The Ramblings of a Quixotic Dad, Firefighter, EMT, and God-knows-what-else…

Heavy Musings

A Note on the Fire-based EMS Debate

I am, first and foremost, a firefighter. That is the career I have chosen.

But I am also an EMT with advanced training, working on finishing my EMT-Paramedic.

My department required me to have a Basic certification to be eligible for hire. But that is all.

No one forced me to advance my medical certifications. I have done that of my own accord and mostly at my own expense.

That being said, I could care less whether fire runs EMS or EMS is a third agency. That’s above my paygrade and beyond my scope. The people I work with in EMS are fine, dedicated people. I am proud to work alongside them, regardless of whose name is painted on the outside of the ambulance.

But what irritates me is when people say that Fire-EMS is just the Fire Department trying to justify their existence by trying to do someone else’s job.

That’s like saying that the 343 firefighters who sacrificed everything on 9-11 were only justified because FDNY also runs medicals.

I know it’s more complicated than that (I think FDNY took over EMS in 2005, but that’s not the point), but yet it is also that simple.

“I can think of no more stirring symbol of man’s humanity to man than a fire engine.”

Kurt Vonnegut was a firefighter. He is also a fire survivor rescued by firemen. At a tribute for our fallen brothers and sisters, he recited the names of all of the firefighters who were killed from the station he was saved by.

Firefighters are not heroes by default, and fire calls are down. I will give you that.

But go home. Look around. Look at the things and the people you love.

Now imagine that all burning to the ground.

I have worked in a burn center. I have seen what flame can do and I have felt its heat kiss my flesh.

George Orwell is attributed (perhaps incorrectly) with saying “People sleep peaceably in their beds at night only because rough men stand ready to do violence on their behalf.”

Maybe we can sleep peacefully because someone stands ready to rush into harms way, regardless of their career (Fire, EMS, law enforcement, military, etc) and who needs their help.

They hear the call, and they answer.

That, to me, is justification.


Writing for the Dead

It was a saying he seemed to like, though he couldn’t resist modifying it.

“Write.” – “For whom?” – “Write for the dead, for those in the past whom you love.” – “Will they read me?” – “Yes, for they come back as posterity.”

I’m not a Kirkegaard expert, so there won’t be any brilliant literary analysis or some  moment of existential clarity. If you want that, you’d have to talk my wife, Dr. KindofAFireWife. She’s the English expert. I just love the quote.

It makes me think of Bringing Out the Dead  by Joe Connelly. In his book (and in the film adaptation), a burned out paramedic in New York reflects on his role as a provider. He has stopped seeing himself as anything beyond an intruder on the end of the people he is sent to help. Indeed, as he performs CPR on an elderly man surrounded by his family, the medic decides that his purpose is now solely to bear witness to the lives of those he responds to.

It’s a great book that shows the dark side of EMS through powerful satire. And let’s be honest: there is a dark side to this job. There has to be. We witness terrible things in dark places. We often share in the worst moments of the lives of those we help. Anyone who says otherwise is either ignorant or lying.

Maybe that’s the real reason I’m typing this. Maybe I want someone to know I was here. Maybe I want to let out the darkness so that it doesn’t follow me wherever I go. Maybe this is my 911 call.

Maybe I just want someone to bear witness to me.

Kirkegaard wasn’t satisfied with the saying the way it was.

“Write.” – “For whom?” – “Write for the dead, for those in the past whom you love.” – “Will they read me?” – “No!”

That’s a bit more damning.

Hell, maybe I’m a little damned, too.


Respice post te! Hominem te esse memento! Memento mori!

It may be just a legend. No one is really sure.

Picture this: The streets are full today. Plebeians and senators, soldiers and scholars; all are there. The delineations between classes are not as apparent today as they usually are.

Over the roar of the crowd, you catch the slightest echo of something. You strain harder to hear it, and there it is again, only louder. Horns. The deep, throaty rumble of horns. The clap of iron sandals on stone. The harsh crack of drums. As the noise grows, the shouts and yells of the crowd slowly meld together into a colossal cheer.

Then you see him.

He rides in a chariot pulled by white horses. His armor is draped with the skins of leopards and the deep purple of royal robes. On his brow sits a laurel crown, the gold leaf glinting in the sun. Behold, the victorious general, returned to Rome and honored for the glory he has brought it.

But it is not the general who catches your eye. It is the lowly slave behind him, the one who almost seems to disappear in the general’s splendor. You can see him whisper into the victor’s ear, but you can not hear over the cheer of the crowd.

Respice post te! Hominem te esse memento! Memento mori!”

“Look behind you! Remember that you are but a man! Remember that you shall die!”

Maybe it’s true. Who knows. The Romans didn’t always keep the most accurate histories. It’s been argued that the story of the servant is more a moral reminder than a literal history.  Perhaps it was meant to serve as a warning to the rivals of Caesar – remember that while you are the victor today, you may fall tomorrow, especially if Caesar wills it.

Remember, thou art mortal.

I’m rambling again. It’s what I do. But this is the story that came to mind this morning as I sat at work. While I was roved out to another station, my regular engine crew ran a cardiac arrest today. I honestly don’t know the specifics, but it wouldn’t matter if I did. They rarely differ. This one did slightly, as resuscitation was ceased on scene. We often ride in, still performing compressions. Not today. No need.

In a recent med refresher course in which they stressed the importance of quality compressions and minimized interruptions (because we didn’t know that already, apparently), they pointed out an interesting fact. I don’t recall the doctor’s name, or what his title was, but I do recall that he was a major player in resuscitation research. One of his key points is that the success of a cardiac arrest resuscitation is almost always determined on scene. If they don’t regain pulses before we put them in the ambulance, they probably won’t get them back at all.

When I first got into EMS, I had to take my CPR class just like everyone else. I was lucky. I had a burned out, retired medic as my instructor, and there were only two of us in the class.

She didn’t sugarcoat it. She told us the things they don’t typically tell you about CPR.

She told us that we would save less than 8% of our cardiac arrest patients. She told us that we would break ribs. She told us we would stare into open, empty eyes while families screamed at us, and that we would begin to feel remorse for working most. I’m glad she prepared me for that.

That’s not to say that I’ve lost my compassion. Far from it. If anything, the calls that haunt me the most aren’t the bloody traumas or massive AMI’s. No, for me, it’s the wife hugging her son in the corner, crying into his shoulder as we pump on the cracking chest of her husband of 50 years. It’s the tears in the crystal blue eyes of a 50 year old man as we tell him not to be scared while we hand squeeze saline bags to try and force fluid into him and to force his pressure above 70. It’s his quiet whisper of “I’m not scared,” while the monitor shows a massive heart attack that has pushed him into cardiogenic shock, and that will ultimately take his life in the next two hours.

What we do is important. CPR is important, and it saves lives. But the ones we don’t save slip in line behind us as make our triumphal entry through the sliding ambulance bay doors with the patient we just snatched from the jaws of death, whispering in our ears:

Respice post te! Hominem te esse memento! Memento mori!”