The Firefighter

Henry Lansing Woodward

© Copyright 2023 by Henry Lansing Woodward

IImage by <a href="">Ronald Plett</a> from <a href="">Pixabay</a>
Image by Ronald Plett from Pixabay

They were animal-like, high-pitched screams and were as loud and disturbing as I had ever heard a scream to be.”

The Silver Sage was on fire on a hot, dry day outside Reno, near Pyramid Lake on the Paiute Indian Reservation. A strong wind was driving it at about twenty to thirty miles per hour and preventing containment.

It was now mid-morning, and my partner and I still hadn’t had a chance to eat or time to use the bathroom. We were far from the emergency location but were the closest unit, so the call was ours. One of the firefighters had been burned when the fire circled back and trapped him within its flames. It was unknown just how badly he had been burned.

It would take a long time to arrive, even driving with lights and sirens. If the patient had any significant burns to his body, he would continue to suffer the whole time we were on the way. And, as it turned out, The Firefighter had many significant burns.

It took us about fifteen minutes to arrive. A long time when a person is in severe pain. As we pulled up and stopped, I could hear screams. They were animal-like, high-pitched screams and were as loud and disturbing as I had ever heard a scream to be. He had probably been doing it the whole time we were on our way.

As we drove up, we saw a small bunch of Firefighters gathered around him. All of them were waving frantically with their arms straight up over their heads. As they waved, their arms crossed over each other to form an “X.”

Earlier this morning, the man waiting for us outside the breakfast cafe had been doing the same thing. Many people did the same in an emergency. It was so common we came to call it the “X” wave.

They had been with this man, and his screams, the whole time we were responding. I’m sure their anxiety and psychological trauma must have been intense. The only option they had for helping was to keep him wet with their fire hoses, which had done nothing to stop the screaming.

We knew he was still alive, awake, and breathing because we could hear his screams as we arrived. These were good things. However, we also knew he was in severe pain, which was not good.

After coming to a stop, we jumped out, ran to the back of the ambulance, and grabbed the gurney. We didn’t bring any other equipment with us, only the gurney.

We knew this would be a “scoop and run” case with all our treatments done in the ambulance. By doing this, The Firefighter would receive definitive care in the hospital much sooner.

Because he was in extremely critical condition with his life in danger, I was required to ride with him in the patient compartment while my EMT partner drove. One other Firefighter came along to be with his friend and partner.

The Firefighter’s screams continued while we drove and were amplified in the small patient compartment of our van-type ambulance. It was very disturbing. So were the smells. They were horrible, and they assaulted my senses. With them and the high-pitched, animal-like screams, it was almost impossible to concentrate on the problems at hand, let alone to breathe.

The exhaust fans were on and set on high, but they were overwhelmed and could not clear the air. My partner opened the front windows despite having the air conditioner running at max. This, too, made no difference.
I started The Firefighter on oxygen using a nose cannula at six liters per minute. That setting is the maximum flow rate for a cannula. Then I applied an oxygen mask on top of the cannula and set this for fifteen liters a minute, the maximum rate for a mask. That was a lot of oxygen, but dying tissue needs a lot. The first task to be done.

The second was to begin a Normal Saline, medical water, IV, and get the 1000cc volume into him as fast as possible. When I finished attaching the tubing, I handed it to the friend ride-along.

Take this and squeeze it until it is empty,” I told him. Then I put another one together and handed that one to him, also.

Sit on this one until it’s empty,” I told him.

Before we had arrived at the ER, the Firefighter ride-along buddy had squeezed three and a half liters of medical water into our patient. This is about twenty-five percent of the total circulating fluids within the veins and arteries. Those fluids probably kept him alive until we arrived at the ER.

When tissue is burned, human or otherwise, the cells are either cooked, partially cooked, or burst their walls when their inside fluid boils. The amount of fluid lost depends on the extent of the burns and their severity. This man’s burns covered about half his body and were mostly third-degree.

A first-degree burn is a sunburn; second-degree burns have big, water-filled blisters. For a burn to be third-degree, the skin is gone, and the muscle is cooked. A fourth-degree burn is when the muscle is burned away, and the bone becomes charred.

Along with the third-degree burns on the outside of our patient’s body, I had to consider the almost certain possibility that the fire had also burned his lungs when he inhaled the hot air to scream. He also had to be losing fluid in his lungs. This man was in big trouble.

Once the oxygen and the two IVs were running, I contacted the emergency room to give a report. Every EMT or Paramedic must do this to validate the treatments already administered and to receive orders for any further treatments the doctor might want to add. In this case, however, I didn’t wait for the doctor to order treatment. Instead, I immediately asked permission to give our patient Morphine for his pain.

Each emergency room doctor deals with the EMTs and Paramedics in the field according to their style. This doctor was well known to have a “Doctor-God” attitude where-in only he could correctly treat the patient.

Usually, he did not give orders for advanced treatments in the field, and Morphine was an advanced treatment. He was the doctor and would initiate any advanced treatments in the emergency room.

He denied my request and would not allow me to give this man anything for his pain, and I knew this was a bad decision. This patient needed Morphine now. So, I did something I’d never done before. While the doctor was still talking, I keyed the microphone and cut into whatever he was saying.

Then for fifteen to twenty seconds, I held that microphone about two inches from the patient’s mouth while he was screaming his animal-like screams. I just held it there, and held it there, and held it there until I was fairly sure the doctor thoroughly understood the severity of the situation.

Right after I closed the microphone, the doctor began talking again. It seemed he had realized the error of his ways and immediately gave orders for the Morphine.

I gave it to the patient through one of his IVs, and in about thirty seconds, the screaming reduced in volume and intensity. Then, in a few seconds more, he stopped screaming altogether. The moaning continued, and he was still in critical condition and shock, but he had stopped screaming. However, it did nothing for the smells.

Morphine doesn’t remove the pain so much as it allows a person to not care about it. At the same time, it reduces anxiety and, to a point, acts as a tranquilizer. It is classified as a hypnotic class drug and works well to alter the level of consciousness and anesthetize the patient.

Those effects allow patients to relax, and by doing that, it lowers the potential for shock. When given directly into the blood flow via the IV, as I had done, it works quickly, and this guy needed it to work quickly.

The Morphine lasted until we arrived at the emergency room and turned our patient over to the doctor and the staff. I reported to the nurse and ignored the doctor. All I needed from him was a signature on the ambulance medical report signifying he had authorized the Morphine.

I presented the medical report form to him, and he signed it. Then he walked away without saying a word. Again, this doctor was known by everyone in the emergency room to do this sort of thing regularly with the Paramedics and the nursing staff.

As I left with our gurney, one of the emergency room nurses I knew well came up, smiled, and moved close to my ear.

Nice touch with the microphone,” she whispered.” I turned toward her, smiled, nodded silently, and continued pushing the gurney.

I was hoping it would work,” I responded.

Well, it did,” she added, “but what’s that terrible smell?”
Again I said, “We are having a busy morning and had a bad call earlier. I haven’t had time to change.”

She responded, “Sure hope you can before you return. That’s a terrible smell.”

Thanks,” I replied. “I know,” and continued toward the door and the fresh outside air.

That doctor never again refused to give me what I asked for, and The Firefighter received the medicine he needed when he needed it.

Outside the emergency room, the firefighter ride-along, who had been watching and listening to everything happening to his friend in the ambulance, was waiting for his buddies to give him a ride back to his station. As I pushed the gurney into the ambulance, he walked up and stuck out his hand so we could shake.

As we did, he smiled and firmly squeezed my hand in a friendly way. At the same time, in a very nice voice, he said, “Thanks, doc. Thank you for what you did. I will never forget it.”

It was a good moment after a bad call.

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