Assignment 5

[NUrban]

Read the August 12, 2020 Gordon Graham article  “Fancy, Shiny, New—and Dangerous” https://www.lexipol.com/resources/blog/fancy-shiny-new-and-dangerous/

Post a discussion answering the following questions by September 15, 2020

   a.   Describe a time when you were “playing in the top left box” and what was the outcome? 
   b.   What did you do to handle the situation? 
   c.   Is there anything you would have done differently? 
   d.   What have you learned to assist others to be prepared for things that fit into this category?   

Reply to two other posts after September 15th and before September 30th.  Your reply should be at least 50 words and no more than 150 words.

Directions to posting and replying: To make your initial post select "reply" under the last written post.  Write your post and select "save".  When replying to two other posts, select”quote" on the post that you wish to reply to.  You will see the person’s initial post appear, you then write your reply and select "save".

[eric.henry]

A time I was playing in the top left box was the first time I had to use ketamine to sedate a combative patient with a serious head injury that resulted from falling off a hover board while intoxicated. He had a blown pupil, was posturing, abnormal breathing, and combative. We were trying to maintain his airway and also get him sedated. The use of Ketamine was newly added to the GMVEMSC protocol and the crew I was working with at the time, along with myself was unsure of the dose needed in relation to the different methods of administration. The patient was a large male that was very difficult to physically restrain. Careflight was en route to the scene, one of the firefighters was constantly updating me on the status of Careflight, and PD was climbing into the medic to help restrain our patient. While all of this was going on some of the crew members were shouting out what they though was the correct dose/route which only added to the confusion because all the doses were different. Needless to say, it was a chaotic scene in the back of the medic.

I finally found a moment to get the protocol book open and double check the dose needed. One crew member was able to obtain IV access, so we drew up the IV dose. Just prior to administering it the patient was able to pull his arm away and the IV came out. Ultimately this patient ended up getting two IM doses of Ketamine before Careflight arrived on scene and used their medications to sedate him since the patient was still being combative.

Something we could have done differently was to review the new protocol a little more thoroughly when it first came out. It is not a good time to try and look up drug doses in the protocol book when trying to restrain someone. There was a lot going on at the same time on this call which only added to the confusion and hectic atmosphere. As the PMIC, I should have taken more control of the scene.

What have I learned...When you find yourself unsure and falling behind, stop and take a time out. Reassess the situation and see what you have in front of you. Make sure everyone has clear defined roles and make sure everyone knows the protocol. Although we always learn as we go, the best time to learn is before the call, not during it.   

[ross.moffitt]

A time I played in the top left box was when I was riding R21 and we got dispatched for a car into a building. On scene R21 found a vehicle that crashed into a house striking the gas meter on the house. Myself and Lt Long was investigating and obviously noticed the natural gas leak under the engine of the truck. I made a quick check of the vehicle and found the driver unresponsive laying on the seat. I advised Lt Long about the victim in the vehicle and we decided to do a rapid extrication since the pt had severe injuries but was still alive. Ultimately the pt was removed and transported to the Hospital where he later died.

In this situation we manually ripped open the door and yanked the pt out of the vehicle. We then drug the pt away from the vehicle fearing it could catch fire with the natural gas leaking under his hot engine. M21 crew brought down the cot and pt was loaded and transported.

In this scenario knowing what we know now we should have taken a hoseline with us, and we should have wore our SCBA. We weren't given good info from dispatch so we handled the call like typical MVA response. If we would have known about the gas leak and the pt still in the vehicle we would have changed our strategy.

I have learned that you can't treat every MVA the same. You need to recon the scene fast and then establish a game plan that is safe for you and the crews working on the scene. Dont always rely soley on the info dispatch gives you.

[slong]

A time I found myself in the top left box was the first time I pumped a structure fire.  I remember driving E48 while working at Miami Township and being more nervous than I had ever been when we pulled off the ramp and saw a large column of black smoke rising in the distance. We had been dispatched to a working apartment fire on the 3rd floor.  We were first on scene.  I could feel myself starting to become overwhelmed with all the tasks before me.  E48's crew pulled a handline and was gone to make an attack on the fire.  I had to make sure and slow myself down mentally to ensure I did everything correctly. 

Slowing down and falling back to my training helped me manage a high stress situation.  I learned that training was vitally important.  It is import to train to the point you cant mess things up.

[Kevin Stevens]

Early in my career we had a fire alarm at a nursing home, we arrived checked the panel and the alarm was coming from the kitchen. We was in there checking for the problem for a while and was unable to locate anything. There was this nice shiny pull type mechanism hanging on the wall and as I started to pull on it I asked the A/C if this could be it. He yelled really loud and told me not to pull on that, He used some other choice words as well and I was like what is going on. After he calmed down, he explained to me that what I was about to do was activate the hood suppression system for the whole kitchen at this NH.
I almost caused a logistical and financial nightmare for this facility.
I studied about hood systems after that and I keep my hands off things that I don’t know or understand what they are. I will always remember this and I did learn from it so I guess all and all it was a good training moment.
Kevin S

[NUrban]

The above responses make it clear that in our job we have many responsibilities and many opportunities to “play in the top left box”.  It is not feasible to think we would know all aspects of our job, for example; operations, equipment, fire, rescue, EMS, HazMat etc.  The only way we can combat “playing in the top left box” is to train, re-train, and train some more. 

[jlogsdon]

Any fire we go on would fall into this category. Bunnell Hill fire in April 2019, we burnt the roof and most of the second floor off the house. It was a less than ideal situation arriving with a crew of two and it was a long lay with high winds. We just slowed everything down and got set up for operations when other crews arrived. I have learned that nothing needs to be done right now. Take a second and reconsider what you're doing before you make a mistake. I misjudged the length of the driveway but it was overcome by the skills of the second crew. Knowing your SOG's and crew consistency is valuable in these low frequency, high risk scenarios.

[jscottCCFD]

A time playing in the top left box...Once my crew and I were dispatched for a public assistance call (clogged kitchen drain) and later upgraded to breathing problems.  When we arrived on the scene the homeowner stated that he ventilated the area already. Immediately we noticed a strong, strange odor.  After determining that we probably should not breathe that stuff we retreated to put on an SCBA.  It later turned out that the homeowner was dealing with a clogged drain and had poured a cocktail of Draino and Bleach down the sink.  This combination created a toxic atmosphere of vapors that would have damaged our airways.  In this scenario, the take home message for me was to always trust your gut and always have a Plan B. 

[Haggard]

A time I was playing in the top left box…. it was the first time I was in the back of the medic alone on the way to the hospital on a “heart problems” call.  I gave adenosine and freaked out when the patient fell back and the monitor changed to asystole.  Even though I was trained, knew about the drug, and knew what was going to happen.  Even though it was for just a few seconds, it still freaked me out.

When situations arise like this, taking a deep breath and recalling our training helps.

[blykins]

Called to gun shots heard on the first floor, apartment A.  Upon arrival, residence were evacuating first floor and second floor.  PD arrived on scene same time.  Medic crew went to the apartment the callers stated the shot were heard from, PD began clearing the rest of the apartments.  The caller did give the correct apartment number.  Found one pt, DOA.  At the time thought we were doing the right thing by going to attempt to help the person. In hind sight we should have staged and waited for PD to clear the entire building before putting ourselves in a scene that was not safe.     

[steve.cox]

There I was minding my own business when suddenly we get called for a Structure Fire in a trailer park in Wayne Township.  Upon our arrival, we were assigned search as there was a report of a "possible" victim.  As myself and my partner entered the trailer we were immediately forced to the ground due to extreme heat and zero visibility.  We went right and started our search. After completing the living room, we made the decision to exit.  It was just too hot.  We get on the front porch and come off air when the bedroom (fire room) flashed.  It sent a heat wave up through the hallway and out the front door like nothing I have ever felt.  I then faintly heard someone yell for help.  I clipped back on air and stepped back into the front door.  There was a FF standing just inside the doorway and the heat blast literally disoriented him and he didn't know where the door was.  I reached in and grabbed his pack and guided him through the door.  Why he was standing there alone, I still have no idea.

We had no business being inside that trailer.  As soon as we were forced to the ground we should have known it was not possible for anyone to survive those conditions.  This was 15 years ago and I was still under the impression we were supposed to go no matter what.  Man how things have changed just in my limited time in the Fire Service.  The truth is, we got lucky that day. 

[jbuehler]

Describe a time when you were “playing in the top left box” and what was the outcome? Early in my career when I worked for West Carrollton, we were working a extrication on the highway. I was asked to retrieve a tool from the truck. When I walked around to the other side to get it, I was nearly struck by a car.

What did you do to handle the situation? I quickly realized how dangerous the environment was and warned everyone else. I assured it was safe then retrieved the tool.

Is there anything you would have done differently? Knowing what we know now about vehicle placement, we should have had another appratues blocking the scene for us.

What have you learned to assist others to be prepared for things that fit into this category? I have shared this story with several other people and stressed the importance of situational awareness and scene safety. 

[michael.toothman]

My "top left box" moment was shorty after we got the new King View scopes. We had a non-breather during office hours and Capt. Buehler came on the call. He was helping work the Pt and was working on the airway. He asked for the King View, and was given it with the blade attached and tube placed. The problem was the scope's battery was dead. I know for a fact that it worked that morning because I checked it. The battery read 221 minutes of power on the screen, I powered it off and placed it back in the box. What I did not know was that the small button that is pressed to power up the scope is sometimes pressed by accident when you put it back in the box. So after morning checks it sat on, in the box, until it was needed. How did we handle the situation ? We tubed the Pt with a Miller blade.
What did I learn? Always have a back up plane. And now, when I check the king View scope I look twice just to make sure.

[astafford]

Playing in the Top left Box, I look back over the years and think of times that would fit this scenario. One sticks out in mind that I will never forget.

Pediatric Code: I have had a few pediatric non breathers over the years, usually they had an ALTE and they were fine on arrival or they were DOA due to SIDS. 
 
A few years back we were called for a pediatric non breather. With many updates while En Route, we knew it was a very serious call. PD arrived first and had applied AED Pads to the Pt and began resuscitative actions. Once the crew arrived, we were in the load and go mindset. While in the medic the crew connected the Difib Pads to the Life Pack without observing the pads. We were under the impression that they were Pedi Pads with an attenuator. Learning later that the adult/Child Pads do not have an attenuator to adjust the Joules.

We learned to slow down and examine the situation.

Given the situation again we would have switched the pads with our Pedi pads.

[michael.toothman]

A time I was playing in the top left box was the first time I had to use ketamine to sedate a combative patient with a serious head injury that resulted from falling off a hover board while intoxicated. He had a blown pupil, was posturing, abnormal breathing, and combative. We were trying to maintain his airway and also get him sedated. The use of Ketamine was newly added to the GMVEMSC protocol and the crew I was working with at the time, along with myself was unsure of the dose needed in relation to the different methods of administration. The patient was a large male that was very difficult to physically restrain. Careflight was en route to the scene, one of the firefighters was constantly updating me on the status of Careflight, and PD was climbing into the medic to help restrain our patient. While all of this was going on some of the crew members were shouting out what they though was the correct dose/route which only added to the confusion because all the doses were different. Needless to say, it was a chaotic scene in the back of the medic.

I finally found a moment to get the protocol book open and double check the dose needed. One crew member was able to obtain IV access, so we drew up the IV dose. Just prior to administering it the patient was able to pull his arm away and the IV came out. Ultimately this patient ended up getting two IM doses of Ketamine before Careflight arrived on scene and used their medications to sedate him since the patient was still being combative.

Something we could have done differently was to review the new protocol a little more thoroughly when it first came out. It is not a good time to try and look up drug doses in the protocol book when trying to restrain someone. There was a lot going on at the same time on this call which only added to the confusion and hectic atmosphere. As the PMIC, I should have taken more control of the scene.

What have I learned...When you find yourself unsure and falling behind, stop and take a time out. Reassess the situation and see what you have in front of you. Make sure everyone has clear defined roles and make sure everyone knows the protocol. Although we always learn as we go, the best time to learn is before the call, not during it.   

Sounds like you did the right thing. You stopped and took the time to find the answer. Doing that saved you time when you had to go to the IM rout. You already had all the information.