By Michael Morse
Sometimes, they wake up dead. In one of the many nursing homes scattered throughout Providence, Rhode Island, an elderly woman succumbs to her disease. Morning rounds are livelier this morning, as the secretary is instructed to call 911.
Ladder 3 is dispatched from the Admiral Street Fire Station, along with Rescue 1. It takes the rescue nearly 15 minutes to arrive on scene, having been dispatched from the opposite end of the city; the crew from Ladder 3 had been there for 11.
A lady is dead in her bed at the end of the hall. We wheel our stretcher past a group of elderly residents who have gathered in the common room for a presentation by the nursing home staff. Twenty or so people look our way as we pass. CPR is in progress. Elliot, the officer in charge of Ladder 3, gives me the report:
"Seventy-two year old female, history of lung cancer, found unresponsive at 8:30 this morning. The staff started CPR immediately, our defibrillator gave one shock, she's asystolic now."
"Thanks, Elliot. Advanced directives?"
"Full code. No IV access."
She has been down for nearly half an hour. Her skin is blue, cold to the touch and clammy. It is probably too late, but miracles do happen, and we continue on. I place a long board on the bed next to her and slide her over. With help from the firefighters from Ladder 3 and my partner, Brian we get her onto our stretcher. Brian takes over compressions, Elliot operates the bag valve device, and we get rolling.
The people gathered in the common room sit silently and watch as we wheel their neighbor past them. How often has this happened to them? I wonder. How many of their friends do not wake up? Do they still bother to make new ones? Some looked horrified. I figure they are the new residents; a few look shocked, some people always do, and most just look sad. A couple of them have no reaction at all. They are probably the senior members of the club and have seen this show one too many times. And, they probably know their turn is coming.
I manage to place the tube, her color returns after a few moments, artificially provided by our work. Elliot and Brian continue CPR as I administer the right drugs via the tube. No response. One of the firefighters drives the rescue and the other follows in the ladder truck. The ER is close; we bring her in, and the code team takes over. The woman's family has arrived and waits in the waiting room for news. Ten minutes later, the wait is over. The lady is gone.
The people at the nursing home would find out later what they already knew. In another day, or week, or month at the most, another fire crew and ambulance will invade their space and take one of them away. But that person might return. As long as there are firefighters, there is hope. It has happened before, and it will happen again. Knowing that everything that could be done had been done makes the loss a tiny bit less painful.
Later, in an old tenement house in the inner city at 11:50 p.m., a baby wakes, struggling to breathe. When everything his mother tries isn't enough and her son continues to struggle, she calls 911. Ten blocks away, the tone sounds at the Broad Street Fire Station, sending The Bullies into the night for another rescue run. They roll out of the bay 30 seconds later, four veteran firefighters, their turnout gear picked up from the floor and taken along, sitting next to them as they speed through the quiet streets. A mile away, Rescue 1 leaves the Allen's Avenue Fire Station toward the same address.
Engine 10 arrives first, a combined 80 years of firefighting experience among them. I've known these guys for 20 years, have seen them at fires, and have worked alongside them. You will not find a tougher bunch anywhere. They enter the house looking for the patient.
A few minutes later, Rescue 1 arrives on scene. Lieutenant Reddington keys his mic and transmits his message. I copy the report, a two- year-old in respiratory distress. Inside the home, I find The Bullies crowded around the little boy, one of them holding the child on his knee, another holding oxygen close, and the other two preparing a breathing treatment. The mother is nervous; she has a four-year-old with cerebral palsy in the next bedroom. She lives alone; the kids’ father left her when he realized his son "wasn't right."
The Bullies bundle the boy up, make sure he has a warm blanket, and take him to the rescue while I make sure the mom is okay and the other boy is taken care of. He goes upstairs to the landlord’s apartment to stay until his mother and brother return. Dad is long gone and will not be coming back.
Inside the rescue, the baby has captured The Bullies. He's still on the knee of one of the firefighters, smiling, enthralled by all the attention. His breathing has improved, his color returned to normal. We get him secured, seat belt the mom, and get ready to go. The firefighters leave as soon as they know the baby "is right."
Then he starts to cry. He doesn’t want me; he wants the firefighters. He doesn't stop until we get to Hasbro Children's Hospital.
Sleep tight, Providence. There are saints in the city, thinly disguised as firefighters.
One of the greatest advancements in the fire service that I have seen since I began my career 20 years ago is the equipping of fire apparatus with advanced life support equipment and training the firefighters as EMTs and paramedics. I have seen countless lives saved by the rapid treatment provided by first responders who know exactly what to do when they arrive on scene. It seems like yesterday that I was a firefighter on an engine company, trained as an EMT-Basic, waiting for the rescue to show up with the right drugs and people trained to administer them and save some poor soul from an overdose, cardiac arrest, diabetic emergency, or allergic reaction.
Progress is slow, but progress is being made. The old adage that the fire service is “100 years of tradition unimpeded by progress” no longer holds true, and more firefighters than ever take the added responsibility of EMS to heart and carry on the great tradition of the fire service, now equipped with a med bag and defibrillator to go along with their axes and hoselines.
Michael Morse is a captain with the Providence (RI) Fire Department and the author of the books Rescuing Providence and Responding. His articles are nationally published and widely read. He lives in Warwick, Rhode Island with his wife, Cheryl.