Engine Company EMS: Clockwork

An ambulance

By Michael Morse

“Rescue 1 with Engine 13, respond to Broad and Connor Street, at the nightclub for a reported shooting…”

We were out the door in 30 seconds, on scene in two minutes. A hostile crowd waited, kind of contained by a few police officers. More were on the way, but for now, our “safe scene” was anything but.

One of the firefighters from Engine 13 helped my partner with the stretcher and equipment from the ambulance; the officer of the EMS engine company kept an eye on the crowd; and the remaining two firefighters from the four-person company assisted me with the patient.

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Sixty seconds later, we had a victim with three gunshot wounds to the torso immobilized, high-flow oxygen running, two large bore IVs established, bleeding controlled, a 12-lead EKG acquired, interpreted and transmitted to the ED. The captain of Engine 13 stepped into the driver’s seat of his truck, his chauffer drove the ambulance, the remaining two firefighters joined me and my partner in the back of Rescue 1, and we left the increasingly volatile scene. Seven minutes from time of dispatch we rolled our patient into the Level 1 trauma room at Rhode Island Hospital. I gave my report, which, because of the excellent work from the engine company, was detailed and accurate. The trauma team got to work and had the patient stabilized and headed up to surgery 15 minutes later.

A man who had every reason to die lived. We barely spoke during the call, every one of us confident in our ability to do our job, and, more importantly, confident in the ability of every member of the team.

You would think that we spent long hours training on how to treat a person shot three times in the torso at a nightclub a mile from our station, but that never happened. The reason everything clicked is because the officer of the engine company responded to EMS calls with the same vigor as he did fire calls. His crew knew to bring their oxygen, med bag, and monitor into every ALS call, no matter how routine. His crew routinely established IV access on stable patients with recurring chest pain. They knew how and when to treat allergic reactions, knew their medications and correct doses, knew the difference between glucagon and 50-percent dextrose.  They understood how the body reacts to adenosine; they learned to titrate naloxone to respiratory rate and did everything in their power to make every call they were dispatched to go as smoothly as possible. They were damned good firefighters and a pleasure to work with.

Lessons learned on routine calls are invaluable when the stakes are higher. Recognizing shock, staying calm and focused, nailing the IV on the first attempt, not fumbling with the oxygen bottle and mask, watching IV flow rates, cutting off clothing, locating exit wounds, re-checking vital signs, having the bag valve mask and defibrillator pads set up and ready to go…these are not skills anybody is born with, even firefighters. Repetition during less-stressful moments helps to develop expertise that shines at times when others struggle. Even salty firefighters (who have seen it all) can benefit from getting involved on every call they run. When every responder is as efficient as their potential allows, teamwork develops, lives are saved, and the fire department earns the respect of the community.

Michael MorseMichael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.

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