Preparing for a Fire/EMS Injury or LODD

fireEMS By Daniel E. DeYear

Monday, May 1, 2017, started out as any other day for the Dallas (TX) Fire Rescue Department (DFR D). The warming temperatures of early May brought a forewarning of the soon-to-arrive typically hot summers of North Texas. Station 19, located in East Dallas, houses Engine 19, Truck 19, and Rescue 19 and a mobile intensive care ambulance staffed with two firefighter paramedics. An unstaffed heavy rescue rig is also assigned to Station 19 as part of the urban search and rescue team serving as Texas Task Force 2. In Dallas, the paramedics are cross-trained as firefighters, and a typical crew at a station has four to six paramedics who rotate between the rescue and the fire apparatus. Nearly all of the other members and officers had previously served as paramedics on a rescue unit earlier in their careers.

The B shift had officially reported for duty at 0700 hours; most members arrived between 0600 and 0630 hours. In addition to checking out the apparatus and their equipment; cleaning the fire station; and preparing for the daily training, inspections, and maintenance programs, they managed to squeeze in cooking and eating breakfast. By 1030 hours, Engine 19 had responded to two runs, and Rescue 19 had responded to four emergencies.

At 1132:51 hours, Rescue 19 and Engine 19 were dispatched to 3125 Reynolds Avenue for a reported gunshot wound. Both units began responses at 1133:43 and 1133:53, respectively. The initial comments displayed on the mobile data computer (MDC) indicated that an individual had been shot inside the house and the complainant had found her child’s father inside with a possible self-inflicted wound and she was afraid to go back inside.

The DFRD responds to “gunshot wounds” on a regular basis, as one would assume, when in a large metropolitan city. Years ago, the department had answered 3,650 shootings in one year. That number has diminished since then, but it is still not unusual for the department to respond to six to 10 shootings during a shift. Station 19 is in an area where shootings are not uncommon, and all members on duty that day had considerable experience working these types of incidents. The scene of the reported shooting was a residential neighborhood consisting of older one-story homes.

Arrival on Scene

As Rescue 19 entered the neighborhood from the west and cautiously approached the address on Reynolds, the police dispatcher had posted an updated comment to the MDC advising that the complainant claimed the victim did not shoot himself but had a gun and was threatening. As Rescue 19 slowly approached 3125 Reynolds, members realized that this address was, in fact, a vacant lot; they began scanning the neighborhood from inside the rescue unit. At about that time, they received another update advising that the complainant now says her neighbor has been shot and he was on the ground in the front yard.

The members of Rescue 19 could now see someone lying in the grass between the curb and the sidewalk approximately 100 feet away on the passenger side of the rescue. A cross street was between their location and the patient. The rescue vehicle slowly crept forward, briefly stopping in the middle of the intersection of Reynolds and Owenwood Avenues. The paramedic riding the front seat rolled down his window and shouted to the individual on the ground to show the responders his hands. The subject began moving and complied with the request. The driver of Rescue 19 then slowly pulled up alongside, and then slightly past, the individual on the ground.

As the paramedics exited the rescue, the passenger-side paramedic suddenly observed another individual with a rifle approximately 60 to 75 yards farther east of their location. This man was about four to five houses away on the south side of the avenue, which was the passenger side of the rescue. The paramedic notified the driver of this when they met at the back of the rescue near the individual on the ground. They realized they were now in a dangerous position and needed to retreat to ensure their safety.

The rescue unit was positioned between them and the suspect. The driver attempted to get back into Rescue 19 to relocate the unit while his partner entered the rescue from the rear. Suddenly, the suspect fired at the driver, who retreated to the rear of the unit. He made a second attempt to reenter the cab, but the result was the same. Both paramedics were trapped behind the rear of the rescue unit about 12 feet from what now appeared to be a victim lying on the ground who was not the suspect. Within seconds, the paramedics heard more gunshots and witnessed the original victim being shot again just feet from their location.

The paramedics now knew they needed to run and sprinted north, attempting to run between two houses toward an alley. The driver of Rescue 19 was successful in running from the shooter, but the second paramedic was shot as he was crossing the street and fell against the opposite curb on the north side of Reynolds Avenue. Engine 19, which had arrived from the same direction, was stopped about 100 yards behind Rescue 19. The crew of Engine 19 witnessed the paramedic get shot and fall. The bullet struck the paramedic in his right leg between his knee and hip. Immediately, Engine 19 and the Rescue 19 driver transmitted several distress calls advising all responders that the gunman was actively shooting the first responders.

The crew of Engine 19 witnessed the suspect pursue the Rescue 19 driver between the homes and shoot the other paramedic a second time as he passed him lying in the street. This second bullet traveled through his left arm.

What ensued in the following minutes was obviously chaotic, intense, frightening, and heroic. The driver of Rescue 19 escaped from the shooter and ran an obstacle course around the street, alley, another cross street, and back to Reynolds Avenue as the Dallas Police Department (DPD) began arriving. The driver was attempting to return to assist his partner, but a heroic police officer had entered the location and was able to reach the injured firefighter paramedic and load him into the police car. The police officer drove Code 3 to Baylor University Medical Center (BUMC).

Additional resources, equipment, and personnel were either assigned or responded, including 784 [the emergency medical services (EMS) shift duty officer], Rescues 32 and 44, and Battalion 8. By now, all DFRD and DPD members were aware that a firefighter paramedic had been shot and a gunman was at large.

Two deputy chiefs (806 and 807) oversee the DFRD Emergency Response Bureau. Each is responsible for approximately half of the city. As deputy chief at 807, I was on duty and responsible for the uptown/downtown and all areas south, which included the response area where the shooting occurred. As I continued toward the shooting location, the acting 806 deputy chief announced that he was closer and would respond to 3125 Reynolds Avenue. I then decided to go to BUMC where the injured member was being transported instead of responding directly to the scene. While en route, I contacted Battalion 8, the on-scene incident commander, to find out how seriously the firefighter had been injured. I was told that he had been shot in the leg. I let out a sigh of relief: It did not sound as serious as it could have been.

Injuries More Serious Than Anticipated

Meanwhile, the Dallas police officer who had rescued the injured member was nearing the BUMC. The members of Rescue 3, who had transported a patient to BUMC, were preparing to leave and return to service when they heard on the radio that a firefighter had been shot in the leg and was being transported by a DPD patrol car. The Rescue 3 members took a proactive measure and obtained a tourniquet before the police officer and the injured member arrived at the emergency room (ER) loading area. They quickly assessed the condition of the wounded firefighter paramedic and determined that he had lost a significant amount of blood; he was unconscious. One member of Rescue 3 applied the tourniquet to the paramedic’s leg as they attempted to remove him from the back seat of the patrol car and onto a stretcher.

As the wounded firefighter was being wheeled into the emergency room, his pulse stopped. He had lost so much blood. Cardiopulmonary resuscitation (CPR) was initiated, and the BUMC staff began advanced life support and other life-saving measures. The resuscitation necessitated an emergency thoracotomy with open-chest CPR.

When I arrived at the loading docks of BUMC, several fire department representatives and fire companies were also arriving, including Truck 19 and staff members. Thinking that the shooting had involved only the member’s leg, I passed several firefighters who had stressed looks on their faces. I finally asked a member as I passed, “How bad is it?” The response was, “Bad. It’s real bad!”

As I entered the ER area, the firefighter was being moved from the ER to the elevator that would take him to the operating room (OR). CPR was no longer being performed; but, by his appearance and the faces of the dozen or so people attempting to save his life, it appeared that the situation could not have been more critical. The time was now 1215 hours. I felt the football swelling in my throat: It seemed that there was a very good chance that the DFRD family would be experiencing another line-of-duty death (LODD). We needed a miracle. Not only did I know the member, but I had worked around this well-respected man for years and was his fire academy commander years ago when he began his career. For the seventh time in my career, I made the quick call to my wife to tell her I was okay in case she had heard anything on the news or the kids, neighbors, or other family members called.

Challenges

Here, I would like to focus on the challenges few fire department members, fortunately, rarely experience. These responsibilities often fall on executive staff members, chief officers, and chaplains. They often have to do the most unpleasant jobs and are responsible for notifying the next of kin that their loved ones have been injured or even worse. They must share updates with the brothers and sisters within the organization and keep up with the breaking news and ever-changing updates. In addition, I have found that no matter how well you plan the process, social media will derail everything.

The chief of the department and the chaplains were out of town. Two assistant chiefs were now at the hospital, but one was transitioning to another department, and the other had recently been appointed. Although he is extremely conscientious, capable, and competent, he has had minimal exposure to these unfortunate events. The other assistant chief knew that I had had experience with this type of situation; thus, I began working as a team with him, the Station 19 captain, and a deputy chief from the EMS Bureau.

Meanwhile, the tightly knit crew from Station 19 and other on-duty and off-duty members from surrounding fire stations who worked closely with the wounded member and his crew began arriving at the hospital. The BUMC staff quickly secured a secluded location on the 15th floor where the fire department could set up and organize the process of notifications while waiting for updates from the OR. Meanwhile, the number of firefighters and off-duty members began increasing as word spread that a firefighter had been critically wounded. The 15th floor was appropriate; it had a large auditorium and three smaller rooms we used for snacks and drinks and private conversations.

Locating Next of Kin, Monitoring Patient’s Status

We began the arduous process of gathering emergency contact information for the injured member. His wife’s name, address, and phone number were obtained from the Information Data System. This was confirmed by the Station Watch Book. Although the injured member was well known at Station 19 and within the department, his personal life was relatively private. The captain knew his wife’s name and that they had a son about three years old. The injured member resided about 32 miles away, 45 minutes to an hour from the hospital. The battalion chief in closest proximity to the area, Battalion 2, was ordered to go to the member’s home to contact the spouse. The trip would take at least 30 minutes.

Thus began a waiting game, as we stood by for hopeful news from the OR. We anticipated that Battalion 2 would find the member’s wife at home. She was a nurse and possibly worked in the Baylor University Medical System.

The DFRD’s medical director takes care of our members and their families in times of crisis at any hour of the day. Fortunately, he was at the BUMC and accompanied the critically injured member into the OR, enabling him to provide updates on the member’s condition. He reported that the member was alive and appeared to be somewhat stable and that they were still tending to his injuries and further stabilizing his condition. It was touch and go. We met in the auditorium and updated all of the firefighters on his condition.

While we were still waiting for Battalion 2 to arrive at the member’s home, the media and social media frenzy began. While we were discussing additional options for notifying the member’s wife if she was not at home, we were informed that his father lived nearby and there was contact information for him. Suddenly, out of nowhere, a hospital employee walked into the room and advised that the family was here. Three Hispanic women were led into the room; they introduced themselves as the wounded firefighter’s girlfriend, sister, and mother. We were somewhat confused, as the injured member was originally from Korea, and we believed he was married with a child. The assistant chief began updating the women on the status of the surgical procedure and expressed our concern and support. I then asked the women what street they lived on. The reply was, “Reynolds!” We immediately knew this was not the family of our injured member. This was the family of the citizen who was originally shot and was lying on the grass. When they introduced themselves to the hospital representatives, the latter assumed they were the family of the injured firefighter.

The vice president of the hospital was now with us. We asked if she was able to check the BUMC employee roster to determine if an employee had the same last name as the wounded firefighter. After several minutes, she advised there was a nurse whose name matched who worked at a clinic outside of the city limits and that she was on duty. We immediately focused on trying to reach her. The hospital vice president wisely contacted someone at the clinic to discreetly find out if she was married to a firefighter. She was not the firefighter’s wife. We were back to square one waiting for Battalion 2 to reach the firefighter’s home. Battalion 7 was dispatched to the address of the member’s father in an adjoining city. We were attempting to cover all of our bases.

Public Notification; Arrival of Additional Groups

Within moments, I received a text from an off-duty lieutenant telling me that the news media was reporting that a Dallas paramedic firefighter had been killed by a gunshot wound. I checked two Dallas news Web sites. Sure enough, their headlines read, “Dallas Paramedic Shot and Killed!” Additionally, all of the social media outlets were lit up with similar inaccurate information.

About three years earlier, I was in an emergency room where a brother firefighter had been pronounced deceased. While the chaplain’s office was attempting to reach his wife and family members, they ultimately found out through social media that their husband, father, and son had passed away. In that incident, the command staff was obviously disappointed and concerned that perhaps our own members were partly to blame for the information spreading so quickly on the Internet. The reality, however, is that a department can do very little to prevent this. Every nurse, doctor, technician, worker, patient, and family of patients in the hospital has the information. All have a cell phone with instant access to social media and the Internet. In all likelihood, through no malice on anyone’s part, the news can be spread in a matter of seconds. The public information officer (PIO) was at the hospital and was assigned to immediately contact the news outlets and update them with accurate information.

A brief discussion ensued about our options if the wife was not at home. We learned that the information on the father in our files was incorrect. He recently had moved out of state. It was decided that if the wife was not at home, we would call her cell phone, obtain her location, and send someone to her location immediately.

Battalion 2 finally informed us that his wife was at home and that she and their son were on the way to the hospital. By now, the news was being broadcast everywhere, and social media was still spewing inaccurate and misleading information. Based on the medical updates we were receiving, it was a real possibility that he would not survive his injuries.

Several events were now unfolding concurrently. Dozens of on- and off-duty firefighters were gathered awaiting information and wrestling with the overwhelming desire to do something to help. The critical incident stress management (CISM) team had been notified, and some members were arriving. The Dallas Firefighter Honor Guard was present; the Friends of the Dallas Firefighters had arrived and had ordered food and additional drinks for those present. Command had to make decisions concerning returning the fire and EMS companies to service and replacing staff members who had been most affected by the situation and had to be relieved of duty.

Arrival of Wife, Son

Battalion 2 notified us that he was at BUMC and was coming to the 15th floor with the wife of the injured firefighter. Someone suggested having a translator present because we did not know if she spoke English. This was a last-minute issue we had not thought about. I asked the vice president of BUMC if a translator was available; fortunately, a translator was there.

The translator arrived, followed by the injured firefighter’s spouse and their son. The chief had now arrived. He and the assistant chief spoke to her and supported her. The medical director and the surgeon who had been working on her husband arrived and explained that the firefighter was alive and very seriously injured and that it would be “touch and go” for a while. All present needed to be strong. The surgeon told his wife that her husband was a very strong man and even more strong-willed and that was what has allowed him to survive. His wife was strong and composed. The pastor of her church and his family arrived, and it appeared that she would have all of the support she would need regardless of how the situation played out.

The Honor Guard developed a roster-schedule of on- and off-duty members to stand watch around the clock for as long as was necessary.

Lessons Learned

  • Update contact information. The importance of having each member keep his contact information up to date cannot be overstated. The information should include more than name, contact, and relationship. It should include also numbers for contacts other than immediate family members, such as for other relatives and friends, and the names and the dates of birth of the children. It is also suggested that members note in their record the names of department members who should assist their family should an accident or other emergency occur.Our department has a document, A Member’s Family Guideline for a Line-of-Duty Death, which was developed by a deputy chief, that addresses special instructions a member may have such as a living will, power of attorney, religious and funeral preferences, and other personal information that would be helpful to the organization and the family during the most unpleasant of experiences. This document is confidential and is kept in the chaplain’s office.
  • Establish a meeting place. Secure a private location as quickly as possible. Make refreshments available; accept offers of food and drink donations. Keep distractions, especially the media, and anything that can affect emotions away from the location.
  • Staffing. The members most impacted in these situations need to be removed from duty, and companies must be placed back in service as quickly as possible. Everyone wants to help; don’t hesitate to accept those offers. Mutual-aid companies and fill-in companies can assist with service delivery concerns. In this incident, Engine 19, Truck 19, Rescue 19, and Rescue 3 members were relieved of duty. They were not sent home; experience has shown that they want to stay at the hospital or go back to the fire station and support each other. This is entirely their decision; they need to do what is best for them.
  • Debriefing. The CISM process needs to be instituted.
  • Release of news. Continually remind your members to stay away from social media. They need to remind their family and friends to do the same during critical events like these. Never post a member’s name or health status until an official statement has been released by the department. They should say nothing at all.

Follow-Up

All the prayers were answered. The injured member survived his horrific injuries. Even though on May 1, 2017, he suffered cardiac arrest three times during his procedures, he was discharged from the hospital on May 31. He has undergone 15 surgical procedures and still faces a long road to recovery. He and his wife are expecting another child in October.

The gunman had initially shot and killed his roommate/godfather and his neighbor across the street, who, thankfully, also survived, before shooting the firefighter paramedic. After following and attempting to shoot the second firefighter paramedic, the suspect reentered his home and committed suicide.

The responding firefighters and paramedics followed all procedures and policies regarding their safety but were caught in a dangerous, developing situation that could happen to any fire company in any community.

How well prepared is your organization with regard to critical injuries and LODDs? Policies and procedures may identify roles and clarify tasks to be accomplished, but critical injuries and LODDs are not easily categorized into structured policies. They are often very fluid and will involve distractions over which you will have little control; but, the better prepared you are, the better your chance of survival.

Daniel E. DeYear, a 39-year veteran of the fire service, is deputy chief of the Dallas (TX) Fire Rescue Department and is assigned to the Emergency Response Bureau. He previously was deputy chief of training and the fire marshal. Before coming to Dallas, he worked for the Carrollton (TX) Fire Department and served as an international fire marshal for the U.S. Department of State.

Related training:

http://www.fireengineering.com/articles/2017/04/protecting-our-fire-service-family.html

http://www.fireengineering.com/articles/print/volume-170/issue-8/departments/what-we-learned/lessons-learned-after-a-line-of-duty-death.html

http://www.fireengineering.com/articles/print/volume-162/issue-12/departments/volunteers-corner/lodd-standard-operating.html

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