Dear Sirenhead: You may find this strange, but soon after the collapse of the World Trade Center, a group of EMTs and medics were at my house watching the events as they occurred, and one EMT said, "I wonder if Sirenhead is OK." The room got silent, and I suddenly realized that since we didn't know where you work, there'd really be no way to know. Then, when I didn't see your column in the November issue, I too began to wonder if you were safe and sound.
I called JEMS and was told you were fine. So I thought I'd write to let you know someone was thinking of you and ask what you felt as you witnessed those horrible moments on television.
-Mary K. in N.J., via Internet
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Thanks for checking on me. The carnage freaked me out. I've been rattled before when watching a guy jump just six stories to his death, so I can't imagine how the crews in New York coped with dozens of people raining down from more than 1,100 feet.
Although I often joke about my fire friends snoozing in their La-Z-Boy chairs, I respect what they do and cried like a baby when the towers collapsed. Truth is, I've been in a really bad mood since Sept. 11 because the news media have ignored the fact that not just firefighters died at the WTC.
Plenty of dedicated EMS personnel also worked hard-and died. Who stood by, waiting to treat the injured occupants as they exited or were carried from the structures? Who ran to their fallen comrades as they lay unconscious after the buildings collapsed? And who ran to Starbucks and bought cases of water with their own money to flush the eyes of firefighters and citizens after the clouds of debris choked and blinded them? You know who-EMS crews.
The news media deserve a big thumbs down for failing to recognize the efforts of EMS that day. Contact your local media and make sure they recognize the efforts of all the EMS providers-not just the firefighters-who responded that fateful Tuesday.
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Dear Sirenhead: Recently, an exceptionally challenging call resulted in my performing an extraordinary skill. The call came in for a subject with burns from a trash fire. The first-in engine crew reported a "working trash fire" and a Priority 1 burn patient with pending respiratory arrest. On arrival, I found the guy with third-degree burns over 95% of his body surface area. I intubated him with difficulty. Numerous IV attempts proved unsuccessful due to the severity of the burns. But that turned out to be the least of my worries.
My crew reported increasing difficulty ventilating the patient because the circumferential burns around the chest were causing poor chest expansion and reduced lung expansion. After re-evaluating the patient, I knew I could do only one thing: I consulted the burn center, reported the situation and requested orders for a field escharotomy.
The orders were granted, and I performed the procedure without complications. It improved lung compliance, and the patient had a return of spontaneous respirations. At the burn center, I gave a patient care report to the ED staff and burn center manager, then returned to my station to complete the maze of paperwork. My EMS officers, the county medical director and state medical director all received notification of my actions.
As expected, the patient died from complications due to the burns, but I felt I bought him some time for his family to say goodbye. Afterward, I received positive feedback from the burn center manager and other regional EMS officials. However, many of my colleagues felt the procedure was excessive and now call me a "hacker." In your opinion, was I wrong?
-Rich D., NREMTP, via Internet
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I'm as progressive as the next guy, but I must admit I was ignorant about what's involved in an escharotomy. I thought it was like cracking a chest, and I nearly hit the roof when I read your letter. My first thought was that I would never perform sidewalk surgery on a patient with 95% body burns whom I knew would likely die.
But when I called a friend who's a burn surgeon, he told me an escharotomy is simply an incision to open the top skin layer. He also said the procedure could save a life. So if your state law and medical protocols allow for an escharotomy and you were trained and cleared to do one, then you're probably legally clear.
Still, I hope you can also perform crics and decompress a patient's chest. I'd hate to think you could perform a field escharotomy but not implement advanced airway procedures that'll more frequently impact patient care
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The opinions expressed by Sirenhead are his own and not those of the publisher. Address your questions to Sirenhead, c/o JEMS, P.O. Box 2789, Carlsbad, CA 92018 or e-mail them to sirenhead@jems.com.
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