Now for something completely different. This blog I created is called Dad Under Fire, Fatherhood and Fire fighting both take courage. Well so far I have posted about fatherhood, but today I want to focus on fire fighting. I have promised you in the past, that if I write a blog that could be upsetting to my readers, I would warn you ahead of time. This is one of those posts. I could lose some followers, or even gain some with this topic. I’m going to tell you about my first experience with death on the job. I will draw out a very clear picture of what I saw and experienced. Please be warned some of it will be graphic, some of it will be hard to read, but ALL of it will be honest. You’ve been warned.
It was almost 4 years ago on a Thursday morning , around 10:00 am, it was my 4th shift since graduating from the fire Academy. I remember it literally like it was yesterday. I was riding the back of the Rescue truck. We have an Aerial (Ladder truck) and a Rescue truck stationed in my fire hall. The Aerial truck is primarily used to go to fireS and alarm bells. They will also attend medical calls if the Rescue truck is already on another call when it comes in. I like riding the Rescue truck because we get to see a variety of calls, from fires to car accidents, to other rescues. You really get a feel for the job on the Rescue truck.
Back to that day, the bells went off in the hall alerting us to a medical call for an ‘unconscious patient’, I was riding in the junior position on the truck and my senior man had been on the job for over 20 years, he was soon to be promoted to captain. On the way to the house we would often get updates on the patients condition from our dispatch. I remember looking over to my senior man and saying “I’ve got a weird feeling we’ll be using this at some point today” as I patted my hand on the large orange suitcase in the truck. Inside that suitcase was our Auto defibrillator used to shock the hearts of our patients back into a regular rhythm. Often times people think from watching television, that when people are shocked, it’s actually starting their heart. This is misleading, in fact the only people who receive a shock are those that already have a beating heart, but it’s beating out of sync. The defibrillator will momentarily stop the heart in the hopes it catches it’s regular rhythm again. This is called a “Shock-able rhythm”.
Its was no sooner that I had said we were going to use it today, that my captain called back from the front seat and gave us the update “CPR is now in progress”. Who ever had called 911 was now giving the patient CPR. It was ironic because as that person’s heart was stopped, mine now doubled in speed. This was it, this was what I just spent weeks training for at the fire academy. This time it was real, I wouldn’t be doing CPR on a dummy in ideal conditions. I looked over at my senior man and we discussed our protocol. We decided once we got there, he would start the chest compressions and I would get the pads ready to stick to the patients chest and start to work on his airway. During CPR we manage the patients airway by inserting an “OPA” which is basically a small curved plastic device that keeps the patients tongue out of the way while we administer oxygen via a bag valve mask.
As we arrived I was ready, I went over the plan in my head over and over again. I had on my rubber gloves, my n95 masked (looks like a dust mask that painters sometimes wear) and my safety goggles. This personal protection equipment is to protect me from any bodily fluids that may be flying around. You don’t want to contract anything from the patient, especially if it’s the reason you are doing CPR on them in the first place. After grabbing all our supplies we jumped off the back of the truck and entered the house, a semi-detached house with the front door wide open. I went to look for our patient upstairs (They are often found in bed) and my captain went to search the basement. Before I even reached the second floor landing, I heard my captain call to me that our patient was in the basement. I scurried down the stairs ready for action. I was caught entirely off guard by what we came across in the basement. There was a woman, roughly 50-55 in age, completely naked bouncing on top of the chest of a naked man in his 80’s on a couch that folded out into a bed. When she saw us she jumped to her feet, grabbed a shirt and started telling us he just died in front of her. Well my senior man and I went past the woman to assess the man. My captain spoke with the woman to get any information that could help us or the paramedics when they arrived.
When my partner and I got to the side of the bed I opened the case and was about to get started. That was my first mistake, right away my partner told me we need to move him to the floor. I later found out it was because chest compressions are nearly useless on a mattress and are optimal when performed on a hard surface, like the ceramic floor we placed him on. It makes each compression more efficient which is great for pumping blood through the heart. I grabbed the man’s feet and my partner grabbed his arms. We lifted him and laid him on a blanket on the floor, completely naked and lifeless. It’s amazing how awkward it is to lift and carry someone when they are lifeless and limp. Once on the ground I applied the pads of our defibrillator to the man’s chest and moved up to his mouth to work on his airway. It’s weird what things stick out in your mind in a situation like this. I vividly remember how bad his teeth were, and the amount of saliva in his mouth. I had to remove his top set of dentures and slide this plastic tube in and around his tongue so I could administer oxygen to his lungs. It was rather seamless. Much easier than trying to do it to a rubber dummy in the academy. Once the airway was established, the paramedics arrived and prepared drugs they were going to administer to him to get the heart working again. At this point our defibrillator had analysed the patient and advised us to “shock” him. The paramedic called “clear!” (Just like in the movies) and then pushed the glowing button with the lighting bolt inscribed on it. The patients entire body jumped, and we checked his pulse and continued chest compressions. By this time my partner had been doing compression on the man’s chest for about 6 minutes. Every 3 minutes it is recommended that a fresh set of hands are doing compressions, to ensure a deep compression is achieved. Chest compressions can be extremely tiring, especially since some people are thicker than others and you have to push hard and fast.
Now that the paramedics had taken over, they were also able to place a smaller tube straight down the man’s throat into his lung to give oxygen more efficiently. This freed me up and allowed me to switch to chest compressions to give my partner a break. This was it, the first time I would literally squeeze a man’s heart providing artificial life. I was astounded how “squishy” it felt. It was nothing I could have imagined. One thing that isn’t widely mentioned, is the bones that break during CPR. Often (99%) of all chests break when you start pressing. It’s probably one of the grossest things I’ve ever done. You have to remind yourself “Life over Limb”, which basically means, his breast plate and ribs will heal, its more important to keep him alive. I can’t even count the amount of ribs I have broken in the past 4 years, but you have to suck it up because if you don’t do it, the chances of death occurring are almost impossible to overcome.
Back to that day. We spent about 45 minutes doing chest compressions while the medics administered a plethora of drugs and we finally got a pulse. I can’t explain the emotion of finding that pulse after working so hard. Now that we had a pulse, we all needed to get him packaged on the stretcher and off to the hospital before he ‘crashed’ again. While we were moving him up the stairs, we lost the pulse again, so here we are in the driveway strapping him to a stretcher while I continue CPR all the way into the back of the ambulance. I stayed with them in the ambulance to ride to the hospital giving chest compression the whole way. That was a new experience, racing through traffic, weaving in and out of cars (All of whom would never imagine what was going on in the back of this ambulance as it sped by them) while trying to do chest compressions. This continued all the way to the hospital until we passed him off the doctors and nurses in the ER.
I went back to the waiting room and waited for my ride (Big red fire truck) to pull into the hospital and take me back to the hall to clean up. I had left the patient at the hospital with the doctor’s and he had a pulse. There isn’t anything else you could ask for, it’s up to the doctor’s now. My captain gave me the “Atta boy! great job” and we went back to the station.
The toughest part about this job is never hearing the outcome of what happened to the patients. It falls under patient confidentiality, and unless it’s a high profile incident on the news, we never know if we helped. Well a year later the fire department had an awards ceremony and everyone who had performed CPR on a victim in the past year that survived received an award. We never got one, so I’m lead to believe he didn’t make it. That is another myth Hollywood leads you to believe, anyone who gets CPR lives. Well it’s pretty rare for CPR to have a success story, unless the cardiac arrest is witness and CPR is administered immediately. The statistics don’t lie. Since this first incident, I have had 35+ VSA’s (Vital Signs Absent…. which means dead). I stopped counting at 30, and that was just my first 3 years. Out of those 35+ I’d say 7-8 of those people we found had been dead for days and beyond help. That means i have done CPR on close to 30 people. Everyone is different, yet all their ribs break the same.
It’s a part of being a firemen that people don’t know about. We see dead people, a lot of dead people. Some are older and die of natural causes, and some are victims of trauma. Neither makes it easier to deal with, you just have to try your best and remember “They were dead before you got there” anything you did was to save them. You have to move on and forget about it, which is why I stopped counting them.
Hopefully this post hasn’t offended you, and instead has let you peak into my world at work. Most of you have kids and can relate to my other posts, this one was a bit different. I am going to use posts like this as therapy to put my thoughts out there instead of keeping them inside. I’m always amazed, when I come home from a shift and I pick up my son for a hug, I think to myself “Just a few hours ago I was doing CPR on a man in front of his shocked family at 3am in his living room and now those very same hands are holding my toddler. It’s very contrasting images, and really makes you appreciate the people around you.
Again I hope I don’t lose anyone with this post. Feel free to comment or share it with others and let me know how you feel about reading posts like this. If I should do another one similar (About work) down the road, or if I should just stick to my toddler. I’d love some feedback.
Keep Your Head up and your Nuts covered