s priority issues, prior care, current state and immediate needs. Numerous other details should be transferred on paper or by electronic report. Avoid clouding the handoff with information that’s not immediately critical.
I got to the station a bit early for some reason and got a breakfast burrito at a local coffee shop, because - somehow - I knew something was going to happen. Shortly after 8 am, we were toned out in Rescue 481 for a traffic accident but we were recalled before we got out of town.
Once we were back to the station, we had just a few minutes time for a few rig checks, and then we were toned out on Engine 481 for a pretty bad two-car accident. No one was seriously hurt, but there was a lot of me practicing traffic management and putting down absorbent and carrying Hurst extrication tools and taking vitals of the drivers and moving apparatus around the accident scene. Then we had a transport of a confused gentleman with some serious cellulitis to his leg, and we loaded him and made him comfortable. I took several sets of vitals, both with the monitor and by palpation, and managed his gurney while the paramedics gave report.
We responded after dinner for a public assist for a suspicious person who was reported to have passed out behind their vehicle, but they quickly woke up and drove away when we arrived. We suspect that they may have been using substances but we couldn't be sure, and they drove away before we could get a law enforcement unit to respond.
Then as we were getting ready for bed, and I was studying diabetes and altered mental status for my EMT midterm, we were toned out for what turned out to be a 70-year-old man with dementia who was missing and who may have fallen into the water. It was below freezing, dark, and colder in the water - so we ran Code 3, arriving in Medic 483 and Heavy Brush 481. I helped the water rescue firefighters get their gear ready and helped assemble the inflatable boat. The Deputies also at the call found the gentleman, and we went from a rescue situation to a recovery situation. After the Deputies and the Water rescue team retrieved the body in the Stokes Basket, we transported to a local mortuary. After the Deputy Medical Examiner completed his evaluation and also found a bottle of alcohol in his pocket, we transferred him to a body bag and helped the mortuary staff get him into their cooler. Once we got back, well after midnight, I hosed down the muddy and wet Stokes Basket and we got Medic 483 back in service.
Fortunately, we had no calls all night and we actually got a few hours of sleep. I was up on the extra bed upstairs, so I didn't get that good of quality of sleep. We got up for the 8 am meeting, most of which was a discussion of the weather patterns and the several inches of snow expected in the area by nightfall. We know that our traffic accident, medical, and rescue calls go up quickly so we set up our own EOC (Emergency Operations Center) to triage/prioritize calls coming in from C-COM, and spent the afternoon installing chains on Rescue 481, Medic 483, and Engines 481 and 488. We also sent out a couple of folks to the Delena Substation to get chains on Engine 486 and Medic 482. I pulled my turnouts off Medic 483 and racked them because I knew I could be responding in any of the apparatus, and having my turnouts more centrally located would buy me a few more seconds to prepare, and also allow them to dry out a bit.
And then it began. The snow started coming down hard before we finished getting Engine 481 up on the ramps so we could get the chains on the drive tires, and then the calls started coming in all over the county. We picked up three traffic accidents in a row, but fortunately, we didn't have to transport anyone. We took vitals and administered First Aid and depleted Medic 483 of bandaids, but all three of our calls refused transport. Our station has a state highway running through it, and we are responsible for a good chunk of that highway - and that's where our calls run.
We finally got to bed after midnight - but we were up at 4 am for a call in Engine 481 for a report of a woman trapped in her mobile home because her awning was full of snow and had collapsed. So, there we were, in full turnouts, in the dark, with the trash hook, clearing snow at a trailer park. *grin* We cleared off her awning, and her neighbor (who is well known to us), and cleared. By the time we got just gotten back to bed, we were toned out again for another 'regular' who was having trouble breathing, as well as some substance and mental health issues. Her caregiver was also having a 'vertigo attack', so we transported them both to the hospital. The paramedics took the difficulty breathing patient, and I took the caregiver to the hospital triage/lobby. After that, I met up with my crew, cleaned the gurney, loaded and restocked Medic 483 - and then it was far too late to get back to bed.
I went off shift and drove in the direction of home slowly, due to the snow and weather conditions. I, fortunately, got a homemade breakfast with Pepper on the way home, and more coffee, and made it home safely - where I took a three-hour nap. *smile*
A Stokes basket is a rescue stretcher. Created as a high-density polyethylene shell supported by a permanently attached heavy-duty aluminum frame, this rescue basket is ideal for moving a casualty or patient to safety in most types of rescue situations.
Reporting
1. Eye contact—When handing over patient care, responsibility and information, it is critical, especially during team-to-team transfers and when receiving clinicians are multitasking, to begin by making eye contact with the person to whom the patient is being transferred. This helps identify that the handoff is beginning, which individuals are reporting and receiving, and sends the message that “We are communicating now, you and I.”
2. Environment—Whenever possible try to minimize noise, interruptions and distractions. For example, momentarily turn down a radio, stop nonpriority activities or move to a quieter area to give your report.
3. Ensure the ABCs—If there’s priority critical care that must be initiated or continued, this must be immediately conveyed to and addressed by the receiving clinician or team. These include lifesaving interventions that are needed immediately (for example, placement of a chest tube) or must be continued (for example, CPR) for the patient’s survival. The receiving clinician should either direct the reporting provider’s team to continue care during the handoff report or direct the receiving team to take over the priority task. The receiving clinician must then continue to take the report in order to establish the mental model or “big picture.” If this is not done properly, the receiving team risks starting over from scratch, losing valuable patient care progress made by EMS or, worse, jumping from one critical issue to the next as they are discovered with little coordination and prioritization.
4. Structured report—There are numerous standardized report formats with countless variations, from the widely used SBAR to ATMIST, PACE, the 5 Ps, I-PASS and more. Mission-critical communications research has shown the use of a structured format greatly improves efficiency and reduces errors, but little evidence shows any one system is better than another. The important point is to pick a structured format and use it, preferably one familiar to both reporting and receiving providers.
5. Supply documentation—The verbal report should consist of the patient’s priority issues, prior care, current state and immediate needs. Numerous other details should be transferred on paper or by electronic report. Avoid clouding the handoff with information that’s not immediately critical.
