Last night's duty was busy and eventful. No time to watch the Idiot Box (what I call the TV) and I like that just fine.

I showed up early and got signed in. New General Orders are out and we were going to have a drill to go over them in the training room. Cool. Helped set up the training room. There were a couple of other FF's there and they helped out (sort of).

Got a lot of crap from the other FFs in the training room while setting up. Usual new guy crap talk. Who are these punks? Yeah they're fire fighters (fire technicians, actually), but they're what, 19? 20? The ideal they work for is the "saving a child from a burning building while the mother looks on with grateful tears" scenario. Everything else is a boring waste of time. Including treating patients....

I'm 32, seen a lot of dead people. Saved a lot of live ones. I'm a federal officer and a defensive tactics instructor. I've been around the world, arrested and beat up a few people, been beaten up myself a few times, exchanged gunfire, cried in the boat or ambulance after a dead kid, danced for days after an awesome rescue, fought fires on ships, and lived a lot more. I've met a lot more people from all over the world and learned to get past my own pride and insecurities and get along with anyone. I mean ANYONE.

I'm used to a more military setting, too, where some punk mouthing off to me is easily shut up with a barked order, snarl and instructions to go clean the underside of something nasty. I have a great NCO voice and a whole catalog of epithets to get the message across. That's what comes from 12 years of service, 4 years of sea time and a clear sense of command.

I'm also used to camaraderie. The automatic, "we're shipmates so we're friends and that's that" attitude that comes with being in the service. At the Firehouse, I often feel that I'm not "in the club" yet and worthy of only despite. I'm too old for that crap!

The training: The new General Orders cover our jurisdiction's application of the Incident Command System. Very easy for me since my class last semester called "Disaster Management" was all about the ICS. Pretty cool to see it at a more tactical level. Most of what applied to us was how our Rescue squad, Ambo and Ladder truck fit into various incidents and structure. Neato.

First call came not long after training finished. 41y/o Male, Chest pains. We head out with Driver, officer, me riding 3rd and a brand new volunteer riding observer. We have a medium duty ambulance so, there's plenty of room. I get in, buckle up, have the new fella do the same.

On scene: 3rd story walkup apartment, we go all the way to the back bedroom, I'm scanning the whole place all the way through, listening, sniffing. My habit of "situational awareness" is too ingrained. Don't want to be surprised by a dog and the patient's environment can give a lot of clues. Daughter greeted us at the door. leads us back to bedroom.

Pt. is in bed propped up. Somewhat alert and oriented. He tracks me with both eyes as I come in. His left arm is at his side, his right is across his chest. I get right down in front of him, eye level and say, "Hello, My name is *****, I'm here to help you. Tell me what's wrong."

"My chest hurts." The left side of his face is droopy and I hear that he had a stroke months ago. Oh boy. I put my hands out in front of him, palms up and ask him to take my hands and pull on both of them equally. Good. He's got equal strength. I didn't like his arm positioning when I came in.

I get a strong pulse, Bp normal, blood O2 at 98%, skin is warm and dry. He can tell me his name, where he is, but has no idea what day it is. That slurring is bugging me. I ask him, "On a scale of 1 to 10, with 10 being the worst pain you've ever felt, how bad is the pain in your chest?"

A long pause, the mouth is moving. Working on words? "Eight." Really quiet.

"Is the pain moving around or is it staying in one place?"



"Up here." His right hand travels from his sternum up to his left shoulder. Oh boy. The driver, D. and another EMT, S. are with me. D. goes for a stair chair and I ask S. if ALS is en route. Yes. Good.

All the while the wife is in the bed too. She just had surgery on her foot and she can't get up. She's alternating between being firm and demanding with us, "What hospital are you taking him to?" and touching her husband on the arm, "Ok, Baby, Ok." The daughter hovers and looks for things to do, people to call. I know how she feels. Helpless. I focus on the Pt. This kind of family stuff touches me deep.

By the time we have him in the stair chair, ALS is on scene. I pass all my info to the medic and go get their stretcher while the rest of the crew get the Pt. down the stairs. 2 minutes later, he's in the Medic unit. The daughter's in the front seat of the unit, crying. She lost her careful composure, finally. That's her dad. That's scary for her big time.

Afterwards, S. goes into "instructor mode." He starts to critique my work. He says I talk to the patient too much. That I don't need to tell him everything I'm doing. He also says I move too fast. Ok, I sometimes do. I'm high speed. He gives me other feedback, "we don't really wear our seat belts in the back." He also questioned why I left the pulse O2 meter and the Bp Cuff on the Pt. I tell him that with this type of Patient, I'm going to take vitals frequently and leaving them on is like a reminder to do that.

I met S. at the Volunteer Recruit School 3 months ago. He had never touched a patient then. Now, he's flush with his certification as an EMT-B, and an officer on the ambulance. Ok. I don't tell him that talking with a patient develops rapport and shows compassion. I also don't tell him that engaging in a constant conversation with the patient helps me keep track of their mental status, especially in a potential stroke victim. I don't tell him that I ALWAYS wear my seat belt. In an ambulance, I like being the EMT, not the patient.

Back at the FireHouse, we go over paperwork and we're done. S. means well. There's not a bit of malice in the guy and I like him. I can't wait until I'm the medic and not the EMT-B. I don't like handing off a patient. I want to go with them. I want to see them through. I want to know the end of the story.

One of the FFs at the station, C. is a career FF in another jurisdiction. Assistant chief lined him up to give me and the new guy SCBA training. Cool! C. is competent, patient and teaches well. I learned a LOT! C. really pushed hands-on and it's good. The SCBAs are really different than the OBAs I used back in my shipboard firefighting days. We put them on, took them off and repeated the process with turnout gear on. Practiced a lot. Cool. Check me out: SCBA Pimp! Note the much disdained BLUE HELMET. That's the indicator for EMS only in my jurisdiction. Most FFs think we're just this side of useless. Ah well....

By the time we finished all this it was 11pm and time for my tired butt to go home. I log on to the laptop (wireless with DSL at the FireHouse, Nice!) to check email and read one of my favorite blogs before heading home. Sure enough! One bell, Ambo call. Yippeee!!!

25 y/o Male. Back spasms, no other complaints. Another 3rd floor apt. but only one flight of straight stairs. Ok.

Enter the apt. to find Pt. on his left side on the floor in front of the couch. Alert oriented, about 6'2", 275lbs. This guy was great. Great attitude, worked with us, though in a lot of pain. D., who drove again, had just gotten over the same thing. Back injury while weight lifting, subsequent debilitating spasms. He had a lot of sympathy for the Pt. The Pt. was so affable that we all interacted well. We told jokes and worked together to get him moved. S. called the squad to get some people to help get him down the stairs. All vitals normal.

We got a flexible backboard and he scooted himself around the floor until we got him on it. Pretty much a simple transport to the ER which was thankfully quiet so nobody had to wait. We worked with the nurses and moved him onto a bed. Everyone was in a good mood, friendly and it went very well. The Pt. was a good sport and I think that had a lot to do with it.

A nice finish to a pretty decent night. I got a lot of training, ran some calls and got to "strut my stuff" a bit. On both calls, S. stood back and let me take the lead. Got home late and slept like the dead.

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