With the Catlett (Va.) Volunteer Fire Rescue crew turned in for the night, I began to feel ill as I headed to the restroom. Shortly after, the unthinkable happened. I crashed to the floor—not once but twice—and was bleeding profusely from the head.
The occurrence was a combination of a medical, cardiac and trauma incident. I began to feel the room spin as I exited the restroom, and the next thing I knew I was on the floor bleeding abundantly with a laceration over my right eye. I attempted to crawl into the hallway and made it to the bunkroom of my partner, Fauquier County (Va.) Department of Fire Rescue and Emergency Management firefighter EMT-enhanced Cory Butler.
But as I attempted to stand, open his door and call for help, I blacked out a second time. Something struck my occiput as I fell and created a large hematoma with major bleeding.
The crew, now awake, was suddenly confronted with the need to treat its lieutenant as a patient—a patient with a complex injury and unknown illness. To make matters worse, my profuse bleeding had caused the area from the restroom through the hallway to look like a crime scene.
“I first thought someone had entered the station and assaulted the lieutenant,” recalled Engine Captain Jonathan Moore. “The noise when his head hit the ground woke me from a dead sleep.”
The confusion and lack of a clear understanding of what happened was stressful for the crew members. Butler said, “I had limited time to react, having been woken from a sound sleep to be presented with my partner lying in a pool of blood.”
EMT Natalie Vanbuskirk awoke and, like the other members of the crew, jumped into action. She attempted to gather as much information as possible about what had caused this incident.
The crew obtained my vitals: blood pressure was 114/62 with a pulse of 67 beats per minute, respirations of 16, a pulse oximeter reading of 99% at room air and a blood glucose level at 93. Further evaluation found three issues: gastritis, vasovagal cardiac response and trauma to the forehead and occiput. There was also an arterial bleed that caused an 8–10 cm hematoma growing from the occiput.
Looking at the vitals, the crew thought I was stable—but I was anything but. The complexity of my multisystem injuries made it even more difficult to decide on a mode of transport or method of treatment.
Because our station is located in a rural area, the first decision we need to make in a complex incident is the need for air medical support. For my colleagues, this was an extra-stressful judgment because of who their patient was.
Butler told me after, “I thought of calling for air medical transport to a trauma center, but I was concerned about what you would say.”
This is a stressor that needs to be placed aside; treat a colleague how you would any other patient and use the proper resources regardless of what you think he or she will think of your decisions.
My colleagues decided I was stable enough to be treated at the Fauquier ED, so they called communications to dispatch a medic unit to meet Catlett Ambulance 7 en route.
As the crew rapidly began treatment, I was adamant I not be placed on a backboard because I know how uncomfortable they are and was already in enough discomfort. Plus, with the absence of cervical pain and upper back pain, it was unnecessary.
My demand, however, placed the crew under additional stress—they’re used to having a cooperative patient who doesn’t argue with protocols.
Looking back at the way I acted reminded me of a time when I was the one treating a colleague, and why treating one of our own can be difficult.
I was with a fellow firefighter who had returned to the station after completing his physical. He told the shift captain he wasn’t feeling well but attributed this feeling to not eating since the night before. The captain asked me to check him out since the firefighter wanted to go home. I checked his vitals and his cardiac rhythm—this was before we had 12-lead ECG in the field.
Even though all his signs told me he wasn’t OK—elevated blood pressure, upper abdominal pain and cold sweats—I allowed him to assure me he was. He went home, lay down in bed and was found dead by his wife that evening. Thirty two years later I still feel the pain of losing him and will never know if things could’ve been different.
It’s important to trust your instincts and not let a sick or injured colleague sway your decisions. I should’ve been placed in C-spine precautions because when the idea of using a cervical collar was mentioned again, I raised my head and moved it side to side to show I had no neck pain. This movement caused blood to spurt from my head wound across the stretcher and onto the floor. Lieutenant Jeff Bates mentioned the bleeding, and I could hear the stress in his voice as his tone changed from “everything is fine” to “this isn’t good.”
My level of consciousness was still alert and I was able to answer questions, but I was still experiencing short periods of confusion. There was nausea, fecal urgency and abdominal pain. When the gastric cramping increased the vasovagal reaction was intense.
Upon ED arrival my crew had ruled out a cerebral bleed and an aortic aneurysm. The bleeding was controlled and a CT scan was completed with negative results. My vasovagal response in the ED caused my blood pressure to drop to 70/44, pulse to 40 and respirations to 18. It’s believed the abdominal pain and cramping early in the incident caused the cardiac reaction. At this time the hematoma was 12–14 cm.
My hospital stay was three days, but the most stressful day for my crew members was the first, when they realized how serious and complex my injuries were.
The ED had a lot of patients the morning of my arrival, and this caused my battalion chief to suggest transporting me to a trauma center. He and the other crew members were especially worried and stressed because they’d seen other patients in similar condition not survive. They managed anxiety by talking among themselves and providing support for each other. This is a stress-coping mechanism first responders practice every day, and is a great way to relieve some feelings of anxiety.
The complex injuries suffered by the lieutenant created an extra level of stress for his own attending responders. Photos Kenneth Johnson, Jr.
My colleagues were particularly stressed about their transport decision. When they saw in the ED how serious my condition was, some felt they should’ve decided to use the air medical helicopter—their best resource wasn’t used when one of their own was in need.
It’s impossible to predict patient outcome with certainty, and the decision to transport to the local ED is done every day. Incidents like this shouldn’t be dwelled upon. However, when dealing with a colleague, don’t shy away from using resources just because you think it might be overdoing it.
This particular incident placed my crew in a difficult position, but it’s provided my organization with a basis for change in our policies about sick or injured team members.
As with all facets in the fire service, change is often slow and difficult, but we need to reassess the way we take care of our own. Many departments have a burn protocol that mandates all burns, no matter how small, get seen at the closest burn center. We need to look at this protocol for all illnesses and injuries so we provide the best appropriate care for our own.
We all want to provide the best possible care to each other because we’re part of a family. If the outcome is negative and there was something that could’ve been done better or differently, it’s going to have a lasting effect on your organization.
This event had a positive outcome, but organizations need to be prepared for the possibility of negative outcomes. Is there critical incident stress management in place in your service? Is there an active employee assistance program (EAP)? The first time you hear about EAP shouldn’t be in a crisis. Organizations should have exposure and training prior to needing these programs.