Read an Excerpt
LET BURN
The Making and Breaking of a Firefighter/Paramedic
By Rachel K. Wentz
Michigan State University Press
Copyright © 2013 Rachel K. Wentz
All right reserved.
ISBN: 978-1-61186-071-9
Chapter One
GETTING STARTED
I never intended to become a firefighter; I knew nothing of the profession. My introduction to the fire service was the result of my interest in medicine. I was attending the University of Central Florida, studying my first love, anthropology. But I knew that a future in anthropology meant years of study and I was young and impatient. I wanted the freedom that came with financial independence from my parents, which meant settling on a career in which I could be trained and educated within a reasonable time frame. The most important thing to me was a job that was challenging and pushed me to excel; one that would incorporate my interest in medicine with the ability to assist those in need. My father, a navy captain and chaplain, always said that if I had a job in which I helped people, I would always have a reason to get up in the morning.
So I spent a rainy afternoon in the university's library, scanning books on career opportunities and training programs. Sitting among the narrow shelves, I focused on the professions I found interesting. The job of a paramedic had always intrigued me. What could be more purposeful than assisting people in emergency situations, when they need help the most?
I grew up watching the show Emergency and found the profession fascinating. Paramedics are faced with different types of emergencies each shift—variety well suited to my short attention span. The fact that it involved medicine also drew me. At a very early age, I developed a fascination with the human body, especially the skeleton. I was amazed by the complex anatomical and physiological systems that make up our bodies—the thousands of chemical reactions that take place each second in order to sustain life. Growing up the daughter of a naval officer, I relished the times when my mother would usher me and my siblings into the base hospital for our vaccinations prior to traveling overseas. To me, hospitals were encapsulated worlds of human drama. I would wander the halls while awaiting our appointment, the cool smell of disinfectant stinging my nostrils. I watched the staff rush from room to room, wondering what was happening to the people inside. I was drawn to the field of medicine from the start.
I found a book describing the education and training involved in becoming a paramedic and set to work. The local community college offered a program and I quickly applied, just making the deadline for new applicants. The first step in the process was becoming an emergency medical technician (EMT); the training consisted of a semester of coursework followed by a semester of fieldwork. EMTs are trained in basic lifesaving procedures, including bandaging, splinting, and cardiopulmonary resuscitation (CPR). But I wanted more. I wanted to be able to administer medications, start intravenous (IV) lines, and perform advanced medical procedures. So I set my sights on completing the EMT program and going straight into paramedic school. My paramedic training would consist of two semesters of coursework, sitting for the state exam, and a "provisional" period of fieldwork during which I would complete an extensive checklist of skills before being allowed to practice on my own. The fieldwork began.
DOWN AND OUT
The roots of our nation's emergency medical services (EMS) actually began in Europe during Napoleon's military campaigns of the early 1800s. His physician, Dominique-Jean Larrey, was one of the first to note that expedient ground transport of injured soldiers to field hospitals could improve survival rates. These practices were later incorporated into American military campaigns. During World War I, the first field "medics" accompanied ground soldiers onto the battlefield. By World War II, medics were cross-trained as soldiers, and the era of the combat medic was born. During the Korean and Vietnam conflicts, helicopters became the most expedient means of transporting the injured. This quick transport, combined with more sophisticated equipment and field hospitals, vastly improved survival rates among combat personnel. Many of these groundbreaking techniques and practices evolved into today's EMS systems, with expedient and effective transport and treatment of the injured being the primary objective of prehospital care.
EMT and paramedic programs in the United States prepare future EMS providers through a combination of course curriculum and field training. In the classroom, they learn the fundamentals of anatomy and physiology, a range of treatment procedures used in the field, and the skills to administer these treatments. Fieldwork is where they practice their skills on live patients under the supervision of experienced professionals, either in the emergency room or on an ambulance or rescue. The hands-on application of knowledge to real-life situations is critical, since books can teach basic concepts, but can't compare to the challenges of dealing with real patients in real emergency situations.
During my first semester of EMT school, I began my emergency room shifts at a small ER in downtown Orlando. I arrived an hour early, eager to get started. The physician on staff turned out to be an excellent teacher, letting me shadow him throughout the morning as he interviewed and treated patients. I took blood pressures, bandaged wounds, and assisted him with suturing. The morning flew by and before I knew it, it was early afternoon and I had yet to break for breakfast or lunch. I was walking out of the ER when the doctor called me into one of the examining rooms, saying he had an interesting case I might want to observe.
The patient, an elderly man lying face-down on the examining table, had come in with a large lump on his back between his shoulder blades. The doc explained to me it was a sebaceous cyst. Sebaceous cysts typically arise from swollen hair follicles. They form benign, enclosed sacs under the skin and are filled with an oily, foul-smelling, cheese-like substance. Of course, I didn't know all of this when I entered the room. I stood by as the nurse prepped the patient and the doctor assembled his equipment.
He began by injecting the cyst with a numbing agent. He applied this using a small syringe, making multiple injections into the lump. The injections caused small beads of blood to appear on the cyst, which the doc quickly wiped away using a piece of gauze. When the patient was thoroughly numb, he took a scalpel from the tray and made an incision across the cyst. It immediately began to ooze a mixture of blood and a yellowish substance that looked like cottage cheese. The first wave of nausea washed over me and I took a few deep breaths to try to clear my head.
The doc proceeded to squeeze the lump, forcing the cottage cheese out of the wound and onto the patient's back where it was quickly wiped away by the accommodating nurse. When I thought it couldn't get much worse, he then took a small pair of blunt-nosed scissors, stuck them directly into the incision, spread them open, and squeezed the remainder of the cheese from the lump. That was it. Suddenly, it was as if heavy, black curtains were closing in front of my eyes. My vision was reduced to a narrow hazy slit and my hearing was blotted out by the roar of rushing water in my ears. I knew the signs and symptoms of psychogenic shock, where a sudden draining of blood from the brain can induce unconsciousness. I knew I was about to experience it firsthand. I slowly backed out of the room, feeling my way down the short hallway and out into the small waiting room. The room was empty and I felt my way to a chair, tried putting my head between my knees, but was quickly overcome and passed out with my head against the wall, my legs splayed out in front of me.
I had fled to the waiting room with the hopes of remaining unobserved, noting the room was empty when I was leaving for lunch earlier. However, when I came to, I woke to a large panicked woman sitting next to me, screaming at the top of her lungs "She's having a seizure!! She's having a seizure!!"
Although I was confused, pale, and sweaty, I assured her I was all right, hoping to shut her up before she alerted the entire staff. Too late. The doctor, followed by two nurses and the receptionist, rushed into the waiting room, only to find me sitting there, pasty and humiliated. I explained what happened, and they assisted me to the restroom where I washed my face and collected myself. That was my introduction to the emergency room. That experience has served me well. As humiliating as it was, it taught me that when dealing with high-stress situations, control your breathing, keep your knees soft, and stay focused.
A BRAVE NEW WORLD
I developed an early fascination with trauma. Whether it was blunt force injuries from falls, penetrating injuries from shootings or stabbings, or dismemberments that accompany high-speed collisions, I was intrigued by injury patterns and the complex methods of treating someone with multisystem trauma. When it came time to begin riding in the field, I told my instructor I wanted as much action as possible, the busiest truck in the city. He advised me that if I wanted action, there was only one place to go: Orlando Fire Department's Rescue 2.
Station 2 was one of eleven fire stations that protected the city limits. The department was established in 1883 following a fire in a downtown dressmaker's shop. It began with six volunteers whose equipment consisted of a hose and reel, buckets to form a brigade, a painter's ladder, and a hand-drawn wagon with which to transport the equipment. Over its one hundred-plus year history, it has developed into one of the most progressive fire departments in the Southeast. Its emphasis on specialized training is reflected in the department's Special Teams, which include a Dive Team, a Hazardous Materials Team, a High Angle Rescue Team for elevated rescues, and a Heavy Rescue for specialized extrication scenarios. Rescue 2 was one of three units assigned to Station 2, located on Orlando's west side. The neighborhood, just blocks from historic downtown Orlando with its beautiful buildings and tourist attractions, is known for its violence and poverty. Shootings are a regular occurrence, and a large percentage of the emergency calls involve the sizable homeless population that wanders its streets.
I drove by the station the day before I was scheduled to ride. I wanted to check out the location, as well as see what an actual fire station looked like. So I cruised by like a stalker, casing the neighborhood. The station was surrounded by small businesses and shabby houses. People wandered the streets, many pushing their belongings in shopping carts or dragging them in large grocery bags. The station itself was a two-story white masonry building with an American flag out front and a homeless man asleep on the bench next to it. A tower truck was parked on the driveway in front of the station. It had its ladder extended high into the air as men worked around it, kneeling next to equipment as they completed their morning checkout.
The size and complexity of the rigs was intimidating and my belly tightened when I thought about reporting for my clinical. But I showed up the next day, Easter Sunday, timid and ignorant. Fortunately, the crews were friendly and unassuming, and they welcomed me inside with greetings and handshakes. They showed me around the equipment, explaining what each piece was used for and the various ways they were implemented to attack fires. The station consisted of a rescue, a fire engine ("engine") and a ladder truck (referred to at OFD as a "truck" or "tower"). Each person had an assigned position, and the tasks of each position depended on the type of incident. The interconnection of personnel and equipment fascinated me and I was instantly hooked.
OFD, like most departments in Florida, works a twenty-four-hour shift that begins at 8:00 A.M. and ends the same time the next morning. "Calls" are the emergencies and nonemergencies that the crews respond to. This term derives from two sources: an emergency incident typically enters the Dispatch Center in the form of a phone call and the Dispatch Center then "calls" out the station via emergency tones. A call is also referred to as a "run," the term being interchangeable. Each morning, crews exchange information as to the number of runs they had the previous shift. A busy shift as Station 2 can consist of up to twenty or more runs. The language of firefighting and EMS is full of jargon, acronyms, and slang, although it varies throughout the country.
Aside from my fascination with the trucks and equipment, I found the environment equally intriguing. The crews joked incessantly. They seemed to prey on each other's faults and weaknesses, and nothing was off limits. They teased each other about events of the previous shift, told stories about embarrassing episodes in the crew's past, and even made fun of each other's physical characteristics. From an anthropological point of view, it was like observing a foreign culture or secret society. There were unspoken rules of conduct, especially where rank was concerned, but it was an atmosphere of camaraderie and humor. That first day at Station 2 would direct the next twelve years of my life. That day was also the point at which my mother began to die.
LOSS
Following my graduation from high school three years previously, my mother had been diagnosed with breast cancer. It appeared not as a lump, but as a small indentation in her breast she happened to notice one morning in the mirror. She was diagnosed, had a radical mastectomy, and took chemotherapy for a year. It was a difficult year of illness, treatment, and hair loss. She pulled through that year with stoicism and grace, never revealing her fears and frustrations.
For three years she was fine. Her exams and scans were negative and we had begun to breathe a bit easier. But then the vomiting started. For several months, it became increasingly difficult for her to keep food down. At first she brushed it off as indigestion. The family practitioner she worked for diagnosed it as esophagitis. How he could have ignored her past history astounds me to this day, knowing what I now know about the tendency for breast cancer to spread throughout the body. She began to lose weight, eventually becoming weak and anemic. She was taken to the ER the day I reported to Station 2. I called my father that afternoon to check on her condition, but all they could determine was that she was bleeding internally. The source of the bleed was a mystery. Thus began the last year of her life.
The cancer was back, having spread to her stomach and bones. There was little they could do other than treat the symptoms and try to keep her comfortable. She endured additional rounds of chemotherapy in hopes of slowing the disease's progression. Her lungs repeatedly filled with fluid, requiring several trips to the hospital during which chest tubes were inserted into her fragile body to enable her to breathe. Many of the patient assessment skills I learned in school I perfected on her. I learned about the "tented" skin and sunken eyes of hypovolemia, where lack of fluid in the body causes the skin to shrivel and loose its elasticity. I learned the difference between rales and rhonchi, various breath sounds caused by fluid buildup in the lungs. I also learned what it was like to deal with terminal patients. I divided my time between studying and taking care of her. She would die at home one year later on Christmas Day, two months after I became a medic. She was the first person I ever pronounced dead.
(Continues...)
Excerpted from LET BURN by Rachel K. Wentz Copyright © 2013 by Rachel K. Wentz. Excerpted by permission of Michigan State University Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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