Plan B

I have noticed that many of my stories, and those of others have a happy ending because of a "Plan B."  What if Plan B doesn't work?  Has anyone done any planning for those low percentage and high visibility calls when all the stars align just right and you are presented with a major fiasco?

Case in point the December 26-27, 2010 snow storm that hit New York City.  Twenty plus inches of snow blanketed the city with amounts exceeding thirty reported in Northern New Jersey.  This is a Plan B occurrence. But when did it change to a C,D, or E?  When buses unable to move clogged the streets?  When there were ambulances and fire trucks stuck in the street?  When firefighters had to walk a block into a scene because of all the abandoned vehicles stuck in the street?  When priority streets called arteries were not even continuously plowed?  When 1300 EMS calls and an unknown number of other emergency calls were backlogged waiting for any unit to become available to take them (NY Post, NY Times, Phila. Inquirer)?

How do you plan, and what do you do when it's your town of city?  I don't want this to become a Seven Step Process or selecting the best choice technique review.  I just want to get the ball rolling for a discussion of what if based on current events.  A simple way to include all levels of the group and have everyone learn something about abilities and capabilities.

I have long ago forgotten the terminology for sitting around and blurting out the first thing that comes to your mind when a problem or "opportunity" is discussed.  "No answer is wrong, just shoot from the hip."  Then someone writes down the answers and later they are sorted.  At the firehouse it is called the kitchen table.

Here's the way our discussion went.  What if we got 20 plus inches of snow?  I'd ski to work!  I'd find my snow shoes.  I'd probably end up here for a few days.

What about as far as the department?  Well. we have two four wheel drive ambulances.  The medics have a Suburban.  What if there are more than two calls?  We could take the squad it has four wheel drive.  We have those John Deere Gators we use for brush fires.  Yeah, and don't forget the snowmobiles.  Where are they stored?  What if we have a fire too?

You get the idea.  It's not a scripted show.  Talk, remember, relate.  We can see what didn't work on the TV and in the newspapers.  You can literally go as far as you want with this incorporating outside equipment and setting up unified command etc.  Just like the table top exercises that the training and planning guys do just on a different level.

Don't just sit there and say I'm glad it's them and not us.  Maybe you'll even get to Plan F.

Click, Click, Rats

Let's set the stage for you.  I'm the driver for the heavy rescue.  I've worked for this particular assignment for years.  Hell it seems like two lifetimes.  I love every part of it.  So when the first call of the night (in this case the whole day) comes in I mount up and hit the start button.  NOTHING, just click, click, rats.  Hand me a light, go through start sequence again, order firefighter to plug us in, tell officer we're screwed, special call squad, quiet except for cursing.  We have now switched to plan B.

Find the charger, locate the batteries (yes, there are five of them), and hope we can charge them up quickly.  Take out the rear forward facing seats to access the batteries hook up the quick charger and...wait.

We are not fond of waiting.

Now, think of charged batteries as a full can of your favorite beverage.  In this case our can was empty of beverage, squeezed by hand, thrown on the ground, and crushed flat by a truck.  These batteries were DEAD.  It's going to take some time to rebuild that can before we can refill it.  Now what the heck cased this major fiasco?

Reviewing the service records for the day we find that radio maintenance installed a new radio head swivel in the cab.  Dead short from new install?  Possibly.  At three minutes the inside cab lights come on.  We're making progress.  At six minutes we roll it over and it starts.  Recall by command.  So, what did we learn?

Trust no one.  Do your checks as required.  Maybe even start the apparatus just like we exercise the tools.  Know your apparatus- even the silly things like where the battery is located. And continue working as a team.  None of us will forget this episode for a long time.

OK, so my bad luck string has been extended.  MVA with entrapment and we are rolling out the doors before the dispatcher took his finger off the transmit button!  We got it knocked.  Two cars a couple of good injuries, fire up the Hurst tools (yeah we have two preconnected), door, dash, seat. Record time!  In fact I think the firefighter using the tool actually put it down and raised his hands like a cowboy riding a bronco.  That's when the engine guys started to reposition their hose line.  I sense that this is not necessarily a good thing.

I turn around toward my rescue and see smoke coming form the tool compartment.  Not a wisp but a full blown column of smoke.  Part of the truck is now out of sight because of the smoke.  The officer and a firefighter are already there trying to figure out what is happening.  As I am taking in the less than positive drama that is unfolding in front of me I detect some movement out of the corner of my eye.  The engine crew is sighting in the compartment and my guys for a super enema.  I casually step in front of them and after a brief verbal altercation obtain a consensus that water flowing at 100 PSI would not be the agent of choice for this particular happening.  I refuse to use the word emergency because that's more paperwork.

After years of electrically rolling up the Hurst hose the springs that fitted over the end of the hose to avoid a kink had slammed into a plastic relay cover just enough times to finally break it and have the spring metal make electrical contact.  Maintenance was summoned repairs were made and other rescues are now getting a  quick review of their electrical components and their locations.

I am working hard to figure out if this was actually number two or if I can think of another issue that gets me out of the "you know they come in threes" bonus.  Maybe it's time to take some  personal days.

EMS Sale! Limited Time! An Historic Event! No Money Down!

We lived through Thanksgiving Pre-sales, Black Friday Big Sales, and Cyber Monday Internet Sales.  Apparently EMS is feeling left out.  So today we are sponsoring a: call 911 for one and receive one free BLS transport masquerading as an ALS call.

I don't know who put the word out on the street but let's say we had more than our usual group of loonies.  This sale thing does not transfer well from retail store to public service.  It's 0630 and the over night boys are just returning after a whole night of not returning to quarters.  They look like, well, the bags under their eyes have bags.  Cue diabolical dispatcher number 911.  Ambulance, Medics difficulty breathing, chest pain, fall, possible OD, arterial bleeding, diabetic episode, psychiatric problem, I don't have any idea what he said because I was focused on my partner and what I thought he said: "You guys look tired why don't you clean up and go home."  No good deed ever goes unpunished.

I have an aversion to assisted living facilities.  I question both the assistance and the living but that's another story.  We arrive at shift change and are accosted by the workers: "Why are you here?"  Well, let's see, we know that you serve a great breakfast?  "Over here ambulance driver."  Allow slow burn to commence.

OK, so I'm not much to look at at 0630, but I have training, I have a uniform, and by God I have a name tag!

"Can you move that THING."
Pardon me?
"That YELLOW thing."
Are you referring to my stretcher?
"You're making me late to breakfast."  (Yeah, sure buddy, let me push this useless thing back five doorways so you can get your fat never mind to breakfast.  Don't worry about that elderly woman in the room that we always have trouble getting into because they got the cheapest elevator they could find, in the smallest size available, and it's built so even a wheelchair takes up most of the room and she's having difficulty breathing.)
Ah, wait a minute sir and we will be finished here.
"She's not sick."  (Odd that's what I was thinking.)
What would make you think that sir?
"She shut her oxygen off last night and didn't turn it back on."  (I may reconsider moving the stretcher for you new friend.)
Hey Newly Minted Medic:  Is her oxygen on?
"She doesn't have any oxygen."
"Yes I do sonny.  It's over there.  Turned it off because the hose gets all tangled up."
Let's put that back on like this young lady.  Cue O2 sat increase from 88 to 95.
"Oh, that feels better.  I can see again."  (Lord just take me now.)
Retarded Nurse #1:  Well  she still has to go to the hospital because I already made out the paperwork.
Cue Sprint commercial, as we stand in silence quiet enough to hear the old guy waiting in the hall pass gas.  I know they dropped a pin but my commercial is way more appropriate.
Do you want to go to the hospital?
"No need to I feel fine."
Sign here.
RN#1: Well you just ruined my whole day.  (Glad to have spread some cheer anywhere I can.)
By the way sir how did you know she didn't have her oxygen on?
"Hi Retired Gentleman."  Hi Elderly Retired Teacher.
I'm on my way to breakfast.  Can I get my teeth from the night stand?
Cue second period of more profound silence broken only by the sound of RN#1 jaw hitting the floor.
Retired Gentleman smiling as he pushes past to grab teeth.
Recall ALS, were returning.  Come on Newly Minted.
RN#1:  Can you take Retired Department Store Worker to the ER?  She hasn't been feeling good since yesterday.
Taxi 1 to dispatch...as it turned out only 9 more to go!

Waiting Room Purgatory

This missive is about appreciation.
During the last few days I must have been in the ER twenty or more times.  Before that, over the course of years I'll bet the person I walked in with never spent more than a few minutes on my stretcher before we waltzed in and deposited them in the good hands of the ER Staff.  That's literally thousands of calls, transports of all kinds, and "bing" go to the head of the line.  I will never take that position for granted again.

I have seen the dark side and I didn't like it one bit.  Powerless does not even begin to describe the feeling of desolation and abject uselessness as you sit there in the waiting room, well, ahhh, waiting.  But let me back up a moment.

My wife and I were honored to host several of my daughter's college friends for a weekend get away before finals.  They had fun, ate and slept too much and finally prepared to depart with me as their chauffeur.  Half way through the trip one of the young ladies developed abdominal pain and within a few minutes we decided that a visit to the ER was in order.  Cue music from the Twilight Zone.

Name, address, do you have an insurance card?  Now what seems to be wrong?  Severe stomach pain What's your age?  Oh, 17 and are you her father? Ah, no.  In loco parentis?  Ah, no.  Form, power of attorney, verbal approval? No to all.  Well then I guess we will just assume she needs care.  Cue evil organ music in the background.

There are now four other groups of people sitting strategically in the waiting room.  We walk in and are ignored, stared at, summarily dismissed, and given the once over as if we were there to take children from their mother.  No one looks sick.  I assume that our person, unable to sit without constant movement and moaning about pain, should rocket to the top of the Triage list.  I was mistaken.

The kid that was sleeping, the guy holding his finger, no not that one, and the old guy that sneered at us as he walked by to the coveted triage room all were seen before our now laying down and crying young lady.  I looked around momentarily for the "take a number" sign worrying that I had missed it on the way from the desk.  Instantly that reminded me of a bakery and I realized I would be starved until we sorted this whole mess out.

As my charges vacillated back and forth between school work and abusive comments about the staff I realized that they were planning a coup.  The girls marched on the RN receptionist and said "This is unacceptable.  Our friend is obviously sick and we have waited an inordinately long time to see a doctor.  Something must be done"  I marveled at their rookie attempt to intercede for their friend but I also immediately tried to distance myself from the expected volcanic eruption of wrath by quickly grabbing my cell phone and dialing 9-1 as I prepared to seek emergency help for these young and less than worldly girls who were about to be instantly chewed up and spit out by this wily veteran of the trenches.

The woman barely moved as I watched the drama unfold in the reflection of the TV tube, taking a breath and not even looking up from her computer monitor she quietly retorted "I don't know where you're from honey, but in my world you have to be the sickest one here to go next.  Please sit down."  She made Cool Hand Luke look like a nine year old with A.D.D.  I was in the presence of an ER God!  They did as they were told.

Eventually it was our turn and with the speed and reflexes of a hockey goalie the ER nurse took in the sick girl spun into the ER and closed the doors in front of the other three friends while at the same time mumbling something about limited space.  Not even the Great Gretzky was scoring an entrance in those doors!  I made the translation for the distraught crew and they again assumed the waiting position.

Mom arrived from her home hours away.  She is an ER nurse and through code words and body positioning she quickly bluffed her way past the receptionist, as if by miracle touched the unknown ER door opening mechanism, and gained entrance into the treatment area.  She stuck her head out and asked the girls to come with her.  They smiled and Cat Walked past the receptionist without realizing that she knew she held the true power and they only gained access to the inner sanctum of treatment with her unspoken approval.  I nodded my appreciation to her and for a nano second I thought that the corners of her mouth were curling up as if to smile, but she immediately regained her super powers and thousand yard stare as she returned to the computer screen.

Blood tests, CAT Scan, poke, and prod and the medical experts, along with the ER Nurse Mom, determined that an appendectomy was warranted and we received notice of such as we completed our return to school.

I now understand the hierarchy of an ER in much more detail than I had ever anticipated.  I appreciate the pass I get from the receptionist when I arrive with my patient, and to some degree I can now sympathize with those poor souls watching me walk by with another patient as they continue waiting in "Waiting Room Purgatory."  It's now time for bed.

We Need Change

So have you read anything about that EMS 2.0? Beep, Beep.  Rats

Don't go that way, too may trucks.  Have you tried that place to eat?

So what's the deal on that EMS thing?  These guys are trying to make things better for us and the patients.  We don't need a another union.  It's not a union.  Siren and lights, pull to the right idiot!  Where'd they say the call was?  Keep going.  OK, so there could be options other than taking patients to the ER.  I'd like to take them to jail.  I'm in. OK command we're two minutes out.  How many helicopters are coming?  Maybe we could be trusted to determine if the patient really needed an ER.  Like when they get that miracle drug D50? Yeah, like that only better.  Better start slowing down.  Not hauling people has to cut down on my paperwork.  It's your turn in back by the way.  Do we have any help coming?  Ten and second due ALS.  We're lookin' at two priority ones.  Split up.  No one riding with him I'm back to help you.  Like that 2.0 thing?  Yeah Cap, just lay the board here and we can use some help rolling him on to it.  Head, right arm and leg, pelvis.  Next time take a plane when you fly.  It's not the flight it's the landing.  Thanks everybody, OK let's go.  Does EMS 2.0 get me out of the nursing homes?  Not entirely. Someone still has to go and assess.  But if the patient slid from her wheelchair to the floor and told you she did maybe she doesn't have bilateral hip fractures just because the CNA says she does.  Helicopter is two minutes they want a report.  SUCTION!  OK, now pass off to fly boys.  Jeez, I can't take you anywhere.  What did you do roll in it?  Somebody has to do your work.  Is that what EMS 2.0 is for?  No the work is still there, we just get choices and so do the patients.  It's kind of anti-dumping.  When you get a say in things usually it works out to everyone's satisfaction.  Hey let's get you clean and go for two brownies with peanut butter icing.  Let's go back to the station and I can show you EMS 2.0 on HappyMedic.com.  I'd be a happy medic if I could have a brownie.  Beep Beep.  Rats.  2.0 here we go!

SOP/SOG

As I was re-reading my company SOPs it occurred to me that no where in them does it say proceed to the call disregarding all traffic regulations, rules of nature, and common sense; while maintaining speed generally associated with requirements for flying an F-16 in a Dog Fight.  Only one EMS promulgation even allows speed at no greater than ten MPH above the posted speed limit.  But are you ready for this?  All edicts stipulate seatbelt use in moving vehicles and the EMS papers don't mention when not doing patient care.

Is every call an emergency?  Risk a lot to save a lot.  Risk little to save little.  Don't risk anything if you can plan ahead.  Seat belts and speed are both under our command.  Keep them under control.  Yeah, I think my kids would miss me.  Thanks to Firefighter Close Calls for the pictures.

You Are What You Read

In between discipline, training, planning, and WOW actual calls it occurs to me that we have some down time that we could responsibly fill with knowledge enhancement activities.  Do you like that?  A new acronym KEA.  Yeah, what the heck does that mean?  Let's call it reading.

It doesn't make a difference if it's printed matter, blogs (thank you dear reader), or internet news.  It counts as reading.  Watching fireman vs. policeman is NOT reading and hence not a KEA.  Posting pithy retorts on your or someone else's FaceBook page is not KEA, although it sometimes requires reading between the lines.  So what is it?

Let me share my monthly Fire and EMS reading with you.
Daily: Statter911, Firegeezer, Firehouse Zen, Raising Ladders.com, The Fire PIO, Three Mouse Clicks From Disaster, Pink, Warm, and Dry, Street Watch, Future Ditch Doctor, Happy Medic, No Ambition But One, The Boogie Man Is My Friend.
Weekly: Firehouse.com, Fire Engineering.com, Dr. Grumpy,
Monthly: Firehouse Magazine, Fire Engineering Magazine, The PA Fireman, EMS, Fire Rescue.
For fun: B-Shifter, Rescue Men, When the Bronx Burned, Alex Cross

OK, you get it.  The list can sometimes become overwhelming.  But there is literally something for everyone.  Cruise the blogs, catch up on the news sites, and yeah, even read a book or magazine.  In fact how many of us read a book more than once?  Start a station library and bring in some of your lightly read books or magazines.  I think you'd be surprised what others will pick up once they see someone else is doing it.


So your homework today: focus on KEA and let's avoid the KIA (killed In Action).

An Oldie, But a Goodie

Possible CVA my ambulance is due.  OK, look up the address, cross street, note that ALS is not available, tell new guy I'll drive, and we're off.  New guy and I get along pretty well.  He can't stop asking questions whenever he is with another human being but as an adjunct instructor for the community college where he is paying to take his EMT/Paramedic/LPN/RN/MD I feel obligated to give him well thought out and correct answers.  OK he's only getting his EMT there but because of all the questions it seems like he is studying for his nursing boards or medical degree.

Why are we going this way?  Because there are designated emergency corridors we use when we respond.
Why don't we use the lights and siren?  Because it's Sunday and I don't want to cause ten "Sunday Driver" accidents on the way to our nothing call.
How can you be sure about the call?  Well statistically 75% of ALS calls don't merit ALS.  50% of BLS calls could safely be driven to the doctor's office for an appointment tomorrow.  Oh, and I hauled this patient's mom from the same address about a dozen times.
On Scene.
"Hi, I'm Newly Minted EMT can I help you?"  I secretly wish, just for a whimsical moment, that I still had the deep caring attitude of my partner.  But I also place a mental side bet that within six, no three months we'll have him working on the dark side with the rest of us.  Let the games begin!
"It's my son, he had a stroke and can't move his right side. OPQRST.  Patient blinks and stares as mom answers questions.  Other reviews that I really don't pay much attention to, something's not right here.  Mouth doesn't droop, no drooling, follows us with eyes where ever we go.  Hmmmmmm.

OK now my OPQRST, Opportunity to Preempt or Quit Resultant Stroke Treatment.
OK Newly Minted, let's load him.  "Yes, we need to get him to the hospital."  Cue crying by mom.  Haul patient out to ambulance.  Get his oxygen ready and I will start filling out paperwork.  Cue odd look by Newly Minted.  He already knows I hate all paperwork.  Catching on? Nah, not yet.

Me to Newly, OK this Medical Assistance paperwork, I think I have it all filled out.  Now in order for the patient to not be billed they have to sign for the trip right?  I cut off his answer and say Mr. Patient, can you sign here?  Mr. Patient grabs pen, signs name, and lays back down.  Oh, did I forget to say that he is obviously right handed?  As I thank him and move to get out of the back of the ambulance I note the extra bright 200 watt light bulb that just lit up above Newly's head.  Yeah, he got it now.

I think I heard him curse under his breath as he was filling out page two of the narrative...I't's going to be a shorter walk to the dark side.

Last Responder Not First Responder

Recently My Department was notified that a local business was removing an existing fire sprinkler system during a significant remodeling effort. Naturally the Fire Chief called to express his, and the department’s, disappointment and offer some suggestions about retaining the operating system. Principally he mentioned that there has never been a multiple loss of life in a fully sprinklered building and that fire sprinklers are widely recognized as the single most effective method for fighting the spread of fires in their early stages - before they can cause severe injury to people and damage to property.

The building owner was appreciative of the information but told the chief that it’s simple economics. According to the new building codes during his remodeling and improvement project he was able to decommission and remove the system thus saving money on future costs of upkeep. In fact his insurance company told him that he would realize no savings from continuing to have his property protected 24 hours a day by a properly installed fire sprinkler system. Needless to say the chief and the entire department were incredulous.

Much to my chagrin the chief verified that the building code provisions do allow the removal. Obviously the fire service is ashamed that we allowed these things to happen. However, there are other opportunities for recourse. For instance, even only contacting a few insurance representatives it is obvious to me that significant discounts are available at many insurers for maintaining a fire sprinkler system in a business. Other locales have instituted new ordinances or begun education campaigns to challenge widely held, but false information about performance of the systems. There appears to be a lot to do.

We call ourselves “First Responders” but in reality we are the “Last Responders,” is a quote from retired Phoenix, AZ, Fire Chief Alan Brunacini. As I reviewed codes for this writing, consulted with insurance executives, and spoke to state and local authorities I realized that this is absolutely true. Firefighters are the last line of fire suppression in a usually desperate attempt to stop the progression of loss from fire. We react to a perceived emergency based on a series of choices that were made long before we were notified.

The building code, government, architect, builder, inspector, decorator, and even the owner all have input far in advance of our arrival. It is the conglomeration of their decisions that dictate our tactics and strategy. If we attempt to intervene early in the process, as with the International Code Council vote on residential sprinklers, we are vilified and accused of being nothing more than a special interest group. Ironic isn’t it that the very things that could make our job easier, or more difficult, are not within the purview of the fire department?

Rest assured that when called upon we will respond, commit resources, and mitigate the disaster to the best of our abilities. But also realize that we intend to become a force for change locally and nationally. Watered down building codes and safety requirements help no one, it is that early intervention and prevention that pays the best dividend. We will have safer communities, less loss, and as firefighters we will all get more sleep.

Is It a Full Moon?

The belief in Fate, a divine hand, or just plain bad luck is encouraged and promoted by our understanding that call volume has some association with innocuous universal truths.  Friday the Thirteenth is a widely held bad luck date.  We adamantly hold that any shift during a full moon is automatically assumed to be both busy and filled with oddity.  That bad things come in threes and we just know that there are certain individuals that are a magnet for unusual calls.  And possibly the worst case, any confluence of the just mentioned idiosyncratic beliefs portends real disaster for us.

Just think, if we are unlucky enough to work on Friday the Thirteenth, during a full moon, after two bad calls, with a crap magnet?  We might as well receive Last Rights and make a down payment on a cemetery marker because the world is about to end!

You are chuckling to yourself, but quietly lest you bring down some form of retribution on you or your crew, because you know as soon as someone utters the phrase "it sure is quiet" all hell will break loose.  The same thing happens when you challenge any of these universally accepted truths.

How do we combat these assumed truths?  Should we even address them?  More importantly can we use them to our advantage for training, education, or safety?

Obviously if we believe these things we should prepare for them.  The full moon comes every 28 days.  Friday the Thirteenth occurs every year.  If we get two difficult calls can the third be far behind?  All of these things must trigger a response from those of us that lead.  We can use the coming full moon to plan for pending issues.  Training and equipment checks can be completed or at least encouraged based on these or any other belief.

Now I'm not advocating an immediate transformation or return to support for unsubstantiated superstitious beliefs, just turning negative belly-aching woe-is-me  mentality to our benefit.  Maybe you can see this in other avenues.  It takes time, it takes leadership, but the rewards are attainable with little or no cost.

Thinking, educated, trained risk takers developing strategies to prepare us for the future, or just a few officers using an opportunity to encourage learning and preparation.  Yeah, it just might work.  By the way, the next Friday the Thirteenth Full Moon is 6/13/2014.  Enjoy!

Old School, When Did It Become a Negative?

Remember when...fill in the blank.  It usually has to do with someone telling or showing us something that made a difference in how we continued.  My memory is being taught how to draft with a 1966 Ward LaFrance.  The slight of hand that was needed to pull the tank suction, activate the primer, adjust the throttle control, and "hear" the water as it entered the pump.  I'm not sure how long it would've taken me to learn the complex operation but I'm sure that the officer with the patience of a saint streamlined the process.  That's what I'm talking about, spending the time, sharing the knowledge, and bringing your fellow firefighters up to another level.  Yeah, professional.

As a group of young guys prepare to take their certification test I picked up a 2.5 gate valve and mentioned that this item was a pass/fail when I took the test 20 or more years ago.  We talked about where it goes on the hydrant and why.  Simple and to the point.  Something that you usually skip over and no one notices until they need it.  Now other stations will notice and remember that they should be doing it too.

What's your story?  And better yet, what are you willing to share?

Normalizing Deviance

When do you stop questioning unsafe practices and without actually verbalizing it accept short cuts as the real world way to do it?  At what point in our OJT (on the job training) do we get the mental enema and stop thinking "this isn't right?"  Yeah, peer pressure, new guy, go along to get along.  But when it finally catches up with the crew watch out because the longer something has been avoided the more it seems to hurt when your number is up.

Stay safe, be safe, work safe.  Yeah the grammar sucks but it's easier to apologize to your English teacher than to a grieving family member. 

Yeah, that's me

I am stunned by the illiterate, uneducated, and mean spirited rants that I see personally and via comments on the internet.  Where is our civility?  That's where I come into the picture.

I have been a fireman for 30 plus years.  I don't know squat, but I have a long memory and a sense of being "The Last Responder" not a "First Responder."  No one calls us at zero dark thirty because we are the first number they came across.  They call us because in their protected little world they have reached the stone wall and there is no other alternative they can think of to remedy or mitigate their problem.  They need to be rescued.

When I arrive I will solve their problem because I've become an informed risk taker by watching and learning from people, printed media, and the internet.  Embracing all of them to prepare me to think straight through the problem to its conclusion.  I'm not getting a cramp from patting myself on the back, it's what is expected of me.  It's what is expected of us.

Fireman, firefighter ambulance driver, EMT paramedic, rescue guy, haz-mat.  I don't care what you call us, we are responsible for all of it.  Embrace it, learn it, and for crying out loud be safe doing it.