Now, I understand how and why medical response became one of the missions of my fire department and much of the fire service, but my personal experience with EMS has shown me that ALS calls are really a paramedic spirit animal that appears infrequently, yet captures the public's imagination of what we do on aid runs, and that my EMT-Basic skills on BLS calls (most calls) revolve around the "Basic-3": 1) Using the Magic Box for vitals. 2) Advanced lifting tarp maneuvers. (And because the Ambulance crew forgets that their bed is generally their most important scene contribution) 3) Gurney fetching. So I've chosen to reshape my perspective about medical runs into a way to improve my fire ground abilities. For me, EMS means, "Evaluate Making the Search".
I'm far removed from being the originator of this mindset. I've personally heard Bob Pressler, among others, speak on tactical fire size ups during aid runs several times. Though his acronym does differ: EMS = "Every Minute Sucks". However, it doesn't matter where the idea came from if it can make you and those around you better by sharing it. Like Colonel Hackworth said, "Don't expect the combat fairy to come bonk you with the combat wand and suddenly make you capable of doing things that you've never rehearsed before. It will not happen."
You want to get better at fire sh*t, better do fire sh*t.
The reason why I phrase this, "Evaluate Making the Search," is because I am assigned to a Truck company, and search for my department is primarily a Truck duty. If you are on an Engine, that's cool.. I guess.., just think of it as, "Evaluate Making the Stretch." But whichever rig you're riding, know that your evaluation starts at the station. I typically drive, so when we get tapped out on a medical, I play it through my head like a fire run. Do I know the route? Any "moon cratered" streets along it? What's traffic doing at this time? House or apartment? If apartment do I know the layout? Will the Truck fit the complex's driveway? All this (and watching out for idiot drivers) is on my mind as we roll.
When we arrive on scene, I perform my exterior size up. What's the house type? (bungalow, split-level, etc.) Where do I think the bedrooms are? The stairs? Does it have a basement? Do I think it might? How would I access it? Are security bars present? How easy is it to make the backyard? Etc.
Now mind you, this is quick, just like on the fire scene. I'm not standing in the front yard looking at the patient's house while they're at the window looking at me. Likewise, when I enter the home, patient assessment is primary. I don't walk in looking like I'm casing the place for robbery.
But like I said, most EMS runs for my company are not emergent. So when not performing my Basic-3, I check out the home. If it's a multistory, invariably the patient is upstairs. So did I call the stair location? What about the bedroom layout? I also take note of what's under the bedroom windows for VES. I assess what I got right during my initial size up, and more importantly what I got wrong or missed.
Part of my search evaluation is also looking for signs of increased occupancy. Cars in the driveway is Search 101 right? What we need to do is find and practice those extra clue-ins as well. For instance, it's not surprising for my crew to walk into a living room filled with mattresses. What is surprising, and never ceases to confound me, is how an individual can lay on the floor trying to go back to sleep right next to us as we assess their housemate. What I do understand though, is that if people are sleeping on the front room floor, then expect people jammed throughout the home.
We also have large immigrant populations in my first due. And in my experience. these groups, especially in apartments, tend to have large extended families under one roof. Since there is also a propensity for no shoes worn in their homes, I glance around apartment thresholds to take note of shoe numbers for an occupancy guess.
Once my BLS skills are all used up and the patient is on the gurney, I have no qualms about asking them or other residents specifics about the home that I can't solve. Where are those basement stairs? Are the knee walls a finished space? What I've found is that people love talking about their homes. And if they're at all hesitant in their reply, I will just tell them straight up that it's to assist our search for them if their home ever catches fire. Amazingly they become nothing but forthcoming with information upon hearing that.
As we clear the call, my crew will often point out and discuss with each other notable layout features like surprise basements or hidden stairs. Or commonly, after we've moved a massive weight, we'll talk through what that patient's removal would be like during lights out good heat conditions, with less hands and no tarp. We are also sure to spend those few extra moments outside examining those structures that exude that "Gonna Burn Someday" feeling.
Like I said before, this isn't a new idea that I'm writing about. But if it is new to you, just know that the more you intentionally "Evaluate Making the Search/Stretch" during medical calls, the better you will be on your next fireground, guaranteed.
I wish that my department wasn't caught in the "you call (for anything), and we'll come" response model that those of us riding the rigs experience everyday: a liability based framework that generates the "Detroit of EMS" comments from those on the backstep.
But that's not my reality nor the reality for many of you reading this, I'd guess. The answer to when that will change escapes me.
But what I do know is that any moment that fire with entrapment can occur, so I'm going to take every opportunity to prepare for that emergency, even during those calls that are not emergencies. If you adopt this mindset I believe on your next three am bellyache, despite what Bob says, "Every Minute doesn't have to Suck."
Just most of them.
