Showing posts with label Paramedic. Show all posts
Showing posts with label Paramedic. Show all posts

Sunday, May 3, 2015

Evolution of a First Responder Rookie to Retirement: Info for Writers with Cpt Michael Brigati

Captain Michael Brigati
Many of you are writing about the men and women who run to the scene when 911 is dialed. In my own writing, Lexi Sobado is a rookie and she feels a little overwhelmed in a world where her team has already been burnished with experience. As we construct our characters, I think it is interesting to take into consideration where they are in the spectrum of their career. 

To discuss this I have invited retired Captain Michael Brigati to reflect on this topic. Michael was a firefighter, paramedic, and elite SCUBA rescue team member.

Fiona - 

Michael, let's begin with the idea of expertise. Obviously rookies would look to their captain and expect to find a figure to emulate. What does it take to be an expert? Can you explain your evolution to proficiency?

Michael - 
Expert…that's a big word and there is no one answer. I believe any professional, in any field of endeavor, might say it is the attempt to attain that level, that defines their proficiency. If I achieved the skills necessary to advance my career and become more resourceful and adept, it may well have been seeded in my love of sports, academics and being a student of nature. 

Playing sports, but perhaps team sports in particular, requires not only learning an individual skill set based on desire, technique and repetition. But when working with others to succeed, demands understanding that the sum is truly greater than the individual. As regards academia; by definition, as a student, my role,was to absorb the wisdom through lectures given, study and enhanced thought processes. Of course, nature is the greatest of teachers, and I’ve spent the largest part of my life outdoors simply observing. To survive, one must adapt and use what is available to flourish, even learn what not to do; valuable lessons in that as well.

All of these combined to help me succeed as a firefighter, officer, paramedic and rescue diver. The Fire Service is the ultimate ‘team sport’ and I am convinced that is why it is deemed a brotherhood, which it certainly is.

I would also be remiss if I did not add that the very first thing one must do, to even try to become an expert, is to keep quiet and listen to those who’ve earned their stripes. Again, that applies to all my examples above. To become the ‘master’, one must always be the ‘student’. I have to give a ‘shout out’ to Chief Jim Graham in that regard. He was my mentor in the Chesterfield Fire & EMS Department and one hell of a fire ground officer.

Fiona -
Michael, in the county of Chesterfield, Virginia, where you worked, they have an interesting fire system that folks may need to understand as you are answering questions. Could you explain why a fire truck shows up if you call about chest pains?

Michael - 
Everyone of our firefighters are at the least Emergency Medical Technicians (EMT); but there is an ALS medic (Advanced Life Support) provider on every unit, all the time. We respond with fire trucks and an ambulance with ALS is sent at the same time to continue care all through transport. 70% of all emergencies in Chesterfield County are medical, the other incidents

Fiona - 
This has not always been the policy. It's actually fairly new that the fire and EMTs in Virginia are paid professionals and not volunteers. Did you begin as a volunteer?

Michael -
Yes, the system of combined Fire and EMS began in the seventies. As for myself, no. I never volunteered. I was working as a counselor for the Virginia Department of Corrections. A friend told me of the work, and it appealed to me. After a rigorous testing procedure and interview, I was taken on...a raw recruit if ever there was one.

Fiona - 
Who is selected as a recruit for the program?

Michael - 

The county government uses all manners of communication and media to advertise openings. It is not uncommon at all to receive literally hundreds of applicants for a recruit school. That number changes from year to year depending on vacancies, growth in the county and other mitigating factors. It is open to the public. Anyone over the age of 18 is eligible, and we have hired people in their late thirties. And of course, gender, ethnicity and such are irrelevant. The fire and EMS department simply wants the most qualified individuals. It is what the public deserves. The testing is quite stringent and along with background checks and drug testing, the process is very thorough.

Fiona -
You mentioned you were "a raw recruit if ever there was one" and that is an excellent beginning for the topic today - what were your first thoughts on entering that world?

Michael - 

My first thought was this: It's a Fire HOUSE. You live there. Meals get cooked, beds made, bathrooms other words, it was a 'reality check' for me. Even in these seemingly mundane tasks, there is great purpose. You must pull your weight, because who you are and what you are willing to do as a person is being revealed and observed by people you will know for many years in sometimes the most difficult of situations. If you shirk responsibility at 'home', word spreads and this first impression is critical. 

Fiona - 
Put yourself back to your time when you were training. What were your basic thoughts about the job and what surprised you the most?

Michael - 
The repetition in training to learn the tools of the trade and when to use them was remarkable. It didn't take long to recognize that the better shifts trained constantly. And since we responded to just about any emergency, it became clear that it made sense to train regularly.

We went over the simplest procedures frequently and at first I didn't understand why so much time was spent on them. It didn't take long to realize it was done so that in emergency conditions we could react in an 'auto pilot' mode. People hear of it in the military. Phrases like "training took over." So very true. After all, the worst of emergencies don't happen on a beautiful sunny day, they occur in thunderstorms, at night, in fire and smoky conditions where life does indeed hang in the balance. 

You have to be able to work calmly and orderly, with confidence that what you are doing is right, a lot of times, there is no second take. That stayed with me for all of my career, and I've never forgotten it.

Fiona - 
What was the first gut check that made you look at your role in the grand scheme, and it felt like a seismic shift? The whole "Holy crap this is truly life and death that I'm dealing with here" moment. And how did this change who you were as a first responder?

Michael -

Everyone recalls their first real 'worker'. That's jargon for when its a true emergency; a house fire with people trapped, a violent wreck with people screaming in the car -  things of that nature. 

My first experience was a house that exploded because of leaking gas; literally lifted off its foundation. Fire smoke, late at night. I will always remember being a jumpseat Firefighter, the position one starts their career, and jumping off with my 80 pounds of gear, and stopping dead in my tracks. All my senses were magnified. I stood there, I'm sure with mouth open, until one of the veterans slapped me in the back and said, "Let's go. Follow me." The world was surely different after that. I was now officially a firefighter.

Fiona - 
How much pressure do you feel from "no second take?" Do you rehash? Can you let an event go? Do responders develop a philosophy that helps them through the "deaths doorstep" situations? And if yes to the last, at what point in the responders career does that begin to gel?

Michael - 
There is a tremendous feeling of pressure. 

Early on it is a huge weight. That goes back to an earlier question about evolving. Learning and following a veteran, moving cautiously. It is a unique job. I have seen many leave the service because of the stress; understandably so. 

It may sound cold, I assure you, it is not, but a Firefighter will tell you he or she is "at work" and when in that mode, can work under extreme conditions. But you cannot get cocky, thinking you are superhuman or nothing bothers you. That sets you up for disaster. 

Running an incident where children are involved...critically injured and even dying...these are the worst. They strike deep and can stay with you. Everyone has a level of 'detachment' I was able to keep my perspective by realizing I was there to help, and it was all I could do. 

Because of my background in mental health, I ended up becoming one of the original peer counselors for stressful incidents and was even asked to present at the World Congress of Critical Incident Stress in Baltimore.

 I think for me, it all 'gelled' after three years or so. Seeing enough calls, learning how to respond to them, and accepting outcomes aren't always what we want.

Fiona - 
If an author is writing about a firefighter, the place the responder is in in his or her career will inform the abilities, reactions, psychology etc. I am wondering what changes an author should consider as their character ages or as we enter a story say of a mid-career responder. Perhaps you could explain with your characters in Fire Thieves.
Michael - 
One has to have a good memory and an honest perspective to write about the particular period a character, in my case, firefighters, are in. A rookie will not be savvy, A veteran will not be foolish. 

Critical to that, as the firefighter has collected calls and response behaviors, it will change; evolve dependent on the stage he or she is in relevant to their career. My main characters are just about at the end of their career. They have seen much and being brothers, know each other quite well on several levels. To bring them to life in this stage of their career, I went so far as to gather my good friends, several retired, some approaching that milestone, and would chat with how they did things as they approached the end of their career. It was a good way to stay on track and not get caught up totally in what I thought alone. Always helpful for a writer to have such excellent sounding boards.

Fiona -
Every responder I have ever spoken with talks about their Fire Family. The Assistant Chief who is teaching at the Citizens Fire Academy I am participating in could have retired years ago, and he is not planning on heading out the door yet; he's needed as the next generation is trained and prepared to take over. How does a responder know enough is enough, it's time to hang up my helmet? How hard is that transition? I imagine once a responder always a responder much like the Marines.

Michael - 
The fire service, like any business, is divided into divisions. Each a separate entity meeting the needs of their particular mission. 

In 'operations', the actual hands on responders, there is a wear and tear - physically, mentally, and emotionally. Most realize, even if reluctantly, that when they can't 'do what they used to', or they slow the crew down at a call, then it's time to consider a change to a position out of operations or retirement.

Others, as in your example of the Chief, are in the training division which is not as hard on the body and one is able to stay on the job longer in a valuable mentor mode so to speak. Same is true of arson investigators, maintenance and logistics. 

And you are absolutely on target...once a firefighter...always a firefighter. I am still called captain when I visit a station. And even when traveling, as a member of this brotherhood, you can stop at just about any fire station and be taken in, have dinner. It is simply fantastic. Some do have a hard time leaving it behind, and are always in touch with the service, and the men and women who are like family.

Fiona - 
What do you wish I had asked today? What do you wish all writers knew when they wrote about responders at different levels of their career evolution?

Michael -
Authenticity. Without that, a writer will fall short as this kind of work, like the military, is based on codes of contact, language, behavior that is uncommon to most all other careers and absolutely critical to be 'spot on'. A writer can still get that. As with any good author, reference work is the key. That and having a friend in the service. But even that can be handled. Citizen Fire Academies, fire service speakers, and I can assure you...if a writer was interested, they need only ring the doorbell at a station house, talk about what they were doing, and they would be INUNDATED with help and assistance.

Fiona - 
Tell us about the book you've written that puts us into the Firehouse.

Michael - 
A fire rages out of control at a large chemical plant, and it’s threatening to detonate into a massive toxic fireball that will kill thousands near the capital of Richmond, Virginia.

The Meagher brothers, career firefighters both, are there to battle the blaze and fight to get it contained before the facility's highly volatile ammonium nitrate explodes. Little do they know that this fire will suck them into a complex international web of deception, death and lies, intended to destabilize the Middle East and culminate in the destruction of the U.S.S. Defender, incinerating the 2,000 Marines on board headed home after deployment, and initiate a war between the U.S. and Iran.

Aided by their father, William, a private investigator and former Fire Chief, and friend Marcus Delorme, an FBI terror expert, Patrick and Shane, begin to suspect that this was no ordinary accident. When their closest friend, Vincent, an arson investigator in the Chatterton County Fire Department, is murdered in a second conflagration, they're out for blood. But will they discover the connection to the Defender, about to leave Iraqi waters, in time?

Fiona - 
Now, Michael - everyone is asked to tell us their favorite scar story and like many people who have highly dangerous and physical lives , you inexplicably have no scars! That's crazy to me. But surely you have a plethora of harrowing stories. Can you tell us one?

Michael - 

Fiona…no physical scars, but as anyone in Emergency Services, a few scares and yes, a very harrowing story. It was springtime, my first year on the elite water rescue team for Chesterfield County; my third year as a Firefighter. The Spring rains had swelled the waters of the Appomattox River in the area known as Battersea Beach. A dangerous, and popular, rock garden where citizens of Chesterfield and Petersburg would come for a days adventure. Unfortunately, a young man had slid from the slippery rocks worn smooth by the rising waters and went under in the rapids formed by the boulders in the area.

There were only two divers available that day. A skilled veteran, Craig “Catfish” Vaughn and myself; new to the team. Our land based crew that day, headed by Rick Butcher.

Typically, divers use a practiced pattern and are tethered with safety lines, but this was impossible due to the violent surge and volume of water. Catfish and I dove separately, each trying to stay in the eddies, the pockets of calmer water found behind each submerged obstacle, as we groped frantically to try and find the boy.

In a violent and dangerous river flow such as this, where the water is incredibly thick ,murky and strewn with debris; rescue divers call it "zero viz", you literally cannot see your hand in front of your mask. 

My adrenaline was pumping at least as fast as the Appomattox as I darted from one eddy to the next; diving alone with no way of anyone knowing where I was, my exhalation bubbles nonexistent, lost in the crest of waves breaking on the surface.
Feeling my way along the bottom, I inched past the edge of the rock formation I was scouring, and kicked powerfully to try and cross the swift current, intent on searching elsewhere. I underestimated the flow and caught in its grip, was shoved helplessly downstream until I was pinned against the trunk of a large underwater tree trunk; a ‘strainer’ is what such an object is called. 

Try as I might, I could not move, the water far too strong, my air supply starting to dwindle; no one knowing where I was and no way to call for help. I started to panic and honestly believed I would die right there.

It’s difficult to explain, perhaps it’s our primal nature to survive, helped considerably by the training I received in the Fire Service, but I managed to calm myself enough to formulate a plan. It would be my only chance to survive. Feeling objects hitting me, then the tree trunk before swirling past and getting kicked down stream, I began to roll, much like a carpet being rolled, away from the trunk and towards the crown of the tree. It was the only way I could move. Eventually, I got to the thinner branches; kept rolling, until the force of the water ejected me away from the tree and downstream.

I have been in perilous conditions in house fires and commercial structures, but far and away, the closest brush with death was underwater that day early on in my career. A lesson I never forgot and used throughout my career.

Fiona - 
Ach! A nightmare.

These photos are from a different water rescue scene:

If you want to know more about SCUBA search go HERE

So as we end our interview - you can stay in touch with Michael  -

Fiona Quinn's Newsletter Link, Sign up HERE

Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.


Saturday, December 3, 2011

EMTs and Gunshot Wound Information for Thriller Writers


When I learned CPR, it was on a dummy like the one strapped to the gurney in my EMS photo on the right. It was okay training. In the back of my mind, I think that what I learned on the dummy might not translate so well when and if I were actually doing those chest compression and singing, “Ah ah ah ah Staying alive. Staying alive…” that ironically provides the perfect tempo for CPR.

English: A paramedic preparing a intra-venous ...Image via Wikipedia

It was a real treat to have the second year paramedic students role-play for us. Mainly it was relieving to know they practice on each other. If I were lying out on a road somewhere and the first responders were practicing on me as a human - instead of me as a disembodied plastic torso - for the first time…well, I’d be grateful, no doubt, that someone was willing to show up - but I’d be hopeful that their hands had been on real people.

Real people indeed. A girl stumbled into the room in a daze, gasping for breath, collapsing on the cold tile floor in the ambulance bay where we perched to watch and learn. An ambulance pulled up and the work began.

Paramedic work, like all field medicine, requires a little MacGyver-esque ingenuity. For example, the victim had two open wounds. These were not referred to as gunshot wounds. The paramedics I spoke with are not allowed to diagnose - though I have had paramedics write and tell me they can so check the locality of your book's setting.

In order to apply pressure and seal the wounds, front and back, they used the pads from a defibrillator. Very effective. They discovered that the victim had a deviation between her right and left lungs. Her wound must have caused a tear in the lung causing it to collapse. That’s life or death. But Kent Sears and his crew went methodically forward. They used an intravenous needle taped (any foreign object that has entered the body either by design or accident, and is sticking out, needs to be taped) to the victim’s chest balancing the lungs.

When the lungs collapsed the victim passed out. Splat. They needed to get an
IV line in. How do you do that if the vein has collapsed? They used an Intraosseous or IO machine. It looks like a hand held drill. They screwed on a drilling attachment that had a spoon like bit. They have this enter into the flat portion of the fibula (in the leg), or if this is unavailable they can use the humeral bone (at the shoulder). This process is very quick and is usually done on someone who is unconscious. If it is done on someone who is aware, they give a quick burst of Lidocaine before they introduce the fluids.

WARNING Trigger alert  Video Quick Study

Pain ratings for the IO

Entry drill 3
Pain with drip (no Lidocaine) 8
Pain with drip (Lidocaine) 1
Pain pulling out apparatus 1-2

How do the first responders know what to ask? They use a mnemonic.

O - onset - when did this start?
P - provocation - how did this start? Ex. With a heart attack victim

      where you doing something strenuous?
Q - quality - Is it sharp? Is it dull? Does it throb? And so forth.
R - Radiation - where do you feel the pain?
S - Severity - This is the famous 1-10 scale. 10 being your head is

      about to explode.
T - Time- are there any changes over time.


S - signs and symptoms
A- allergies
M -medications. What medications are you taking?
P - pertinent - What pertinent medical information do we need to

      know? Ex Are you pregnant?
L - last - When is the last time you ate or drank? Important for

E - events - What events lead up to the medical issues?

Here’s some interesting shot related information:
Once the bullet enters the body it can bounce around and go anywhere. The physics of the ammunition entering the body at any spot can cause hydrostatic shock. Basically a shock wave that runs through the body and can injure the brain. This is why gunshot victims wear a
c-collar and are on a backboards.

The victim’s health comes first. The
EMTs are trained to cut away from the cloth where the bullet was introduced. They try their best to preserve evidence. Of course, all that goes out the window when a life is on the line.

The EMTs appreciate people who can help. The will often give hysterical family members something to do. Sort the old “go boil water, Dad!” scenario. They need to be careful though. They’ve had it happen that someone is hanging around looking like they want to be helpful, but they are really just there to make sure that the job got done and the victim dies- especially with gangs.

There is something called a Tactical Medic. This is someone who was trained as an EMT and trains with the sheriff or police though they do not do police work per se. And this job might be an interesting one about which to write. Especially in a situation that goes very, very wrong.

I hope you find this information helpful. Please let me know if you have any questions.
Enhanced by Zemanta