Firefighting in Iraq brings a whole new challenge for firefighters. When the heat gets to around 130 you have to watch and rotate your guys out of their bunker gear. You have about 10-15 min before you have to go into rehab. The bad part is that at most of the bases you only have 15-19 firemen and if you have multiple fires (After an attack) you are running out of water very quickly.

Most bases only have 1 Engine, 1 tanker, 1 Rescue. So, you have to work and plan your fire attacks very well and you have to think outside the box most of the time. I enjoyed working in Iraq for 4 years and I met a lot of Fireman from around the US. Being former Military, it was good to be able to help them out anyway I could.

LAST PART

On a positive note, there are some good things that happen. We are faced with difficult calls and decisions that do end up with a positive outcome. Over the years I remember seeing people near death, in death or heading down a near irreversible state and they have been treated with appropriate measures and are alive to this day because of us. Elation and feelings of worth are also a large part of our jobs and emotions. There is no better feeling than when the family member of a critically ill patient thanks you for saving a life of their loved one. The sincerity and gratefulness makes the negative seem worth it.

If you don’t feel that life is precious, if you don’t realize that we are truly only here for a short time, then you might not understand where I am coming from. I often tell people that if you want to judge my feelings and my personality, do what I do, see what I see and feel what I feel. Next time you see a headline story about tragedy and loss of life, think of the people that are responsible for saving that life, trying to save that life and possibly failing at it.

Whether it is 0330 hrs, or 1530 hrs, rain, snow, shine, hurricane or blizzard, call 911 and we will be there for you, whether you have slammed yourself into a tree killing your passenger or an innocent bystander, whether you have messed yourself in a drunken fit, had a seizure or a heart attack. Maybe overdosed on drugs or suffer from an incurable disease, or maybe you are the victim of someone else’s stupidity, We will be there for you.

PART IV

Recalling other calls in my time, such as lost pregnancies where fetal tissue was discarded or left on a bed, or in a toilet. I can remember calls where crack addicted fetus’ were discarded because the mother never knew she was pregnant, or knew and but never stopped her habit and never received pre-natal care. I can remember being called to the home of a woman who just lost her 20 year old son in a vehicle accident. She was a non- English speaking lady, sitting in her hallway surrounded by State Troopers. I have witnessed several senseless deaths in facilities where people are in the care of healthcare providers and have been mistreated or not treated.

I can remember going on cardiac arrest calls where a man my own age stood up to get a drink and dropped dead. The helpless feeling of having a viable person die in your hands is not a comforting feeling at all. I remember a young girl that died at home after a short simple illness, a child pulled from a pool in cardiac arrest only to die in the arms of strangers. I remember pulling up to a young child struck by a car, seeing her lifeless body in the street. I can remember losing it after giving a report and calling home to my children and thanking God that they are ok.

Responding to fatal accidents, covering bodies with a white sheets, while the family is notified of the passing of their loved one. We have to leave situations like that and go back to quarters and fall asleep. I often wonder what gives us the ability to do this? What is the long term effect on us? It has left me with several emotions and personality traits that I don’t care to have, I don’t care to feel and I just simply don’t want. Will any of us be able to forget? Should we forget? If we do forget, will that be ok? What will happen to me when I am done with my career? Will I ever be the same?

PART III

To fail to help someone is hard for a Paramedic. There is a guilt factor that sits in your head for an undetermined amount of time. “Should haves” and “could haves” and “the didn’t do it” factor play over in your head. At times, you regain pulses, maybe just long enough for a parent to say goodbye. If that’s all we accomplish, then that’s a lot. What you say to a parent is never enough to ease pain and suffering, but when they see you do everything you can, it speaks volumes. We have minimal training in how to deal with the family of a deceased child. This is a skill that only a voice of experience and compassion knows.

The loss of a patient is difficult enough, but when it involves a child, sadness, guilt, depression as well as PTSD are all common feelings. Any provider that tells you they are accustomed to it, or it doesn’t bother them, isn’t telling the truth. Although repetitive exposure to these types of incidents hardens you and changes the way you look at things, none of us are immune to the emotions. These calls sometimes take the toughest person to their knees in tears. Some wake up at night with a playback of the incident and some don’t realize the effect it has on them at all.

Anyone can be trained to perform a task, anyone can be asked to get into a truck and respond, but it is not until you get out and make contact that you understand what we go through. This job is different because if we make a mistake the chance of it affecting someone’s life is real, the chance of them dying because of it, is real. We don’t get to do it over. We have to live with the results.

There are several other stressors we encounter. Picture being dispatched to calls for assistance, arriving you find an elderly male that has died in bed sometime during the night. Next to him is his wife of 50+ years, she looks at you and you can see the sadness in her eyes after you tell her that he has passed. Switching gears into a compassionate provider is a hard transition for some. Now picture doing this several times a month, a year and over a very long career. The loss of life, pronouncing somebody dead and making a decision to not work on the deceased for medical reasons and presentation is a difficult decision to make. We walk away while loved ones are left to deal with the sadness, the sorrow and logistics of losing a loved one.

THIS IS PART II OF A MULTI PART SERIES WRITTEN BY AN EMT – IT DESCRIBES THE WAY HE DEALS WITH TRAGEDY

SEE PART I ON YESTERDAY’S BLOG

We all have fears of seeing things we don’t want to see. We all have our own convictions. One type of call I am talking about for myself are pediatric calls. Not a simple fall or bump to the head, I am talking about trauma, death and abuse as well as terminal illness. To face your fears when responsibility is upon you is the hardest task you will ever have to do. I have been face to face with this more than I care to remember.

To me there is no call that comes over the radio or intercom that creates emotion like a baby not breathing or child hit by car. Having had deceased children in my care is something that I can never forget. You can forget the elder that passes, you can forget an MVA that someone was injured or the countless drug overdoses you have encountered but you never forget the deceased or severely injured kid calls. These calls can end career of some of the best EMS providers out there.

The human mind can only take so much cumulative stress. This type of call revisits you at any given time, maybe passing by the house or the scene of the call. seeing temporary memorial placed at the scene where a young life was tragically taken, or seeing the parents sometime after the incident.

There are certain things you remember when faced with these calls. I remember facial features, I remember hair color and injuries. I can remember intubating these kids, doing IO needles and the horrible feeling associated with them. I remember the parent’s anguish and onlookers crying at the tragic event that took place before them. I remember hospital staff working to save a life. I remember losing the battle, giving report and then hiding in a bathroom and downloading my emotions alone. The time to break down is not when the treatment is taking place, not when the greatest responsibility of a life is in your hands. I am charged with saving lives, that is my job.

THIS IS THE FIRST OF A MULTI PART SERIES WRITTEN BY AN EMT – IT DESCRIBES THE WAY HE DEALS WITH TRAGEDY

Part l

Here are some of my thoughts on the things I have seen and experienced over the years of EMS and public service. It is not meant to be anything but an overview of how we deal with stress and tragedy on both a small and large scale. To give you an understanding of what we see, feel and react to on a regular basis. Over the past 18 years of public service with thousands of calls for help, I have developed an altered sense of life, different than the societal norm. Encounters and fears that people hope they never face are what we get called for on a day- to- day and call- to -call basis. To truly understand what we feel, you need to walk in our shoes and see what we see. Since this job is not for everyone, that may not happen. Years ago, I wanted to keep a journal of the crazy and sometimes tragic things we encounter, but after starting it and trying to recall incidents I didn’t want to remember, it all seemed so depressing, I stopped.

To start off, an explanation of what we do is needed. As EMS providers we are responsible for the lives and safety the well- being of thousands of people including ourselves. Treatment modalities range from simple BLS care to invasive airway procedures (ALS) as well as medications and cardiology. That just scratches the surface of our actual responsibilities. Medical care in the pre hospital setting is dynamic to say the least. On a typical day, our range of calls can be anything from an intoxicated child to a DOA (dead on arrival) spouse of someone married for 60+ years. Everything from tragic loss of life, to simple non-complicated trauma is handled by us every time we roll out our stations. This job is not always blood and guts, in fact, that’s a very small percentage of what we actually do. Drug overdoses and psychiatric calls as well as minor illness and minor multiple vehicle accidents are what we are mostly faced with.

It is the calls that “we” all fear that I want to address. As a new provider, I was told by more experienced people that there will be calls that tax you as a provider, every one of us is human and has emotions, the ability to recognize this and deal with our feelings and deal with the tragic events that we have to handle are sometimes not considered in the aftermath of a call. The well being of an EMS and Fire provider as well as Police are not always understood. Understanding that most of us do this line of work because we can. We think that we can handle seeing the sudden death of a child, or young person. The fact of the matter is, yes it is our job, yes it is our responsibility to handle these calls and yes it is our responsibility to handle ourselves after these calls. It does not come without consequences and or stress.

More tomorrow

A call came for a rollover accident on highway 82. It was the first snowfall of the year. When we got on scene, another medic  and I went up to help a lady and her child in the car. As we were walking through the ditch, heard the ambulance back up and I couldn’t think why our driver was backing up. No less than a minuet later, a car slammed into the side of our ambulance, and then into another car. No sooner than that happened, another car slid off the road and into the ditch a few feet away from us. We watched as another car stopped in the fast lane of the highway.

We decided to shut down the highway and all was better. But it was a HUGE eye opener to see how dangerous a highway was and how that car might have slammed into us instead of the ambulance if our driver had not backed up. Lesson: never turn your back on a scene and use the apparatus to block traffic.

Words of a Female Arsonist
Fire became a part of my vocabulary in my preschool days. During the summers our home would be evacuated because the local mountains were ablaze. I would watch in awe.

Below I have listed some of my thoughts and behaviors eight years after the onset of deviant behavior involving fire. I have also included suggestions for helping a firesetter.

Each summer I look forward to the beginning of fire season as well as the fall—the dry and windy season. I set my fires alone. I am also very impulsive, which makes my behavior unpredictable. I exhibit paranoid characteristics when I am alone, always looking around me to see if someone is following me. I picture everything burnable around me on fire.

I watch the local news broadcasts for fires that have been set each day and read the local newspapers in search of articles dealing with suspicious fires. I read literature about fires, firesetters, pyromania, pyromaniacs, arson, and arsonists. I contact government agencies about fire information and keep up-to-date on the arson detection methods investigators use. I watch movies and listen to music about fires. My dreams are about fires that I have set, want to set, or wish I had set.

I like to investigate fires that are not my own, and I may call to confess to fires that I did not set. I love to drive back and forth in front of fire stations, and I have the desire to pull every fire alarm I see. I am self-critical and defensive, I fear failure, and I sometimes behave suicidally.

Before a fire is set. I may feel abandoned, lonely, or bored, which triggers feelings of anxiety or emotional arousal before the fire. I sometimes experience severe headaches, a rapid heartbeat, uncontrollable motor movements in my hands, and tingling pain in my right arm. I never plan my fire, but typically drive back and forth or around the block or park and walk by the scene I am about to light on fire. I may do this to become familiar with the area and plan escape routes or to wait for the perfect moment to light the fire. This behavior may last anywhere from a few minutes to several hours.

At the time of lighting the fire. I never light a fire in the exact place other fires have occurred. I set fires at random, using material I have just bought or asked for at a gas station—matches, cigarettes, or small amounts of gasoline. I do not leave signatures to claim my fires. I set fires only in places that are secluded, such as roadsides, back canyons, cul-de-sacs, and parking lots. I usually set fires after nightfall because my chances of being caught are much lower then. I may set several small fires or one big fire, depending on my desires and needs at the time. It is at the time of lighting the fire that I experience an intense emotional response like tension release, excitement, or even panic.

Leaving the fire scene. I am well aware of the risks of being at the fire scene. When I leave a fire scene, I drive normally so that I do not look suspicious if another car or other people are nearby. Often I pass in the opposite direction of the fire truck called to the fire.

During the fire. Watching the fire from a perfect vantage point is important to me. I want to see the chaos as well as the destruction that I or others have caused. Talking to authorities on the phone or in person while the action is going on can be part of the thrill. I enjoy hearing about the fire on the radio or watching it on television, learning about all the possible motives and theories that officials have about why and how the fire started.

After the fire is out. At this time I feel sadness and anguish and a desire to set another fire. Overall it seems that the fire has created a temporary solution to a permanent problem.
Within 24 hours after the fire. I revisit the scene of the fire. I may also experience feelings of remorse as well as anger and rage at myself. Fortunately, no one has ever been physically harmed by the fires I have set.

Several days after the fire. I revel in the notoriety of the unknown firesetter, even if I did not set the fire. I also return again to see the damage and note areas of destruction on an area map.

Fire anniversaries. I always revisit the scene on anniversary days of fires that I or others set in the area.
Fires not my own. A fire not my own offers excitement and some tension relief. However, any fire set by someone else is one I wish I had set. The knowledge that there is another firesetter in the area may spark feelings of competition or envy in me and increase my desire to set bigger and better fires. I am just as interested in knowing the other firesetters’ interests or motives for lighting their fires.

Suggestions for helping a firesetter. The likelihood of recidivism is high for a firesetter. The firesetter should be able to count on someone always being there to talk to about wanting to set fires. Firesetting may be such a big part of the person’s life that he or she cannot imagine giving it up. This habit in all aspects fosters many emotions that become normal for the firesetter, including love, happiness, excitement, fear, rage, boredom, sadness, and pain.

Prognosis given by psychiatrist: Prognosis is very guarded given the severity of her condition.

READ RED FLAG WARNING – A SERIAL ARSON MYSTERY by Kurt Kamm – HTTP://WWW.KURTKAMM.COM

BEIJING, –More than 2,000 firemen from 14 cities across the Northeastern province of Liaoning worked overnight to put out a blaze caused by explosion of oil pipes near a port in Dalian. With 338 fire engines at their disposal, the firemen spent 15 hours to contain the blaze.

The China Air Force dispatched two aircraft with fire extinguishing agent to assist in the operation. About 6pm yesterday, an oil pipeline exploded, triggering an adjacent smaller pipeline to explode near Dalian’s Xingang Harbor.

Both pipelines, owned by China National Petroleum Corp, caught fire. They were links between oil ships and depots.

The blaze from the larger pipeline was put out about midnight, but at least five subsequent explosions worsened the fire on the smaller pipeline.

*Summer 2004 Alaskan Wildfires – 6.6 million acres
A warm and dry summer contributed to an incredibly active wildfire season in Alaska. A total of 710 fires burned – 426 were caused by humans and 275 were caused by lightning. The three largest fires were the Boundary Creek Fire, Dall City Fire, and Bully Creek Fire, which covered almost 1.5 million acres. More than 2,700 firefighting personnel were involved. There were no fatalities.
* Great Fire of 1910 – 3 million acres
Strong winds on August 20 – 21st spread fires across millions of acres of forested land in Montana, Idaho and Washington. As a result, 86 people were killed; many of whom were firefighters. The Great Fire of 1910 helped establish the US Forest Service..
*Summer 2008 California Wildfires – 1.56 million acres
The state of California spent roughly $1 billion and the US Forest Service spent about $700,000,000 to fight the summer ‘08 blazes, which started in Monterey County where more than 2,000 fires were started by a dry-lightning storm. It was estimated that more than 2,300 structures were destroyed.
*Yacolt Burn – 1 million acres
The Devil Wind from Eastern Washington helped propagate fires in the southwestern counties of the state on September 11th, 1902. Millions of dollars of timber were lost, and 38 people died. Before the disaster, there was no one responsible for dealing with wildfires in Washington. In 1903 a state fire warden was established.
*Yellowstone Fires of 1988 – 793,880 acres
By the end of the summer of ‘88, 36 percent of the park was burned by seven major fires. The most destruction occurred on Black Sunday – August 20th – when high winds caused more than 150,000 acres to burn. More than 25,000 firefighters from various states attempted to extinguish the fires, which didn’t cease until November when rain set in.
*Murphy Complex Fire – 653,100 acres
The largest fire in Idaho in almost 100 years was a product of six lightning-caused wildfires. It started on July 16th, 2007 near the Idaho-Nevada border, and it burned hundreds of thousands of acres of private, public and state land. Grass, brush and juniper ensured that the fire burned for more than two weeks.
*October 2007 California Wildfires – 500,000 acres
A year before the destruction that occurred in the summer of ‘08, October fires engulfed 1,500 homes in Southern California , killing nine people. Half a million people were forced to evacuate as the fire spread across Los Angeles, Orange, Riverside, San Diego, San Bernardino, Santa Barbara and Ventura counties.