Why?

Every book or collection of articles written by or about emergency service talks of how the world of firefighters, EMTs, and other first responders was irrevocably changed by 9/11. I became a firefighter in the summer after 9/11. I had no prior knowlege of what it was like before the towers fell.

To me, firefighter training always included the recognition of explosive devices. I was always told to be wary of fire hydrants, they could have been rigged with pipebombs set to kill me when I cracked the steamer port. Attending a training on a bio-hazardous terrorist attack is no different than a lecture on how to properly place a ladder, for me anyway.

I'm part of the so called "new generation" of firefighters, guys who got on the job after 9/11. To us, all of the weapons of mass destruction training is common place. Hearing the older guys complain about how they didn't have to learn this stuff before the planes, is like hearing them talk about how they used to wear leather jackets that ended just below the knee.

For me, firefighting and emergency service has always included response to terrorism.

The TV in my high school cafeteria showed me the second plane slamming into the towers. I watched them fall in health class. Upon returning home I learned that my cousin Stacey was on the 102nd floor of Tower Two.

While her remains were never recovered, I managed to piece together that she had made it to about the 85th floor, in the zone where the plane would have impacted. Hopefully her passing was a painless surprise.

Saying that 9/11 didn't effect me as a firefighter would be a lie. I am a firefighter because of 9/11. My cousin wasn't alone when she died, countless firefighters were with her, they didn't know her. To them she was just another investment banker, but they were there for a complete stranger.

As stated in another article, emergency service is about people. My job, plain and simple is to be there at the worst possible moment of your life. In being there, its my hope to make things a little bit easier. I want to be able to make the pain and the fear go away.

People look at firefighters and they feel safer knowing that they're there. I've seen the look in a patient or victim's eyes when I arrive on scene. They're still scared but theres a flash, a sort of a glint. They see the uniform, the helmet, hell even the red suspenders and they know someone is there to help them. I'm not trying to say we're saints (personally, I'm far from it) but we are there, doing everything we can to make things better.

September Eleventh was a day that no matter how many firefighters showed up, the pain and fear still just grew and grew. I like to think, however, that the fact that they were there, made those who perished that much more comfortable. Maybe comfortable isn't the right word, there probably isn't even a word for making death easier.

This is a real downer to write but new generation or not, firefighters have to talk about 9/11. It's such an intrinsic part of our culture, not American culture (and it is) but fire culture. Being in a job such as firefighting can make one complacent. Yeah its dangerous, but thats part of the fun. We start to see the danger as a challenge. Then theres 9/11, the ultimate danger, a lot of good people (from both public safety and civilians) were lost on that day. September Eleventh serves as a constant reminder as to why we do what we do.

We are not thrill seekers, although we do a lot of things for the thrill, we are people-people. If I can't save someone, I'll sit there and hold his hand, he won't die alone. As a firefighter, EMT, cop, whatever, its easy to loose sight of why you do your job. Sure, the people will see a uniform and a badge and go bullshit because you represent the authority they hate, but deep down, they are always glad that someone is coming when they call. A relative might not come when you dial their number. Your friend might ignore your email. Your spouse could write off your note. But when you dial 911 we will always show up. In your hour of pain you won't be alone. Total strangers are ready to race to your house, even if all we can do is hold your hand.

Patients and Recovery

I was eighty seven years old, I took Viagra and Nitroglycerin and then called 911 when my chest felt tight and I had trouble breathing. I was also a blazing mysogynist who took one look at the female EMT and told her to go back to makin' babies and pie.

Playing the patient is fun.
Some skills are best practiced on living, breathing and in my case bitching human beings. Just in case your wondering the part I was playing was not my idea, Joe the instructor told me I had to be an old man who hated women and the propper ailments.

So I'm telling Linda that I don't want "No young wippersnapper, and a woman to boot, to touch me in a medical way." When Linda tried to take my radial (wrist) pulse, I'd swat her hand away. When she finally did get my wrist I told her hand was too clammy and calloused to be that of a woman's . For one minute she broke character and laughed, telling me I'd fit right in prison.

All of the annoying things I did were not because I secretly wish to be an eighty something year old asshole (Although.....) but to make the scene more realistic. I've been on calls with patients who acted like saints and patients who acted like Peter Rubulov the Seventh, yes I created a fake name and funny yet touching backstory for my elderly woman hater.

Assessing a patient is hard enough on a dummy, theres an awful lot to remember. Its even harder when the patient becomes annoying, scared (wouldn't you be?), combative, or any of the other lovely things that people become when they are faced with mortality.

We each take turns being assessed, strapped into a collar and onto a backboard. All of us are dressed in MAST trousers, a device developed in the early days of the Vietnam War. Its purpose is to raise one's blood pressure by forcing all of the blood back up toward vital organs.

I've only been on the patient end of pre-hospital emergency care once, for a severe allergic reaction. Since I was not a trauma patient or a BP risk, I've never been strapped to a backboard or wore a collar. Being a patient was a new experience for me and it gave me a new look on patient care. Even in a classroom, when the procedures were fake, I was getting nervous. The collar and the backboard are very restrictive, the trousers feel funny. I have a new appreciation for what patients go through.

It all made me think of my friend Hender. He's back at his home in Rhode Island now, and will be for the next year until he is transfers to the Newport Naval War College for a position as a Marine Adminstrator.

He's got a long recovery ahead of him. Mobility specialists, Bayada Nurses and other experts poke and prod him nearly everyday.

The day after his return, we got together like we used to back in high school. Instead of cheap ass Chinese food we had steaks and beer from the BBQ in his back yard. We swapped war stories--- my latest fires and patients and his actual war stories. He told me about how he and his buddies were taking pictures one minute and engaged in a firefight the next minute. At an old bunker they were clowning around when they heard the ulations that the suicide fighters make before they attack. Being good marines, they charged into the bunker and got into a brief but brutal gun fight with a group of terrorists.

He says simply, with a hint of disbelief. "I killed 'em. All of them."

The lives he took were to perserve his own, and the lives of his squad mates. He's a hero and his only reward is a Purple Heart he doesn't want and scars he doesn't deserve.

The Golden Hour

"If he looks like shit, he is shit," our instructor tells us to begin our trauma assessment lecture. "If he's shit, get out of there. I don't mean leave him there, I mean pack him up and get to the hospital."
Trauma is any kind of injury caused by an outside force, be it a bullet, baseball bat, knife, dashboard or anything else. Trauma calls make up about one half of medical call outs. In order to determine the extent of the trauma, the EMT needs to be able to perform a rapid assessment of the patient in about under two minutes.
The lecture on how to carry out this assessment is two hours long.
Theres a lot to get through. With any severe call you have what is known as the Golden Hour. In other words you have sixty minutes from when the person drops or presents to get them into the operating room. The hour begins when the person begins having their problem. Give maybe five minutes for either the patient or someone else to call 911, another five (because I'm bad at math and don't want to say two or three) for dispatch to get the nature of the call and call fire/rescue. Let's say we're at the grocery store when the call comes in so our response time is down a bit and we get to the scene in ten minutes. That's twenty minutes gone.
Once on scene we have to get all of our gear and get into the house, find the patient and make sure we don't need any additional resources. Maybe ten minutes on scene. But let's say the patient is a 435 pound behemouth and we need to call in an additional engine for man power to lift him. Theres another five minutes. Since my department is a non-transporting EMS provider (we don't have ambulances, just a Squad like Johnny and Roy on the old Emergency! show) we have to wait for AMR to scramble an amubulance, give them five minutes because they don't usually go to the market.
So forty minutes after the patient first presented symtoms we're still working.
Once AMR gets him loaded up and decides whether or not they need one of us to jump in and help out (keep in mind an ambulance needs a driver and with a crew of only two its hard to give a severe patient adequate care) another five minutes are gone.
The ride to the hospital will invariably be through traffic, and we have fifteen minutes to get from Holden to Medical City in downtown Worcester. Even with lights and sirens it's going to be close.
At the emergency room we have to get the door unlocked, get the stretcher in and deal with the doctors who have most likely forgotten about the call we placed on the radio on the way in because they are bogged down with other patients and probably dead tired from working late rounds.
Best case senario, getting a patient from the scene into the OR is going to be very close to exceeding the one hour mark. Now after that one hour, chances of survival fall, shatter the floorboards and drill down through bedrock. With prehospital medical care, speed is your friend but it can also screw things up. Make a wrong assessment or administer the wrong drug and the patient could have a reaction. Lights and sirens allow you to run a red light but there's always some asshole who sees it as his god given right not to stop for you...not to mention the jerk riding your bumper so he can skip through traffic lights too. You have to go fast but you have to pay attention.
An EMT needs to be able to get on scene, make quick, accurate decesions regarding patient assessment and care and get out with the patient fully packaged--- be it on a backboard, MAST Trousers or any devices and get to the hospital.
Just because my department doesn't transport doesn't mean I'm off the hook. The ambulance will always arrive after fire/rescue because thats protocol. Having an ambulance with two private company EMTs arrive at a car or house fire first is useless. They don't have bunker gear or fire equipment and chances are their rig will just get in the way. So fire goes first.
The plus side is that we get to the scene with all of our equipment and take charge immediately. The downside is that we need to have the patient ready to roll as soon as AMR or whoever is providing EMS arrives on scene. Since we can't transport in the Squad (there's no stretcher bay, or stretcher for that matter) we need to get the guy on a backboard or StairChair and then strap him onto the ambulance's stretcher. If the ambulance gets stuck in traffic or a snowbank, whatever....its still tick tock, tick tock.
Time, as you can plainly tell is not a luxury afforded to emergency workers. The necessity for us to be fast and do our jobs appropriately is drilled into our heads at the Academy (fire and EMS).
To get an idea of what its like to perform a Rapid Assessment in the alloted time, find a book you've never read before, preferably one you know nothing about. Take nine random pages and read them, while developing an understanding of their contents in two minutes. Then, while you are reading nine more pages, come up with an accurate and coherent summary of the first nine pages.
The nine pages represent the areas of the body we assess immediately.
At the head we assess breathing, airway, circulation, skin color/temperature/moisture. We move on to the neck and check for vein distention, tracheal shift and C-Spine injuries.
At the chest we assess breath sounds, expansion and heartrate. The abdomen has us checking for rigidity, distention, tenderness and discoloration. We check the legs for obvious injuries and deformities.
Once we've done our intial assessment, we don't have time to write anything down so we just remember it and start taking vital signs--- pulse, blood pressure, breathing rates, pulse ox.
Over the course of ten minutes you will have to take in and remember the equivalent of reading ninety pages of something as foreign to you as the Soviety Military Handbook on Propper Table Manners. But you do it, and you do it well or the person who has trusted you to take care of them and make sure they live to see Little Hiram's Bar Mitzvah will not make it.
Deep down this job is about helping people and caring for your fellow human being. We don't like to admit it, its not macho to talk about loving your fellow man. Thats why we spend so much time beating ourselves up at the gym, thats why we love destroying things in a fire, its why we drink, fart, tell dirty jokes and act like cavemen at the station. We try to act like Steve McQueen--like we're tough guy badasses who do our job for the thrill (and they are some of those)--- but deep down we do it because we love people. Firefighters and EMTs, yeah even cops too, do what they do not to be macho but because we want to help people. We can go into a burning building and tear the place apart, joking and laughing during the clean up, yeah someone's life is ruined but if we think about it ours will be too. We may destroy a sofa or a dresser but you can be damn sure we will grab and protect any photoalbums we find. One minute we'll be swearing and sparring at the station, telling dirty jokes and the next we're holding the hand of an old lady with no family left to be there when she rides in the back of an ambulance.
So thats why we spend hours training for the worst, its not because we're disaster perverts, its because we want to be ready to help our neighbors. Don't get me wrong though, if we get to destroy stuff, use our cool toys and drive really fast, its defintly bonus.

What if the EMT gets sick?

After cutting 20 lawns with the temperature hovering in the low nineties, while fighting a sinus infection, I limp into EMT class for a night of BLS and Airway practicals. Last Saturday was spent shut in a concrete room, with wheezing airconditioning, learning healthcare provider level CPR. Even though I already held this certification as a First Responder, it was necessary to attend to meet the propper hour quota.
When I show up, blowing my nose and sweating my ass off, I have to take a written test and pass each practical station ( a dummy and an instructor giving me senarios) twice. The written test is easy, save for two questions which the instructors subsequently deemed "a joke because in the field, that shit doesn't matter." I finish my exam and use the time waiting for my classmates to sleep-- sinus infections are exhausting, so is Sudafed.
The first practical test is One and Two Rescuer CPR. After five compressions out of fifteen, I'm getting tired and sweating through my Boston Fire Department shirt. Of course, I'm embarassed because I pride myself on being in shape. I should be able to blow through CPR drills like nothing.
The big, badass firefighter is dripping all over the dummy and talking so fast the instructor is worried about him...Great. One the members of my group, a large woman from Glouster RI tells the instructor I was booting black tar heroin. My study partner Gilbert quickly says, "He's heavily medicated, ma'am. He's very sick." I nod like one of those bobbing head dolls on the dashboard.
I get through my two adult CPR senarios with no problem aside from not telling a bystander to call 911, something mandated by the American Heart Association. I somehow think showing up on scene and telling someone to call 911 would not inspire confidence in my abilities as a firefighter/EMT.
After two foreign body airway obstruction (cool doctor speak for choking) drills I receive two more passing grades. As I'm coughing up a lung Tinsely asks "How's that airway doing?"
My favorite senario of the night comes when dealing with a dummy representing an unresponsive 6 year old who swallowed a marble and can't breathe. He's cyanotic and the mother, played by a Kojack bald instructor is going bullshit. "My baaaaayyyybbbaaaaay! OOOhh, my baby!" I calmly walk up and grab the "mother" by the shoulders. "Ma'am," I say very gently, getting "her" attention. "It's the thinning of the herd." After about fifteen seconds of astonished silence the room erupts with laughter. I, of course, then run through what I would aactually do with backblows, and compressions, rescue breaths all the good shit.
I do CPR on a doll representing little Janie, an unresponsive infant. After three cycles of breathing and compressions I get her back to life. Rich, the firefighter next to me takes his turn and manages to remove the little girl's head. He asks if he can keep it to strap to his helmet then makes the headless baby do break dancing spins.
I pass each of my drills with no problem and find my written test waiting when I'm done. By this time I'm dead on my feet, the Sudafed wore off and I'm facing the full force of my illness. While still trying to look tough for my peers, I soak another napkin with my nose. My test grade is a 92, 8 points higher than the minimum passing grade of 84.
As I pack up my binder and books, the thought of a dose of NyQuil and an early bedtime takes on an erotic quality. I try not to think about the twenty lawns and 90 degree weather waiting for me the next day.
My weekends are the only time to myself, the time when I can relax from work and training so when I find out that my Rescue Diver course will be at six thrity every Saturday and Sunday mornings, I try to move things around. The dive master tells me that he usually doesn't like to move the lessons around but since I'm a firefighter--a profession he pursued-- he'll try and make the instructor give me lessons on Tuesday and Thursday nights.
With the freedom of my weekends thus secured I am free to spend time relaxing with my girlfriend of over two years, reminding myself why I am so lucky.

No Airway = No Patient

Peppermint is supposed to stimulate your nervous system and keep you from feeling tired. For some reason your brain associates that flavor with being awake and vibrant. Seeing as how coffee might as well be a bag of glass with my stomach, I give it a shot.
With three or four after dinner mints floating around in my mouth I listen as an EMT-Cardiac from East Greenwich explains airway management to my class. If DNA is the building block of life, Airway Management is the DNA of EMT class. No airway=no living patient.
All of the anatomy lectures we slogged through for the past few weeks are coming into play. Understanding how the mouth, trachea, nasal cavity, lungs and all of the other goodies fit together makes it easier to understand why they become clogged with food, blood, fluid and countless other nasties lumped under the titled "Foreign Body Airway Obstruction."
First Responders, the level right below EMT, the level I have practiced at for the past three years, are able to look in the airway and see that it is obstructed. They can't do a whole hell of a lot more and the belief is that by the time they have the patient extricated from whatever accident or fire he happens to be in, the EMTs will be there to deal with it. Of course in real life the EMTs teach you how to use all of the fancy equipment on the sly before they get there so you can keep Jane Q. Patient from loosing her maiden name and become Ms. Victim.

This was the first official class on how to use suction gear I have ever received. Suction is basically a vaccuum used to remove fluid and particles from the airway of a patient. This allows them to breath again. You pretty much hook up a medical shop vac to a small tube and clean whatever crap is blocking the throat.

When the lecture portion of the class comes to an end, we watch as Paramedics from Roger Williams EMS and local fire departments bring in torso dummies along with a myriad of airway equipment. Within minutes I'm slamming oral airways into place while colleagues shake the dummy to simulate a seizure. I learn how to use a device called an EOA to effectively shut off the stomach with a small balloon, and most importantly what to do if the patient wakes up with the tube down his throat. At one point, while trying to guide the tube in correctly, I somehow managed to push it into the carina, where the lungs split. Thinking I was simply caught up in the plastic of the dummy, I gave it a sharp push...and watched the lung tear right off of the manquein.

My instructor, a large shouldered paramedic from Pathways EMS just shook his head and said, "Well you fucked him pretty good. Actually, thats more of a rape, I'd say." Luckily we weren't being graded on this evolution. Class comes to a close as the instructors conference on how to reattach the lung.

Leaving the hospital after the public sections have been shut down is one of the most unsettling things I've ever experienced. The ambient lighting and the cheesy adult contemporary are still on but there is noone else around. The whole thing is empty as I walk out to the main entrance. Maybe its just because I'm reading a horror book with Nazi Zombies on a haunted U-Boat (Don't ask, my answer will only rob you of whatever respect you had for me) but it feels so unnatural. A hospital is like a fire station. You just don't think of either of them as ever being quiet. You should always hear "Paging Dr. Howard, Dr. Fine, Dr. Howard" in a hospital just like you should always hear fart jokes at a fire station.

What makes the silence so unsettling is that these are the quintessential 7-11s. Always open. You don't realize that the nurses are upstairs playing penny ante poker in the break room, waiting for a panic button to be pushed. You don't realize that the firefighters are trying to catch a few minutes of sleep before the tones come through.

I've been a firefighter for three years, I can safely say that it is one of the most exhausting things ever. If an alarm comes through you go into overdirve. If you're tired, you wake up immediately. I've been dead asleep one minute and the next I'm flooring it to make the first due engine from the station. What makes the job so tiring is that you are always ready to jump up, you never really sleep as deeply as you want. Sure, I can sleep through radio chatter and I won't wake up unless the tones come through but when I do wake up I can probably tell you where the squad was sent on that run when I was "asleep". Being awake when everyone else is asleep is what we are paid for, people sleep better knowing that somewhere, the guys are arguing over whether or not to have chiken or ribs for dinner.

One minute I'm asleep, the next I'm shutting of some lady's stomach with tube and a balloon so that I don't force her to vomit. What other job would give you that kind of rush?

My New Approach to Strength and Conditioning

The pain in my quads is so bad I have to keep my legs out straight when i sit down. Some how two 53 pound cast iron balls with handles making me feel like I have barbed wire for muscles.
And I love every minute of it.
Up until this point my personal best for squats has been 305, thats what usually makes me feel like this. But after one day of escalting density training with two 53 pound kettlebells, I'm beat to hell. With a combined weight of 106, front squats, deadlifts and hack squats with half that weight should not be hurting me this much.
I've decided, after much deliberation, that I will now incoporate kettelbell workouts in to my weekly routine. A kettlebell is a cast iron ball with a flat bottom and a thick handle on the top. For centuries Russian and later Soviet and now Russian again strongmen trained with these evil devices. Cossacks, Soviet commandos, elite paratroopers and Olympic powerlifters flung these things around to tear their bodies apart and carve themselves out of marble.
Now the KBs are finally in the US. For guys like me, who spent their lives up until this point with barbells and old school exercises like the deadlift and floor press, the idea of throwing around a ball is tough to get used to. It took me six months to finally decide to even try KBs but once I did I was certainly impressed.
What makes the KBs so unique is that they offer a total body workout while at the same time isolating muscles. I know that sounds like a contradictory statement but its not. Because of the effort needed to move and lift the KBs different accessory muscle groups are recruited in order to sucessfully complete certain exercises.
My goal is to gain mass, become as big as I can while still maintaining functional strength to aid in my carreer as a fire/rescue professional. While KBs are good as a conditioning tool, nothing beats a good old fashion barbell workout. In an effort to have both strength and conditioning training, I have devised the following workout plan using both forms of equipment. This routine is grueling and can be painful at times but the results are fast. Since begining this routine I have noticed a significant increase in my military press strength. Previously this was my weakest exercise and I always dreaded sitting there and straining against a load that embarassed me. My bench press has also increased, sucessfully breaching a five and a half month plateau.
The workout runs as follows:

Day One:
Barbell Bench Press: 5x5
Kettlebell Floor Press: 5x5
Kettelbell Military Press: 5x5
Barbell Shrugs: 5x5
Kettlebell Renegade Rows: 5x5

Day Two:
Barbell Curl: 5x5
Skull Crushers: 5x5
Preacher Curls: 5x5
Close Grip Bench Press: 5x5

Day Three:
Leg Lifts: 5x5
Leg Curls: 5x5
Kettlebell Front Squats; 5x5
Kettlebell Deadlifts: 5x5
Kettelbell Hack Squats: 5x5

Day Four:
Kettlebell Swings: 2x20
Heavy Bag: 1.5, 2, 3 minute rounds

It is important to note that a day of rest in between each workout is not necessary but preferable. Day Four is primarily for recovery and cardio. Because of the physical nature of my job cardio for each day is not necessary but at least once a week is necessary to break the routine and aid in muscle regrowth. This cardio routine can be substituted with swiming or any other form of cardio work.

All of the kettelbell exercises and the barbell ones for that matter can be viewed and explained at http://www.bodybuilding.com/

Anatomical Humor

Anatomy wasn't fun or interesting in high school, or again when I took it at college either. Hip bone's connected to the...who cares? Well EMTs have to care. I need to know that the little bone in your wrist is your radius, that the large intestine is no longer called that...now its the colon, I need to know that the medical name for the big toe is Halidon (Latin for the "Grand Toe"). What makes the anatomy EMTs study different from that of high schoolers is the injuries.
And really, really grusome pictures of corpses bisected like layer cake.
To sucessfully treat and transport a patient an EMT needs to be able to speak the language of doctors. We get to use all the big words like "testicular torsion" (not to mention understand what they mean) but we don't get to drive the big Mercedes or Cadilacs. I guess its only fair though, med school is six or seven years while EMT is three months. By the way, testicular torsion involves twisting, thats all you need to know....trust me.
Now that all of the legal crap is done, EMT class focuses on the fun stuff, like what to do if you come across an unconcious person, how to stop the blood spraying out of a stab victim. But to do all of that you need to know where the blood is coming from, why its spraying out like Old Faithful. Learning the medical terms is tedious, to make things easier I've scotched taped diagrams of skeletons, human thoracic cavities and brains all the place. Everytime I grab some lemonade from the fridge I learn where every bone in the human body lives. When I go down stairs I see that the kidneys reside above the bladder.
Working a minimum of 8 hours each day and then going to a night EMT class can make you feel like you're going insane. I get up at six am and I'm not home until ten thirty or later. So last Wednessday I decided to blow off some steam. I had worked ten hours landscaping...thats twenty two lawns....and I went to EMT that night. Some of the other students and I decided to go out to a local bar and play some pool because, like I said, anatomy is boring. After slogging through four hours of class we took a short drive to Patrick's Pub and grabbed a round of Guinness.
I learned that a carreer in professional billards was not for me and bullshited with three of my fellow students about why they are taking the course.
One is a respitory therapist named Erin. She wants to make extra money transporting her clients and needs EMT to fullfill the requirement. Her friend Tinsly is a bartender who wants to work for AMR and do volunteer work. Gilbert is a guidance councillor at a school devoid of a nurse who eventually wants to start an extra curriuclar ambulance core at the private school that employs him. All chose to become EMTs because of they want to help people and have some fun doing it.
When I get home I find a message that my friend Hender had called from Camp Legune. The navy finally shipped him back to America but the Marine Corps wanted him at their hospital to have the last of his invasive operations performed by Marine doctors. So he's sitting down in Carolina recuperating from a procedure that was supposed to restore some of the mobility to his legs. As of a week ago he can stand on his own for two minutes unassisted.
According the Corps there's an open position at the Newport Naval War College for a marine. Hender wants that job so bad I can taste it. Originally he went to college to become a teacher but joined the Corps instead. Now, maybe, he'll get some teaching in.
I joke a lot with Hender when he calls on the phone. Most recently I told him to get ready to learn how to scuba dive with me. He said he wanted to concentrate on learning to walk again. I, of course, put him in his place by telling him: "Come on, get your fucking priorities straight here." Humor is a good way to hide the fact that you miss your friend.