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Red Lights to the Left of them, Blue to the right! – Coloring Emergency Lighting

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So you’re driving down the road in an unfamiliar state, let’s say that it’s Iowa or Wisconsin, when in your rear-view mirror you see flashing red lights on a big utility truck coming your way. You can’t really make out what kind of truck it is, but you see red lights flashing so you pull over to let it go by. When it does, you realize that you’ve just pulled over for a tow-truck.

Or how’s this? The same thing happens, but it’s a flashing blue light in Colorado. When you pull over, you realize that you just got pulled over by a snow-plow.

I live in Illinois and work between IL and Wisconsin and there’s quite a bit of a difference between the different lighting colors and upon who can use what color light for what purpose. As a volunteer paramedic/Firefighter in Illinois I run a blue light with no siren in my personal vehicle. Even though I rarely turn it on, I have it in case I get stuck behind a 20mph Grandma on my way to the Big One. Interestingly, the blue light gives me no legal authority or any legal leeway on traffic laws and I must obey all traffic laws even while running the light. I Wisconsin, however, volunteer firefighters and EMS people may use red lights and sirens in their personal vehicles. They have the same legal status as governmental emergency vehicles when they’re driving with their lights activated.

In Iowa, volunteer firefighters may run blue lights in their personal vehicles with no legal authority granted them, and EMS volunteers may run clear (white) lights in their personal vehicles. Volunteers for fire and EMS combination agencies may run a mixture of both, however if a person volunteers for both a separate Fire department and a separate EMS agency, they must be careful to run the clear light for EMS responses and the Blue light for fire responses.

Of course, that’s just for personal vehicles right? Allowing emergency lights in the personal vehicles of emergency volunteers is a debatable issue in some circles. I argue for responsible control of their use and think that they are needed in some communities and not needed in others. Out of the 400-500 volunteer runs I respond to annually, I probably turn on my blue light for less than ten percent of the runs. I use it judiciously, but I know others that I can say did not.

However, this isn’t a post about volunteer emergency lighting and the pros and cons of it. It’s about the messed up spectrum of colors that we use on emergency vehicles in this country. Sure, we have the same stock colors pretty much everywhere. Red, blue, amber (yellow), green, clear (white), and in some states purple (Yes! Purple!). In the southern states, blue lights are for law-enforcement only and red is for fire only. In Wisconsin, law enforcement runs red and blue lights and fire and EMS is red only. In Iowa, up until a few years ago everyone ran red lights except for volunteer firefighters. They changed the law and now allow blue on the Passenger side only. In the City of Chicago, the Chicago Police Department runs blue only and the Fire department runs Red and Green. Downstate Illinois (Read: Outside of the City of Chicago City Limts) runs red and blue for all “Authorized Emergency Vehicles” and blue lights for the volunteers. Green lights are only permitted on stationary vehicles for command lights but can also be used for private security officers. As I mentioned before, in Iowa and Wisconsin, tow trucks run red lights. In Colorado, snow plows run blue. In some states, funeral processions run purple.

Confused?  I sure as heck am.

Consider this: Different lighting colors exist because different members of the driving public see different wavelengths of light in the spectrum (i.e. “Colors”) better or worse in differing ambient light conditions. Also, different colors penetrate different atmospheric and/or ambient light conditions better than others. You can see blue forever at night or in the fog, but not so much in the bright light. Red washes out to amber in the day light but is still fairly visible. Clear lights penetrate for a very long way but can be confused with light reflecting off of a surface almost the same as amber lights. We need a diverse spectrum of colors emanating from our response vehicles in order to ensure that the highest amount of drivers out there are able to see the lights. If someone’s color blind to the particular light color that we choose, they’re not going to see us all that well, are they?

The arguments that I hear for the use of lighting colors don’t hold much weight with me. Who cares if the public is able to see that an approaching emergency vehicle is Fire, EMS, Law Enforcement, ASPCA, Haz-Mat, Tech-Rescue, Volunteer, or miscellaneous. They just need to pull over and get out of the way. One color lighting schemes may give the agency a sense of personality or whatnot, but they’re certainly not the safest way to be seen. An emergency vehicle needs to throw out a lot of light across the spectrum of visible colors in order to help ensure the safest response possible.

So why are we having this hodgepodge of warning light colors? Why do people think they’re a good idea? I can think of a few advantages of having “law enforcement only” colors, as in reducing false traffic stops from people impersonating police officers, but having one color and one color only simply makes it easier for a criminal to get a hold of that one color of light. Why fire would only need red lights is a question that I can’t come up with a good reason for.

So good luck driving out there! If you see me, I’ll be on the side of the road letting a tow-truck go by. Then I’ll run my blue light in Wisconsin because we got a house fire in my district that touches the WI state line and I’ll get arrested for impersonating a police officer. Then I’ll be at work getting into a crash because someone driving out there was color blind to the color red.

Anyone want to add to the confusion? What colors do your state or country use? Is anybody else in favor of a national standard?

Be the Glow Worm – HazMat for EMS.

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I am not a glow worm.

Full disclosure – This is a repost from 09/2009 – It deserved a bump-up and to fix the video. Make sure to watch the vid!

Hazardous Materials, or “HazMat” as it is commonly known, is scary stuff. At least for me that is. In public safety circles, they’re mainly the concern of firefighters and I’ve never received training on them outside of the realm of the fire department. My EMS only agencies have always told me that we remain in the “cold zone” and wait for patients to be brought to us after decontamination.

And that’s just fine with me. Ckemtp is NOT a glow worm… did I mention that?

But, since I’m also a firefighter I finally broke down one weekend and gave in to the pressure I was under to get my HazMat Operations certification. 40 hours of class, lots of homework, and some very dry PowerPoint slide shows. After the first weekend of the class there’s some things that I’ve learned and figured out.

1. HazMat’s still scary.

2. Ck’s still not a glow worm.

3. EMS agencies really need to train more on HazMat.

“We know hazmat” you say. And I know that you’re saying it because that’s what I would have said before those last 20 boring hours spent learning that I knew nothing about hazmat. HazMat is something that we take for granted in that we think that it won’t happen in our jurisdiction, or that it won’t affect us on our day to day. I happen to hope that it won’t hit during my duty days.

This video is from Seward, IL. A small town in the middle of a lot of corn that found itself one day having a big problem. The video is from a surveillance camera on the side of a grade school in the middle of town. The vid starts slow, but has a definite “HOLY CRAP!” moment about halfway through. You’ll see what I mean, all hell breaks loose.


 
See? Holy hell on crutches! That’s anhydrous ammonia, a common chemical used in farming (and in methamphetamine production). A tanker truck full of the stuff sprung a leak and flooded the town with a toxic cloud. Thankfully, nobody was killed. There were a few firefighters sent to the hospital, and some very scary moments, but it all turned out to be ok. This one’s from the same school. It’s just as scary.

Remember this, a HazMat incident doesn’t have to be the once in a while overturned tanker truck full of MethylEthylBadJuJu. Any every day response can turn quickly into a hazardous materials incident.

Not too long ago, an EMS only agency that I may or may not work for received a call for an “eye injury” in one of our really rural response areas. This call generated a single ALS ambulance only response out to the farm where the injury happened.

The medic and the EMT responded out to the scene, which was about a 15minute emergent response. Arriving at the farm, they were directed to the dairy barn to find their patient.

Their patient was in a lot of pain.

Apparently, he worked for a dairy services company and was delivering product to the farm when he was injured. If you don’t know much about dairies, milk processing leaves a byproduct called “Milk Stone” which is the dissolved minerals in milk solidifying on dairy equipment. Think of hard-water stains. Dairies use products containing phosphoric acid to clean it out. It’s like Lime Away on steroids. This stuff is pretty nasty. Dairies use it in a diluted form, but the supply companies carry the concentrated stuff. This patient was filling a container with the high-powered stuff to dilute it into the customer’s container when the concentrate fell. He reflexively looked right down at the falling container and got a face full of the stuff when it splashed back up at him.

Do you remember that chemical burn stuff you were trained on? He had them. Do you remember the decontamination training you had? What about proper personal protective equipment, do you have it? Do you know when to put it on? Do you know how? What do you know about the chemical?

While treating the patient, one of the paramedics noticed that his EMS gloves was turning white. It was the acid eating through it. A lot of water was used to irrigate the patient, and the providers, before transporting the patient to the hospital.

This was an everyday incident that actually happened. Think about how you’d handle it, because tomorrow it could happen to you.

And once again, Ck is not a glow worm.

The day I didn’t die – Firefighter Close Calls

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Laying prone on the quivering floor, I had been pushed down flat on my stomach by the searing heat and smoke. I was as terrified as I’d ever been as I frantically yanked and tugged on the inch-and-a-half hose line that was stretched down the basement stairs towards the engine company that had disappeared down the dark hole an eternity ago. What had started out as a small, concealed fire with light wispy smoke conditions had quickly deteriorated into this hellish, searing inferno that I was convinced was killing the three men below me.

Twenty minutes before this, my two man tanker company had been first on scene to this structure fire that had been dispatched while we were returning from a small brush fire. We were the closest unit and were first on scene. Light staffing that day caught us when this fire was reported during the height of our daytime volunteer shortage. These factors combined a two-man tanker company together with a two-man brush-truck company to make a primary search of the structure. The light smoke and little heat had lulled us into a false sense of security as we entered the single-family home. The concealed fire between the first floor and the basement caught us unaware. It spread quickly and weakened the floors we were standing on. When I found the first floor had been weakened, I sent out my partner to inform command as we were on the tanker and had no radio communications inside the structure. Unfortunately, another engine company with a hot-shot lieutenant arrived and, despite my fervent protestations to the contrary, he took his three firefighters down the stairs to the basement. I stayed to mark their exit.

Outside the air-horns sounded their three quick blasts, calling for an evacuation of the structure. I stayed, waiting for the crew to emerge from the staircase so that I could lead them to safety. They never showed. The intense heat burned me through my turnout gear as I screamed as loud as I was able through my SCBA mask into the abyss. I tugged on the hose and screamed at them to return, only taking a break to recognize the ringing of my low-air warning bell on my air tank. I had no idea how long it had been ringing, but when I noticed it, it was slow. Instead of a sharp ring, it was a slow ding that was getting slower as I was sucking as much air as I could to yell down the staircase.

This moment, this intense moment, was where I made a decision the likes of which I hope I never have to make again. I knew that if I stayed more than a few moments longer, I would suffocate and burn to death right there on that floor. I also knew that the men below me needed me to be there for them when they came out of the basement. They needed me to be there to lead them to safety.

It was a decision that made me choose between leaving my brothers to perish by saving my own life, or staying to face my own probable death. Ding… Ding… Ding… the sluggish bell ticked off my air supply, inching ever closer to the point where it would just stop, leaving me to asphyxiate.

That moment, I chose to flee and save myself. It’s why I’m sitting here typing this story.

I knew where I was in the structure. While it was pitch black from smoke and I was blind, and while every movement made my skin contact my turnout gear and burned me, I turned tail on my stomach and frantically crawled towards the doorway I knew it was only a few feet away. I knew I could make it. I knew my brothers were dead or dying. I knew…

“CRACK” went the floor as it opened up to reveal the inferno underneath my belly. I felt myself falling I saw the flames come up and envelop me. My vision turned from completely black to completely orange as I felt myself falling into the intense heat. I screamed and reached out ahead of me into the darkness. I clawed and flailed forward, grasping on to anything that I could grab to save me. God willing, my fingers found the concrete steps out the outside door to the residence. Inch by excruciating inch I pulled myself up and out into the light and the fresh air.

As soon as I was out of the house I stopped breathing as my SCBA mask sucked into my face for lack of air in the tank. I ripped it off of me and sucked in the sweet outside air. Waiting for me outside, about to try and find me, were the three firefighters who had went into the basement. They had evacuated through a basement door. Nobody knew that I was still inside waiting for them until they made a headcount in the confusing scene and found that I was not accounted for.

Looking back at this experience, I am proud of myself for finding out that I will go up to the last possible second to try and save my brother firefighters… although thinking about the decision I made to turn tail and run, I’m almost ashamed that I didn’t stay past that point of no return.

Of course, my policy is that I go home at the end of the day every day… but still.

Close calls are terrifying experiences. Thinking about losing any one of my coworkers or colleagues is unfathomable. It can happen, however, and we combat this reality with safety and organized command structures. This call was years ago in my career but it sticks in my mind at every call I’ve been to since that day.

Train hard. Keep your wits about you. Take everything seriously.

 

The Hole a firefighter fell through in a strucure fire (uninjured)

The Hole I fell through in a strucure fire (look right by the door)

Wow, that takes me back… A paramedic ruminates

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The other day I was up at the station having a conversation with one of our firefighters when she described a call where she found that “this guys legs were like, all messed up. They were like every which way and stuff. Gross”

Now while I have to give credit to great medical terminology where credit is due, I find it amazing how conversations like this can pull me into my own mental imagery. After ten short, well-paid, and relaxing years on the ambulance (ha!), I’ve got, well a few mental images stored up in the ol’ dusty recesses of my mind that pop randomly into the forefront of my mental picture show. I can’t turn them off. It’s completely random with what stimuli will trigger a vivid memory. One minute I’ll be walking up some stairs somewhere, and the next I’ll be mentally carrying someone down some staircase somewhere on a stairchair while the patient continuously pukes on me.

“It’s ok Ma’am”, I’d say. “People tend to puke on me. I get that a lot.”

So, after hearing this most eloquent firefighter describing her “all messed up legs” call, I found myself in the front seat of an ambulance.

This was some time ago, for some service I might have worked for somewhere. I was driving and New Medic partner was riding shotgun. He was describing his most recent fling while I was living vicariously through him describing his most recent fling. This was well before Gkemtb made my life Awesome, so it’s ok. We were headed to BigNun Hospital for a transfer.

“Dispatch to Ambo 74″ Crackled the radio. “Copy Code-3″

“Sweet!” I love getting called off of transfers. NM got out his trusty notepad to write down the address as the tones dropped out.

“dooooooo doooooooo” Went the tones. “Medic 74 respond Code 3 with Blueberry Hill fire. I-333 at the 34 and a half mile marker for the one vehicle roll-over. State police are advising to expedite”

“Cool!” I love trauma, always have. There isn’t a medic alive who doesn’t like good trauma. Sure it’s sad (see: Splashed Sadness) but nonetheless good, adrenaline pumping trauma gets the heart beating.

NM partner, however, being a New Medic Partner, acknowledged the call and said “Uh, Ck? I haven’t had a good trauma yet and I don’t know how I’m gonna do”

“I gotcha buddy, just follow my lead” I said as I flipped on the twinkles and woo-woo’s and headed out to the Interstate. When we got onto the Interstate traffic was a mess. We were shoulder riding through stopped traffic the whole way. Our lane was stopped dead and the other line was completely devoid of cars. That’s never a good sign. It means that both interstate lanes are blocked at the accident scene and traffic can’t proceed in either direction because the incident is blocking both lanes… either that or there’s gawkers in the other lane. Both aren’t good.

After a while of fighting traffic, fire arrived on scene and asked for our ETA before giving their scene size up.

“About a minute” was my reply.

We arrived on scene and found an image that is burned into my brain to this day. The vehicle, a half-ton white pickup truck, had obviously rolled multiple times coming to rest on its wheels perpendicular in the roadway with the passenger’s side facing the ambulance as we pulled up. The patient’s head and torso was hanging out of the passenger’s side window. The patient was face-down with his chest resting on the window about the level of his nipple line. I can still see the 6 inch wide streak of red dripping down onto the pavement from the patient down the passenger’s door. The red blood contrasted sharply against the dirty white paint of the truck.

We called on scene, hopped out of the ambulance, and grabbed our gear.

“He’s conscious and in a lot of pain” one of the firefighters told us as we approached the truck. I had NM stay outside of the truck as I crawled into the open driver’s side door.

The truck was a mess. Apparently the patient was a construction worker as evidenced by the amount of unsecured tools that had bounced around the truck as it rolled, impacting against the unsecured driver countless times and causing a lot of trauma. An open soda bottle had sprayed its contents all over the scene and the patient as well, giving everything a sugary sweet smell that comingled with the bitter smell of the blood that had splashed onto everything.

But that wasn’t what surprised me.

The patient was face down, hanging out the passenger’s side window. A bystander who identified her as a “nurse” had been supporting his shoulders, head, and neck which were outside the truck. Inside, I was shocked to find that his legs had been completely dislocated from the pelvis on down. It was grotesque. Every one of the joints in both of his legs had been dislocated and twisted. His feet pointed backwards, his knees rotated sideways with one being wrapped around the gear shift pointing oppositely from where it should be. His other was wrapped underneath him. Nothing was in anatomic position.

Gross.

And the patient… yea, he was awake and alert to feel all of this.

“Dispatch from Medic 74″ I said, urgently. “Send us the Helicopter. Blueberry Hill fire will be the LZ coordinator. LZ will be the Interstate. Traffic is completely blocked southbound from the scene.”

“Captain, I’m calling in the bird to transport. Can you land it on the roadway?”

“Sure thing” said the BHFD captain on scene, as he grabbed a crew to set up the landing zone.

“Hey NM, whatcha got up there?” I asked. He’d gotten vitals. The Pt was understandably tachycardic but he had a pretty good blood-pressure. Respirations were rapid and shallow. His o2 sat was 100% on the 15-litres-per-minute by non-rebreather mask that NM had put him on. He was in the process of putting the patient in a cervical collar when I asked.

So at this point I had pretty much no good ideas on how to get this guy out of the truck. His legs were just plain FUBAR’ed to use the term correctly. I couldn’t roll him onto his back with his legs the way they were and I couldn’t figure out a way to get them back into shape in the close quarters of the truck. I palpated down the length of the long bones in his legs and couldn’t feel anything that was broken other than the obvious joint dislocations. Finding distal pulses in the feet was pretty much out of the question with his thick boots on. On top of that, now the patient was beginning to actually feel the position he was in and was beginning to moan in pain.

“NM, any ideas on how we’re going to get this guy out from up there?” I asked.

“Aren’t you supposed to be here to figure that out?” was his reply.

After deliberating for a moment, I came up with a bright idea. I had the fire guys get our cot out with two backboards. My idea was to rest a backboard just underneath the passenger’s side window and slide the patient onto it, face down. His legs? Well… I figured that the damage had already been done to them and that since I would probably have to realign them anyway to restore distal circulation that I would just guide them out as they lifted and pulled him onto the backboard from the outside.

I recruited a wide-eyed EMT-Basic firefighter for the inside part of the plan.

“Here’s what I want to do y’all” I talk southern sometimes when I’se stressed.

“We’re going to sandwich him between two backboards. Y’all on the outside are going to lift and pull him onto a board face first. Me and this guy are going to guide him out from this side.” I calmly stated. “Everyone ready?”

“Um, you sure about this CK?” asked the wide-eyed FF/EMT-B. “Yea, you take this leg ‘cuz it’s not as bad. I’ll take (gulp) this one” I assured him.

“Sir?” I asked our conscious patient. “Get ready. There just isn’t any good w
ay to say this… it’s going to hurt a bit. You may want to take a deep breath.”

“Everybody ready? On the count of three. 1-2-3 go!”

They pulled and lifted and slid. The FF/EMT-B and I twisted and guided the rubbery legs around the gear shift and from under the seat. For his part, the patient uttered barely a whimper.

The legs, and this is one of the coolest things I’ve ever seen a human body do, simply “rubber banded” back into position. It was fast and easy the way they just snapped back into place. Freaky like. The patient slid right onto the board and onto the cot.

I hopped out of the truck and over to the patient. We placed a backboard on his back, picked him up between both of them and rotated him into the correct position. I then went to the truck to set up IV lines and let NM stay there to continue packaging the patient.

I ran down two IV lines as they were bringing the patient into the ambulance. I could hear the helicopter landing in the distance.

“Make him naked” I told a FF/EMT-B from the Fire Dept. Using one of my trademarked lines as I tossed him my trauma shears. He did, and to my amazement his legs, save for some abrasions here and there, didn’t look too bad. He had strong pulses in both feet as well.

I completed a head-to-toe trauma assessment as NM popped in a 14gauge IV. The helicopter medic entered and got another 14 in his other arm. We gave our passdown to the flight crew, finished the packaging, trauma assessment, and IVs and handed the patient off to them. They had kept the engine running on the helicopter for a “hot load”.

I hate hot loads. Something about walking under the spinning main rotor blade of a helicopter gives me the willies. We did though, wheeled our cot under the blades to load the patient in the bird. The chopper took off in a cloud of dust, taking the patient the 5 minute flight to the level 1 trauma center.

“So, NM. Was it good for you?” I asked him as we started cleaning up our truck. It was just plain destroyed with all of the treatment we gave this guy. We cleared the scene unavailable and out of service to return to the base hospital to restock and decontaminate the truck.

“I think that I like trauma” NM said. See? Everybody likes a good trauma now and then.

After cleaning, restocking, and returning the truck to service at our base hospital which happened to be the level 1 trauma center where the patient came to, we checked in with the ER doc.

“Hey, how’d the patient turn out?” We asked.

“Not too bad, he’s already up on the floor” Doc answered.

“What’d you find with his legs?” I asked.

“Nothing. His legs were fine. Just the airway and facial trauma. That was pretty much it” He said.

What?? I told him what we had on scene. He was skeptical. He said that he hadn’t found anything with the guy’s legs at all and that they were fine when he checked them.

I never did get a chance to follow up with this guy. I don’t know what ever happened to him. It was pretty common back then with how busy we were, and even more common now with the HIPPA privacy act.

The firefighter I was talking to at the beginning of the story? I dunno what she said while I was in my own little world. Something about lunch?? Hmmm… speaking of which, I remember a time….


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