IT REALLY IS ALL ABOUT TRAINING!

BY JOHN M. BUCKMAN

On July 22, 2003, Lieutenant David Barnes was presenting a training class on respiratory challenges at German Township (IN) Volunteer Fire Department Headquarters. The presentation was well done, and we learned a new word—”tachypnea.” I had remarked to Firefighter Chris Lemon, who was the duty officer, that I wanted him to use that word on the response tonight, no matter what kind of response it was. We all laughed.

There were 22 people in attendance at training. We had finished the lecture portion of the class and were doing blood pressure checks. I had just finished my fourth BP when Firefighter Phillip Goad called on the radio. You could tell that he was excited. By his tone of voice, I knew that he was on the scene of something.

He told us he was on the scene of an accident at Interstates 65 and 6; it happened right in front of him, and he would be checking on injuries. There was no doubt in my mind that there were injuries. I ran to the command vehicle. I told Chris Lemon to get in; I would drive, as he was the incident commander (IC). In our command system, personnel are assigned duty time. One person is assigned as the initial incident commander, and tonight that was Chris Lemon.

Photos by Brooke Reed, German Township (IN) Volunteer Fire Department.

As we were driving to the scene, Dispatch came on the air and said there was a nurse on-scene and she was requesting the Life Flight helicopter. I told Dispatch to not call for the helicopter. Deaconess Hospital was only five miles away.

By the time we got in the vehicle and started toward the scene, Goad was reporting at least two injuries. He did not report extrication, and that was a relief—but it wasn’t totally accurate. People were still in the vehicles and would have to be removed, packaged, and transported.

When Lemon and I arrived, we saw a white pickup truck in the median. I could not tell the damage to the truck, as we were looking at it from the back. There was a black car down in the median. The passenger side door of the black car was ripped away. I could see into the car. A female was in the passenger seat.

As I grabbed my helmet and coat and headed toward the black car, I heard someone say there was a baby in the back seat of the car. I certainly hoped not. I got to the front of the car and threw my helmet on the hood and dropped my fire coat. Sure enough, there was a baby in the back seat. I went around to the driver’s door. I didn’t know if it was open or closed, but I quickly got in the back seat of the car by pushing the front seat forward. The lady in the passenger seat was screaming. I told her to be quiet—not a very nice thing to say, but at least she was breathing.

The baby was not screaming or moving. I pictured my 19-month-old granddaughter in the back seat of that car. A lot of things raced through my mind, but I knew that she had to come out of the car in that car seat. I hoped and prayed that what I was doing was not making it worse. My adrenaline was pumping. The race against time had started, and the clock was ticking. I hoped that the ambulance would arrive quickly.

The car seat was strapped in. I asked for a seat belt cutter. I could not find the seat belt clip to disconnect, as it was under the seat and the seat had been pushed over into the middle of the car. I checked on the little girl and found no breathing. She had blood all over her. She had head trauma on her right side, where the other vehicle had impacted the car. It was a direct hit. There was massive damage to the car and to the passenger compartment. A big truck against a little car—you know who usually wins. It does not matter who was at fault, but it does matter in who wins the crash test.

I looked into the eyes of this child and saw nothing. There was no breathing. There was no sound. There was no movement. There was nothing. I did finally get the seat belt disconnected and literally ripped the car seat apart to get it disconnected from the seat belt. It worked. I am not sure how, but the baby was out of the car. I laid the car seat down in the median and hollered to Lemon that we had an infant trauma patient and to tell the ambulance we would be ready to load on its arrival.

Where was the ambulance company? It is usually pretty fast, but I knew it wasn’t posted in its normal spot about four miles from the scene but about five miles away, through the back roads. I knew only seconds were ticking by, but it sure seemed like two hours before the first ambulance arrived.

I looked at the baby and tried to adjust her head to see if her airway was open. She had lots of blood in her mouth and all over her face and the side of her head. There was glass all over her body and in the car seat. Nothing worked. She was not breathing. I stuck my finger in her mouth and pulled out a lot of blood. This might not be the way it is written in textbooks, but this is the way it works in the field. Not all of the rules were followed. I did not have gloves on. I wasn’t worried about infectious disease. I was worried about her breathing. I did not want to take her out of the car seat, but I knew if I had to start CPR that she was coming out of the seat. I moved her head again, and at that time I saw her start to breathe. I saw a little movement of her body. It was not any particular movement, but it was movement.

I grabbed the car seat and moved out of the ditch up into the road. I don’t know why I moved, but I did. I hollered at Lemon that I needed suction. I needed the little bulb syringe that we have carried in the trauma kits for years. The bulb syringe would be just about the right size to reach down inside her mouth to try and get some of that blood out of her mouth. It worked. She was still breathing.

Lemon said he was calling for more help and transferring command. Good idea and smart move. The cavalry was en route. You could hear them, and you knew that your comrades would soon be here to help take care of things.

It was a bad accident. There was speed involved, and there was a severe side impact. There was still one patient in the car. There were several people running around screaming. One reportedly was the mother of the baby. When you are first on-scene and it is serious, you feel somewhat helpless, as there is a lot to do and you are only one person. Hearing the sound of the “Q” siren, seeing the sheriff’s car pull up, and watching the rescue squad screech to a stop give you comfort—the cavalry is here!

Where was the ambulance company? Vanderburgh County Sheriff Sergeant Dave Weiss and I both thought about taking the baby to the hospital in his patrol car, but I had second thoughts. I believed the paramedics could help this little girl.

The ambulance arrived. Firefighter Paul Carr grabbed the suction; the baby was now vomiting. It was obvious to me that the paramedics on the ambulance did not know what they were coming into when they arrived on-scene. Lemon had tried to communicate by radio, but it appeared that this team was not completely informed when it arrived, and the second ambulance was assigned to transport the baby.

I decided that I was driving the ambulance to the hospital. I told the EMT that I would drive, and he responded that it was the paramedic’s call. Sometimes in the heat of battle, we say the darndest things. It wasn’t a long drive, and it was mostly a four-lane divided highway. It was only five miles. The paramedic and EMT were partners, used to working together, and this would give the baby the best available team to help her. The grandfather rode in the passenger seat of the ambulance. He was quiet. There just is not a lot to say in these times. You hope and pray that things will work out.

The response seemed like an eternity, but we learned later that it was 24 minutes from dispatch until three patients were packaged and transported from the scene.

On our arrival at Deaconess Hospital, another team was waiting. About 12 people converged on the baby. She was removed from the car seat, and most of the glass was cleaned off her little body. There was not much movement, and there was little or no sound. The paramedics weren’t able to get an airway. The doctor tried and tried. It was quite a struggle to obtain an airway, but the doctor did not give up. The doctor asked for an anesthesiologist to sedate her. I stood outside the room and watched the team work. The baby’s body convulsed as the doctor tried desperately to get the airway, and he did. The Deaconess team was quietly determined to do everything within their power to help this baby.

There was discussion about transferring the baby to St. Mary’s Hospital for some reason. Deaconess is not a small hospital. It is competing to become a trauma hospital. Eventually, the decision was made to transfer the little girl to Riley Children’s Hospital in Indianapolis by Air-Evac because Evansville does not have a pediatric trauma surgeon.

Although the baby was given the best chance of survival by the team of firefighters, EMTs, deputies, and hospital personnel who worked on her, she later succumbed to her injuries.

• When a call is received, expect it to be the worst that you can imagine. That allows you to prepare mentally for the things that you confront. Review with your partner who is going to do what when you arrive at the incident scene.

LESSONS LEARNED

1. Who is going to go around the vehicle and complete a size-up?

2. Review in your mind the layout of the area where the accident has occurred.

3. What are the intersection hazards—overhead wires, light poles, traffic signals, topography?

4. Who will get the trauma kit?

5. Who will be doing patient care?

6. Who will be inside the vehicle?

7. Who will call for more help if it is needed?

• Develop and implement standard operating procedures. If you write it down and don’t follow them, on returning to the station, run them through the shredder.
• It is about the basics at most incidents.
• The ABCs are critical when dealing with patient care.
• Confidence is important. Cockiness will get you hurt. If you are trained and competent, rely on your instincts.
• Your partner is a part of you. Trust is an important part of working in the streets. You must trust that your partner will be there when you need him for backup.
• There is no “I” when operating at a trauma incident, especially in the volunteer fire service, where you may have a different partner for each response. Understanding and operating within the team concept is critical.
• Communication is critical to successfully mitigating an incident.
• Make sure that all response agencies know the radio frequency assigned for that particular incident.
• Having a strong, visible IC and incident command system (ICS) is critical to managing incidents.
• Personnel must operate within the ICS.
• Know the locations of tools and equipment on your apparatus and how to operate them.
• Resources are critical to mitigating an incident—adequate personnel and equipment should be a commonsense part of the ICS. Don’t be afraid to call for additional resources when needed, and don’t be afraid to send them home when you don’t need them.
• Debrief your personnel. Each individual will mentally process what he saw and did differently. As the officer in charge of the incident, making sure that your personnel’s mental health is maintained is an important part of managing an incident. Debriefing is not just about sitting around a room and talking about what you saw and what you did but includes taking care of your people after the incident. In the volunteer fire service, where you don’t see each other every day or even every other day, calling and checking on your firefighter partner is critical to keeping him as a contributing member of your department.

JOHN M. BUCKMAN is chief of the German Township (IN) Volunteer Fire Department in Evansville, Indiana, where he has served for 22 years, and the immediate past president of the International Association of Fire Chiefs (IAFC). He was instrumental in forming the IAFC’s Volunteer Chief Officers Section and is past chairman. He is an adjunct faculty member in the National Fire Academy residence program, is an advisory board member of Fire Engineering, and lectures extensively on fire service-related topics.

There’s No Excuse to Skip Training!

By Heather Bennett

The thought crossed my mind to skip training that night because my parents had just gotten back in town from a weekend away. I knew better than that—it wasn’t a very good excuse to skip. By the time I got to headquarters, I was ready to get to work, but it was going to be an easy night inside with EMS training.

We had just started our blood pressures and breath sounds when I remember hearing people around me getting really quiet and listening to some radio traffic. I thought, “What’s going on?” For an instant, I thought that it was a joke or it was somebody else’s run, but I hadn’t heard any tones. I soon learned otherwise, and we all ran. I was in Rescue 2.

You can’t stop the training that you work so hard at, so I immediately went into work/prep mode: Extrication? Number of people involved? Number of people coming behind us? Their location? Which patient was I going to take? What was I going to grab off the truck? I train hard for moments like this, and I didn’t let myself down. I’m a newly certified EMT, and with that comes more responsibility. I knew that I was going to have patient care, and my thoughts were immediately with the people still in the car. “They’re the critical ones,” I kept thinking.

We pulled up, and I got a good look at the car and the girl in the passenger seat. The chief came running by me with a bloody baby; I knew she was taken care of. I didn’t know how bad she was, but based on the chief’s face, I knew she was not well. No one was around the passenger of the car, and she was screaming in pain, so she was immediately my patient. I got the c-collar ready and stepped in to get to work.

I tried to talk to her. She wouldn’t stay awake for me. I had to do sternal rubs and touch her face several times to get her to open her eyes. She would close her eyes and pass so quietly in and out that I was thinking the worst—but there wasn’t a chance that I was letting her go, not there, not on my watch or in my hands. She had been talking to me and, by God, she was leaving that way.

When I would ask her questions or touch her, she would occasionally swat me away, but I didn’t mind: She was with me, and she knew what I was doing. She had a lot of difficulty breathing and was complaining of back/neck/chest/abdominal pain. I needed to get her out of there, but there wasn’t an ambulance for her yet. It wasn’t her turn; the baby came first.

The ambulance finally came, and we got her out. She wasn’t happy about being strapped down and had a few choice words for me about it—but she was still with me and still talking. When she left the scene with lights and sirens, I think that’s when I took my first breath since arriving. I turned around and took a second to look at everybody. We looked great. Everybody had a job and was as calm as could be. We looked like we knew what we were doing. That sounds funny, but think about it: What’s the worst thing you feel when on a scene or watching a scene like that? You feel helpless or like it was chaos. But we didn’t feel that way. In 24 minutes, we had three patients off scene, and we could all breathe and take a look at what had happened.

I kept looking at the car and wondering how my patient, who did not have a seat belt on, had stayed in a car with that much damage and the door ripped off. I looked at the car and the amount of intrusion there was into the passenger’s space and wondered how she had not sustained more injuries than she did. I also hoped that that baby had not been sitting behind my patient, but she was.

The chief has asked us over and over, “Are you ready? Do you train enough to be prepared?” Tonight, we all did the job that we were trained for. As hard as it was since there was a baby involved, we all did our job! Every patient left the scene alive; that’s what counted.

Heather Bennett is a member of the German Township (IN) Volunteer Fire Department in Evansville, Indiana. She is a certified Firefighter II and national registered EMT-B and is pursuing a degree in paramedicine. She is also completing her bachelor’s degree in psychology.