"You alright man?!" I scream at him, trying to battle through the chaos of the noise. "Yea!! Just check him out, damn it!" He yells back at me. As he tears his mask off, he looks visibly shaken... I would be too if I just somersaulted down a Victorian flight of stairs carrying guy on top of me. I turn my attention down at my knees where the patient that was tossed at me lay. The porch where we were was way too small for everything that it contained. Me, my partner, two firefighters, hoses, bags, a variety of fire equipment I can't even begin to name... and now a body... alive or not was for me to decide.
Moments earlier, I was peacefully munching on my mini-chocolate donuts downing it with a quart of milk... a gas station dinner of champions baby! at 1am on this busy night.... when our peaceful "dinner" gets interrupted by dispatch to a possible house fire "smoke coming from the 3rd story window." The area we were going to is well known for some impressive house fires... the houses are old... all made of wood... and they love to burn. Summer, Fall, Winter, Spring... egh whatever... season non-specific, they burned nonetheless. Knowing all of this, there were normally two outcomes... this was either nothing & we were going to be back in service in 10min or we were going to be there for rest of the night. "I hope it's burning man." My partner exclaims. "We EOT in 4 hours, and this would last us through the night!"
EMS is a weird kind of profession... in it other people's misery can occasionally make our life easier... sucks, but that is the way it is. My partner was right. The house was going to burn regardless of whether I wanted for it to burn or not. That decision was already made for us. People are going to get shot... whether I want them to or not. They are going to die... despite even some of my best efforts... that's just the way it is. For us to say, "I hope it's burning man" doesn't mean that we HOPE for houses to catch on fire... it just means that WHEN they catch on fire, that WE be the ones there for it. This is an interesting concept that no one outside of EMS rarely gets.
We get on scene just behind the fire department. Amazing. 1am. When it is a house fire, they beat us there in droves... when it is a "chest pain" call, I'll have the patient half way packaged before they show up. As we stage a block away from the scene, the fire command advises us that this is a working incident with one upstairs bedroom on fire. "Egh I don't see flames... they gonna have that thing out before we even get out of the truck. I'm not getting out." My partner exclaims. I went in the back to set the stretcher up just in case. I throw in: immobilization, monitor, jump bag, suction... drugs? Nah... I'll come back for them if need be. What else do I need? Blankets... nah... it's too hot out. I jump back in the front, and as soon as I do so, fire command advises that they have possibly two to three casualties in the upstairs bedroom and outside behind the house. "Well @#$@#$!" My partner exclaims again. I call for a 2nd truck as we now have a possible "confirmed" patient/s... the city is holding calls so my call is 3rd in line. Typical night indeed.
We get out & drag our heavily packed stretcher across the cobblestones to the front of the house... spectators have gathered far & wide... some look at us with awe... some with disdain for having awoken them at this time of night... others with pure boredom, I guess expecting to see flames or other sorts of excitement. Just as we get up to the porch, two firefighters tumble out of the front door having lost their footing on the stairs...
And now in front of me was a man... a body of a man... lying prone across the coils of the fire hoses... in front of the entire neighborhood. It was so loud... I could barely hear myself think. I begin to turn the patient over with my partner's assistance when the man's pant legs
slide off under my hands... and with his pants came his skin... all of his thigh & leg skin. He was a bigger man... and the fat underneath clearly reached the boiling point... I have never known fat could & would boil out of a human being... but it did... I hope never again to see it... my instinct already told me the verdict... but my brain has not quite caught up. I immediately open his airway & see a charred tongue & throat... pulseless... apneic... the decision became split second... and final. "He is a DOA!" I yell to the firefighter that brought him out... he is standing right next to me, but yelling was all that I could do to get him to hear me. "Are you @#$%ing serious!!!" He yells back. I wave my arms side to side indicating DOA. "NO!!! WTF man... you @#$@#ing work him man!!! WTFFF... NO!" He and the other firefighter angrily shove past me down the stairs off the outside porch ... in front of the entire neighborhood.
It was done. There was nothing more I could have done. I was the only paramedic on scene. I had the possibility of 2 more patients, and
no additional assist units within the foreseeable future. The man was dead. He boiled inside out. I made my decision. A split second decision. The toughest decision... a decision to officially call it what it was and to do it without hesitation, in front of the firefighters that "saved" this man from the burning building... in front of his family... in front of the neighborhood... all in the midst of a chaotic scene. Right decision? Wrong decision? Who cares... the end result is the same. I had two more patients to worry about, and this one became an afterthought... at that moment.
We in EMS are occasionally faced with split second decisions... and we make some of them without hesitation... because when we hesitate at the WRONG moment, people die... when we hesitate at the RIGHT moment, people live. But when is the RIGHT vs the WRONG moment? Who the hell knows... Like a police officer that has someone at gun point, and makes a split second decision to either pull or not to pull the trigger... I held in my hand the power of working the patient or not... work it, and my other more viable patients may die... not work it, and the patient... may have had a chance.... I guess in the end it really is all about chances... about statistics. At this point, all I really needed now were just two blankets... one to cover the body... the other to cover myself, as I was getting cold from getting soaked by the fire hose... but I didn't bring the blankets, I didn't think I would need them... plus I have other patients to worry about... I'll see them wet, and cold... it's not a problem... done it before... will do it again.............