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    The Overhaul Principle
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Page Two

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"Keep them light until I listen to his chest a little better. We've got
to rule out traumatic chest injury." Gage told him.

Mike Stoker was ready with cold water and he stood close by for
the word to begin cooling measures by the time the three firemen
carried the boy over to all the medical gear and Chet's treatment tarp.

"Start with his legs, arms and abdomen only, Stoker. A very light wash.
We don't want to chill him too fast here." said Roy. "If you see him
start to shiver, stop immediately and get him snuggly wrapped up.
Keep an eye out for any active blood flow into your water. We haven't
checked him out very well yet for other injuries past these bruises and
that hand."

Mike Stoker began his bathing with just an inch wide trickle from
the end of the red hose's nozzle. "Got it." said the engineer
softly. "Is he resisting Chet's vents yet?" he asked DeSoto.
 
"No." said Roy with a worried frown. "We'll try to change that with
some I.V. epinephrine real soon. Craig.." he said, wiggling fingers
for the biophone receiver.

Brice handed it over and then got busy with Roy's stethoscope on
assessing the flushed red boy's lung sounds.

DeSoto never took his eyes off the boy while he spoke with Dr.
Early. "Rampart, this is Rescue 5-1."

-----------------------------------------------------------------------------------------------

Joe Early flicked the recording machine off pause and said, "Unit
calling in, please repeat."

##Rampart, this is Squad 51.##

"Go ahead on your pediatric suffocation victim, 51. I've been updated."

##Rampart we have a male approximately four to five years of age.
Unconscious and unresponsive, being ventilated on 100% O2. He's
markedly overheated with blunt force trauma in evidence. Looks like
a beating. I'll cover exactly what areas are involved after initial vital signs.
BP is 150/102, pulse is weak and rapid at 134, breaths unassisted, were
at eight and very irregular. Our victim is currently undergoing a cold water
washdown over his extremities and abdomen to allow us to start to get
a handle on a very high body temperature.##

"What is it, 51?"

##Stand by, Rampart. We've got to work around some spinal precautions to
ascertain that.##

"10-4. Let me know what you find. Has your victim shown any indication of prior
seizure activity?"

##None, Rampart. No signs of incontinence or unequal pupillary reaction
are apparent.##

"Ok, 51. Start him on an I.V. of..........


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***************************************************************
Date: Fri, 23 Sep 2005 13:25:04 -0700 (PDT)
From: "Jeff Seltun" <finiterider@yahoo.com>  
Subject:  The Saving Grace of Professionalism..


....Lactated Ringer's at TKO and another of 50% dextrose
in water. Protect his airway judiciously, 51. There's a strong possibility
of respiratory alkalosis developing from your active ventilations. They
might bring on secondary hypokalemia. Are there any signs of deep
tendon reflexes?## Joe asked.

Brice checked, running a blunt scissors point up both the boy's bare
feet. He also pinched the skin sharply behind both the boy's knees
while holding them bent and upright. Not one twitch manifested. Craig
shook his head.

DeSoto shared that news. "Negative, Rampart."

##Ok, go ahead and intubate him with an EOA. Sounds like he's already
largely in a coma from his exposure. What's his core temperature
reading?##

Johnny took out the thermometer probe from the child's rectum and
read it under penlight. "41."

"It's at 41c, doc." Roy told Dr. Early, biting his lower lip.

##Continue his cooling measures aggressively, 51. Halt all irrigation
when his body temperature reaches 39c and let it drop no lower.
I want an EKG as soon as possible. If he develops seizure activity,
use a benzodiazepine variant such as Ativan 0.1 mg/kg I.V.
If hypotension sets in refractory to cooling and initial fluid boluses, initiate
a Dopamine drip and titrate to maintain a systolic BP greater than 90 mmhg.
Once you've sent me a strip, continue monitoring vitals and maintain his
full 02 support. Bring him in as soon as possible.##

Roy confirmed his orders. "10-4, Rampart. Point one mg's Ativan I.V. on
posturing, a dopamine drip to raise any developing basement BP to 90,
and an EOA. Stand by for his EKG, lead two. I estimate our ETA at twelve
minutes."

##Standing by, 51.##

Johnny was way ahead of Joe Early. He already had the still child's
chest dried and patched in and it was only moments before he flicked on
the datascope monitor and linked it into the biophone.

Roy spoke once more into the phone. "Transmitting EKG, Rampart."

##10-4.##

Gage, Brice, DeSoto and Kelly all leaned into the screen to read its tachy
signature. Johnny let out a worried sigh. "Frequent PAC's and look at this.
Doctor Early called it right on the money. He's very low on electrolytes."

DeSoto picked up the receiver. "Rampart, we are reading marked
flat T waves with prolonged QTs and prominent U waves on a V tach of
140 with PAC's. There is possible evidence of Cor pulmonale manifestation."

##I concur, 51. Bolus in 100 cc's of that Lactated Ringer's. Most likely
the heat's damaged his lung tissue, causing atelectasis and that backup
into his right descending pulmonary artery. That's probably why we are
seeing a poor breathing effort and the Cor pulmonale. It is paramount, 51, if
he crashes, that you avoid using sodium bicarbonate on any defibrillation.
He's low enough on potassium or magnesium as it is.
Use Dobutamine 10 mcg/kg/min IV infusion for circulatory support with
your first stacking dose of epinephrine should any be needed.##

Roy re-outlined the doctor's treatment and plan if the boy
suffered a cardiac arrest. Then he added, "Rampart, we've examined
all exposed surface areas on our victim. He's got bruising of the left
orbit of his eye, right lateral ribcage, and on the skin over his right thigh
with no evidence of obvious fractures except for a midshaft bone break
on his left index finger. Also, we've found that he's slightly guarding the
lower left hand quadrant of his abdomen."

##Might be splenic involvement. I'll have a surgeon standing by.##


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"10-4, Rampart." Roy practically threw down the biophone into its case
in his eagerness to get the boy intubated and moving out.

Gage re-read the thermometer again, taking it from in between the boy's
frogged legs where he lay in his moistened shock sheets and he held up
his hand. "Ok, Stoker, that's good." he said, and he motioned for the
engineer to take away the cold water stream.

Roy took a small ambu bag from Chet's hand and fastened it to the
end of the boy's esophageal airway once he was through inserting it.
He gave it a few short squeezes while Craig checked the tube's placement.
"Ok, Chet. Take this over again." he said in a hoarse whisper.

Brice gave a curt nod. "It's positioned correctly, DeSoto. ...Ready?" he asked
Gage and the others who were bundling up the boy's sheets, I.V. tubing and
EKG monitor wires away from the pooled water running around his body.

He got all nods around the circle of quiet firefighters.

The heatstroked young boy's spine board was lifted and laid straight onto a
half height raised ambulance gurney, and soon, they started
on their way to the hospital.  Marco quickly followed behind them in the
rescue squad, adding his red lights and siren to the ambulance's.


The foreman sighed as Cap stepped away from the Cadillac ambulance doors
that he had just double slapped. "I hope he makes it, mister. Cause if he doesn't,
then Marty died for nothing and my losing my job over him will just be
another tragedy this company'll bear quietly in the private sector..."

Hank just stared at him, and displayed absolutely no sympathy.
"Your poor man didn't have to die at all today! Haven't you gotten that fact in
through that thick hard hat of yours yet?! This whole rescuing situation was
all ....completely... and utterly.....preventable!"

"I didn't put that car into the gravel pile! That stupid city gang did!" said
the foreman, defensive and trembling. "Why are you all looking at me like
I was the one who kicked that kid around?"

Scotty, rendered angrily mute, turned his back as he began talking to the
police officer newly arrived on scene.

Cap just jerked his head for the other firemen to pick up all the medical
waste wrappers, labels and needle covers without saying another word.

He headed off to give out a station's availability ETA to L.A. over the engine
cab's chatter filled radio and soon, they were free of the sad gravel works
company, ...forever.
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****************************************************************************
From :  crash200225 <crash200225@yahoo.com>
Sent :  Saturday, September 24, 2005 4:35 AM
Subject :  [EmergencyTheaterLive] Waiting


Marco backed the squad in next to the ambulance just as the boy was
being unloaded.  The intense look on both of the paramedics' faces
spoke volumes.  The child's condition must have deteriorated during
transport.  As he followed the gurney through the emergency room
outer doors, Marco heard the sound of distant thunder.  He turned
back to the squad and rolled up the windows.  There was no way of
knowing how long they would be there.

Not seeing Roy or Johnny in the hallway, Marco found a seat in the
nearly empty waiting room.  Having left his helmet in the squad, he
ran his hands through his hair, then over his face.  

The rescue had effected him more than the others knew.  His close
friend had died in an 'industrial accident' several months earlier.  
Though the circumstances were vastly different, the cause was the same.  
Incomplete training and stupidity on the part of the supervisor.  
He hadn't told his crewmates about it, not that they wouldn't
understand.  He knew his friends would try to console him, but he
didn't want that.  The rage he still felt drown out the sorrow that
would eventually surface.  He just wasn't ready to face it, not yet.
When he was, he knew they would all be there for him.

Closing his eyes, an image of the child came to Marco and his barely
controlled anger threatened to overwhelm him.  He thought about who
could do something so horrible to a little child, just a baby
really.   He took a deep breath and let his thoughts drift back to his
friend.  

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"Marco," Roy said for the third time, "Are you all right?"

He had become lost in his memories and had not heard Roy calling his
name.  "Yes, just tired.  How is the boy?"

"Dr. Early stabilized him.  He's on the way to surgery now.  Johnny is
getting supplies.  He won't be much longer."  Roy knew they were all
shaken by the rescue, but now was not the time to dwell on it.  It
was a kind of unwritten rule not to mention the bad runs for awhile
afterwards.  They would talk about it at some point, but not now.

Five minutes later, the three men were on the way back to the
station.  Johnny seemed to fall asleep before they had left the
ambulance bay, head against the window.  Marco was in the center seat
and asked Roy, "You sure he's not sick or something?  He's
usually 'Mr. Can't-Sit-Still'".

"He was okay in the ambulance and at Rampart.  Like he said, he's
bushed.  Nothing some sleep won't fix."  Roy answered with more
confidence than he felt.  He knew how his partner could be sometimes.

"What about Brice?  He went to check on Johnny and fell asleep
himself.  Maybe there is something going around."  Marco reminded him.

Roy thought about it for a few moments before saying, "I guess it
wouldn't hurt to check them both out when we get back."

Neither man saw the smirk on Johnny's face.  He hadn't quite gone to
sleep, but before he knew it, Marco was shaking him.  They had
returned to the station and Roy had the passenger door open.  He was
taking Johnny's pulse.

"Aw, Roy, Marco, leave me 'lone. Tired is all.  Lemme sleep."  he
grumbled.

Roy shook his head and sighed.  "We just thought you might want to
sleep in your bunk instead of the squad."

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"Huh?"  Johnny looked around before stumbling out of the squad and
straight to the sleeping quarters. He didn't bother to strip down to
his t-shirt and boxers.  He dove onto his bunk and, for the second
time that night, didn't remember his head hitting the pillow.    

**************************************************************************
From :  Roxy Dee <laterrapincabesa@hotmail.com>
Sent :  Saturday, September 24, 2005 8:57 PM
Subject :  The Haunted Chat~~


Johnny heard a motion in the darkness in the bunk room
where he lay. ::That's Cap. Is he restless!  And Marco's none
too relaxed either.:: Gage thought as he blinked sleepers
away.  His roving eyes studied the ceiling and flicked to
the window, which was still glowing street light blue.
::Dawn's nowhere near yet.::

The dark haired paramedic rolled over to eye his partner, Roy,
snoring lightly nearby on the next bunk over. Immediately, his
overlarge eyes spied an HT on standby lying on the table
between them ::Got you! :: Johnny grinned quietly.
::You finally went for the tired act Brice and I crafted hook line
and sinker if you have a radio in here with ya.::  

Trying not to laugh aloud, he glanced over to Brice's bulk on
the bed kitty corner from him next to Chet. Craig was quiet,
and his glasses were off. ::He must have continued the joke
after I "staggered" in here if Roy was concerned enough
to keep close communication cover in the bunk room after
checking up on me. Wish I had been awake when he
finally came in for me. Oh, well. Maybe Chet was
there watching him. I can get the play by play about what
happened during breakfast when it's light out.::

Contented with the progress of his mother hen fostering joke,
Gage flipped back over onto his back and closed his eyes
in a sigh and soon returned to a much needed slumber.

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------------------------------------------------------------------------------------
Ten minutes later, Captain Stanley flipped back his sheets,
pulled on his suspendered pants, and shuffled into the bathroom
on his boots. Hank was shocked to find that his face was covered
in a sheen of fine sweat in the mirror. Slowly, he realized that his
heart was still pounding in his chest. ::Why am I still mad? We're
well done with it!:: he thought about the dead man at the gravel
works. The nightmare from which he had just awakened was still
playing shadows of strong emotion behind his eyes.

A commotion made him quickly turn on a sink flow in a pretend
face wash to hide his damp skin.

It was Marco, just as unsleepy and concealing the fact that he
was actually disturbed. "Hey, Cap. Can't sleep?" Lopez asked him
as he startled at finding him up.

"Just thirsty I guess." Cap sighed, hiding the reason why his
sleep had been broken. "I'm headed into the kitchen for some warm
milk. Uh,... want me to fix ya some? Stoker told me we gotta finish
up that gallon before it goes bad on us tomorrow afternoon."

Instead of shaking his head, Marco nodded yes. "I think I need all
the comfort I can get after tonight's run." the hispanic firefighter finally
admitted.  

"Oh?"  Cap startled.
He rubbed a tightness in his chest that was coming oddly
with his boosted heartrate in a pretend scratch through his t-shirt.
"Wanna talk about it?"

Marco eyed him with a haunted look and his eyes flickered over
the hand Cap was using to grip his shirt's front in an attempt
to silence the hammering under his ribs. That grip, matched his
own, on his own shirt, that was trying to do the same thing. "Yeah.."
he said softly, meeting his eyes. "I ..think I need to, Cap... And...
I think you need to, too."

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Hank stopped drying his face in a towel with his free hand
and ended his charade of false calm. In a rush, whispering
confidentially, Cap let loose.  "Oh, it was awful, wasn't it?
I-I- I really think that I wanted to kill that foreman, Marco. With my
bare hands.  And I've never lost my cool on a rescue like that before.
Not ever. Not even half mentally! So why did I feel something like
that tonight? I still feel plenty angry about it now. And it's two
hours later!"

Marco surprised him by taking Hank's sudden deep admission in stride.
Lopez waved it away with a dismissive hand and a tiny smile.
He touched Cap's arm, and started leading him to the more private
space offered by the still warm kitchen and rec room. "Believe me,
I understand completely, Cap. I just lost a good friend a few weeks
ago due to circumstances alot like those that killed our park gravel
worker. I've been feeling a little trapped myself lately over him."

Captain Stanley's eyes radiated instant sympathy and caring. "I'm
so sorry, pal. Abou-- about him." he said as they both padded silently past
the quiescent engine and squad in the bay and then through the kitchen's
swing door.

"It's ok. I....think I'll get over it. Only I haven't figured out how yet."
Marco said, looking shell shocked and vaguely numb as they both
moved over towards the refrigerator and the stove after squinting
painfully when the autolights came on.

"Think we should call a CISM counselor for a late night session?" Hank
asked frankly, opening up uncharacteristically to his troubled coworker.
"I know it's been a while since we as a shift, have called for one."

"Nah, having a shrink come to the station would only wake the others.
And embarrass us further after they nose around a little
for the reason why. Maybe we could...just have it out just between
the two of us, and see if that'll do any good before we try anything
drastic enough like calling for one of them." he said, mincing a salt
shaker around pointlessly on the eating table.

Captain Stanley blinked, his back still to Marco, as he got
out two empty glasses for their drinks. Hank coughed, trying to
relieve the tightness he still felt in his jaw. The nausea which always
came with any stress he dealt with began to rise and it finally made
him speak as he busied himself with the crumpled milk carton marked
"Use Now." and a sauce pan over a low gas flame on the stove. So he
finally gushed, wide open.

Cap turned around, met Marco eye to eye, and opened his mouth.
"Oh, man. I was completely stunned over feeling the way I did in
front of that foreman. Blind rage, rising grief. A whole gauntlet of
emotions. I- I didn't actually know what to do with myself after we
found out that our first victim had been killed because of sheer lame
brained stupidity and total inaction. I've seen people die for
dumb reasons in the past as a captain, but nothing like--" he choked
off, slamming down a lump that threatened to make his eyes water.

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"This was simply the last straw for you, Cap, and very nearly mine."
Lopez said very quietly. Tears flowed unabashed down his face
as he drank the heated milk Hank finally handed out to him.
"And we've got to figure how get it all out somehow, before it
makes us both too hobbled to work well enough to save those
we can still do something about."

Cap found he couldn't release his grief. Not yet. Not even
a half an hour later when Marco and he finally returned back to
the sanctity of their beds and the warm roughness of their beige
woolen blankets.

Trying to ignore the weight of stress still bearing down heavily
on his chest, Cap let go of himself into an unrestful sleep.

In the blackness across the room, Craig Brice watched them both,
thoughtfully analytical and soon, privately worried.

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****************************************************************************
From: "Monster Moofie" <monstermoof4me@comcast.net>
Date: Sat Sep 24, 2005  7:01 pm
Subject: Monday morning breakfast


Meanwhile, back at Rampart the night shift had just
ended. Dixie had called Kel Sunday night and made arrangements
for him to come meet her and Joe for breakfast. Dix hurried and
changed out of her uniform and met Joe at the front desk.

Waving to Mike Morton, Joe and Dix headed out and drove to the
diner.

Having enjoyed a peaceful night, Kel waved to them with a smile. He
held up the pot of coffee as they approached. "I secured sustenance
for you two!" he said with a grin. "How did the night shift go?"

Joe sighed happily as he grabbed the cup of coffee Kel poured
him. "It was fairly uneventful for once. 51's brought in a kid
who had been found trapped in a gravel quarry. He was in pretty
rough shape when they brought him in but it looks like he will be
fine."

"I had a few minutes to talk with Johnny Gage while he was gathering
supplies following the rescue. Would you believe they have added
Craig Brice to 51's A shift?" Dixie queried Kel.

"You're kidding me, Dix!" Kel said in disbelief.

"Nope, she sure isn't, Kel." Joe responded.

Dixie hurried to explain further, "The really funny thing is that
apparently the rest of the guys, including Roy, tried to pull a joke
on Johnny and Craig. Johnny told me he was feeling the change of
season and just in a sleepy mood so he went to bed early last night
instead of staying up for movies and popcorn. The rest of the guys
sent Brice in after midnight to check on Johnny. Once he realized
what was going on, Johnny convinced Brice to set up a joke on the
guys by crawling in Chet's bed and joining Johnny in slumber.
Unfortunately, they got the call out before it worked."

Kel laughed hearing the firehouse antics. "Johnny and Brice joining
together to pull a joke?! That is certainly funny! It was hard
enough when we saw Brice working with DeSoto when Johnny was out
because of the hit and run. I have a hard time imagining Brice and
Gage working together, let alone planning something together! Those
two are like a cat and its prey."


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    The Overhaul Principle
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