Monday, February 05, 2007

The Apartment Fire

It was about 9am, on a quiet morning just before the winter holidays. I was driving. My co-trainee rode shotgun. Our field training officer (FTO) sat in the jump seat in back. We were headed for a station in the southeast part of the city. Then the radio crackled to life.

"This is fire dispatch calling box 8513, report of an apartment fire..."

East of us, in a large suburb. We heard the assignment go out and clicked our second radio over to the operations channel. The first-in engine arrived and sized up what sounded like a decent fire. More apparatus arrived, and then --

"Dispatch from Command, start us a code 3 ambulance."

My co-trainee and I looked at each other. "Are we closest?" I asked.

"I don't know," he said. "Maybe? Levels are low..."

A few more seconds went by. "Huh," I said. "We must not be--"

Five things happened at once. Both of our radios alerted, an unmistakable BEEP BEEP BEEP BEEP. The computer bleeped a priority tone, doo-doo-doo-DEEP. Three pagers started vibrating. A screenful of information came up on the computer with the highlighted text ASSIGNED in the middle. And the dispatcher told us we were going out to the fire.

I looked at the address, asked over my shoulder to my FTO, "Straight out this street, right?"

"Yup," he said. A second later he added, "Only about a hundred and ten blocks away." The gas pedal was flat to the floor before I even hit the switch.

Forty blocks later, fire command updated us: "You have one patient, he'll be in front of the truck company on the east side of the complex."

Oh good, we thought. One patient. Three of us, we should be able to handle it, even if he's badly burned and needs tubed, or whatever. We got it.

"Additional for the medic unit, your patient has lacerations to his arms from glass."

Oh, jeez, we think. No problem at all. We're golden. We got it.

In thinking this we forgot the cardinal rule of emergency medical services, and indeed any 911 response: The radio always, always lies.

* * *

It wasn't hard to find the complex. Usually we respond to medical calls with a single piece of fire apparatus, and if they've arrived first the last directions from the crew member with the mapbook go something like, "Turn right on 42nd and look for the marker truck." A thirty-thousand-pound red truck covered with flashing lights is an excellent indicator of where the call might be.

In this case, there were six or seven such vehicles (five engine companies, two truck companies), plus a few command SUVs. We found the specified truck company and parked behind it. It was beginning to rain a bit. As we're climbing out, a firefighter comes hustling up. In all his turnouts. With his airpack on.

"Hey," he said, sounding a bit worked up, "we need your airway kit over here!"

Airway kit? I thought. For lacerations? Maybe he got some smoke too... I asked my co-trainee to grab the kit and I followed the firefighter. He led me right past the truck, and across the parking lot to a small SUV with the back hatch open.

Standing next to it, wrapped in a blanket, in pajamas, was a woman in her twenties, with soot on her face, darker under her nostrils and around her mouth. Tear streaks cut across the black.

Inside the back hatch, also wrapped up in blankets, were three kids -- a two year old, a four year old, and a six year old -- all with soot-darkened faces. One had a cut on his forehead, and dried blood streaked his face.

I'd like to say that in the five seconds before my partners caught up with me I thought something like, okay, four patients, we'll need at least one and maybe three more ambulances, and we'll need them all on high-flow O2 for CO poisoning, and we need to first off evaluate them for airway burns because we may need to tube them early, and we should probably declare a Multiple Patient Scene and get fire medics to help...

But the truth is, in the first few seconds, I could only stare at them and think, very loudly inside my head: Oh, sh*t.

* * *

My training officer took one look and came to all the conclusions I didn't. "Give me your radio," he said to me, "and get them to the car." He turned away, looking for the command officer for the fire, and said over his shoulder, "High flow o's, and check their airways!"

I looked over my shoulder. It's just me and my partner trainee. I ask the kids, "Are you okay?" and get solemn nods in return. "Okay," I say. "We're going to go over to the car now." I picked up the smallest one and handed him to mom. We got the other two, and all of us walked in the light rain to the ambulance.

We got everyone settled inside, and then it really got fun. A firemedic hopped in (fortunately she'd ditched most of her gear) and so there were now 3 paramedics and 4 patients in the back of the ambulance. Thank god we have the Type III boxes, but even so it was cramped. Everyone's airway got evaluated. Things looked pretty good for the kids, but mom had some soot in her throat. Everyone got on oxygen (just imagine the hoses snaking from two wall-mount ports and two portable tanks).

At some point my training officer stuck his head in the door and told us, "I declared a Multiple Patient Scene [sort of a low-grade Mass Casualty Incident] and we have a second ambulance coming. Do we need more?" My trainee partner and I looked at each other, looked at the kids, and shook our heads.

The denouement of the story is sadly -- or rather, happily -- quite boring. The other ambulance (coincidentally our sister car, working the same hours as us) took the two older kids, and we took mom and the youngest. I drove, with my partner trainee and FTO in the back. They thought about tubing mom -- apparently in the right sniffing position you could see soot all the way to her epiglottis -- but decided to hold off.

Everyone did fine at the hospital. Mom never did get tubed, and everyone's carbon monoxide levels came back low enough that they didn't need hyperbaric oxygen or even to be admitted. They left the hospital before we were off shift.

And our original patient that we never actually saw, with the lacerations? The heroic neighbor kid who discovered the fire, and punched out a plate-glass window to alert the family when he couldn't get in the door. He went by personal car to the hospital, and got all the media attention.

Well, almost all -- there was a lovely shot of our FTO's butt on the 6pm news. You'd better believe he heard about that.


Mama Mia said...

Oh Sh*t is right!! Yikes - what a nasty surprise!

Susan Palwick said...

Great story! I'm so glad they're all okay!

Anonymous said...

We call that the "oh sh*t factor", usually a good indicator that you really do have a sick patient(s). Good blog too, I just found it, have gone through some of your earlier entries.

Ellie said...

I've been behind and just caught up with your blog, excellent writing (and EMSing for that matter) as usual! Could I borrow that black cloud for a few days?