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    The Overhaul Principle
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Page Four

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From: Katherine Bird <>
Date: Thu Sep 29, 2005  9:33 pm
Subject: The Black, the White... and a whole lotta Red...

"Dixie!"  Gage called out as soon as Roy and he had spotted her
through the frightened hospital visitors and the hurrying medical
staff directing them. They headed for her.

Brice, decided on a more practical approach. "Johnny, I'm going
to go find a police officer for a report. We can't move around
if it's not safe..."

Johnny spun, high in adrenalin, and spoke up. "You do that. Let
us know that aspect via HT. We'll go find out the medical needs end
of it."

Craig nodded and departed for the front entrance of the hospital
and the receptionist, who would be the first person to notice the
presence of any police officers who began a storm inside.

Roy noticed the blood splattered on Dixie's navy colored nursing
sweater. "Are many people getting injured by this shooter?"

"Yeah, good question. Where is he?" Gage asked angrily, repositioning
the air bottle and its dangling mask a little more tightly around his waist
by the straps.

"Fifth floor south, and not just one gunman, but two. And they know each other.
Roy, there's only one shooting victim who fell out of a stairwell and
a nurse concussed when she got in the way of someone leaving in a hurry."

"Ok, we'll start sweeping for other injured in the stairwells once the police
have cleared the way ahead for us." Johnny told her. He blinked when he
noticed the bright orange vest that Dixie now wore that had Triage Commander
stamped in black across her breast pocket and in bold print on the back.
He radioed out to Incident Command. "Squad 51 to Battalion One.
Head of triage reports only two casualties so far. She has a radio.." he said, giving
her a spare from his jacket pocket. "My partners and I will give further details as
soon as we know them. Our captain has our incident tags on his clipboard. We will
be heading to the fifth floor, south wing when we are well under police protection.."
he told him.

## Battalion One, Squad 51. 10-4. I'll have all pumpers and laddertrucks
standing by. I'm sending in your captain to relay to us through you during
your sweeps. Keep us fully advised on any possible developing fire
situations or other potential life risks.##

Image of dixroyhttakingcall.jpg Image of batallionnineclosegood.jpg

"Squad 51, Battalion One. We will advise." Roy answered their district chief.

Dixie  grabbed the sleeve of his turnout. "No one's heard from Joe Early
since all of this began. He was last seen in the south wing. Kel's gone up
after him."

"Stupid!" Johnny muttered. "And he's the one who taught the two of us
about considering a scene's safety first."

"Johnny..Joe's his best friend. And mine. Assign blame when this is all over.
In the mean time, we've a h*ll of a lot of people needing guidance before
they go panicking further. It's partially up to us to make sure they don't
go hurting themselves trying to get out of here." Dixie changed her ribbing
tone and said. "I've activated triage protocols hospital wide." she said,
patting the kit sitting on the desk in front of her. "Using the system."

"The chief's already authorized us to use ours.." Roy said. "Ahead of
time. We knew to bring ours along the moment a large building full of
people was implicated."

A clatter of leather shoes on tiles ended the conversation. Six police officers
with their guns drawn ran into the ER for the elevator lobby and the two stairwell
hubs following Craig Brice, who was acting as their guide.

Dixie recognized two officers. They came up to the desk. "We're your scouts,
firemen. Stay behind us until we say the coast's clear." said the fair haired
one firmly. Then he smiled. "Hi Dixie.." said Pete Malloy. "Who ticked off
a patient this time? Dietary? Or the billing department?" he joked.

Jim Reed, Pete's squad car partner, gave a quiet nod and started ordering
the public away from the stairwell and elevator lobbies to give them room
to enter. "Pete! I'll take two of these firemen, and you take the other pair."
he said, carefully keeping his loaded gun pointed up at the ceiling.

The paramedics looked around and saw that Cap was quickly
jogging his way over to them from the crowded entryway.

Malloy motioned Brice and Johnny to go with his solo search.
"Our other four officers are going for the roof, west and east stairwells,
and the basement level to see if we can either negotiate with these two
characters or take them out."

Dixie took a deep breath in sharply, but she knew that lethal force
was in the picture. ::That's ever since Ned ended up with a bullet in his

"What are their names?" Reed asked Dixie, ready to commit anything
to memory.

"Philomena and Georgio Stephan." she said, checking a chart with fingers
that were already starting to shake, not something she usually suffered from,
no matter how hairy her department became during a work shift.

Gage reached over and squeezed her hand. "It's ok. We'll get him down, and
in one piece, too." he said, nodding at Malloy's hand gesture to begin
following behind him for the trip up the stairs. "And that goes for Joe, too."
he promised, heading up the stairwell after Pete but before Craig.
Brice pulled the landing door shut behind them with a snick.

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A second echo of the same sound repeated a few seconds later over
the loud evacuation babble, when Officer Jim Reed, the junior most half
of Adam-12's patrol team, took Roy and Captain Stanley with him,
doing the same search casing, in the opposite stairwell.

Dixie guessed that it would take them less than three minutes to reach
Dr. Morton's level, even stealth checking around every corner with a muzzle
of answering fire power pointing the way ahead first.

Dixie jumped when the nursing student returned and tapped her lightly
on the shoulder. "Here, Dixie. I thought you'd might like to clean up a little."
said Karen giving her a small bowl half filled with warm water and a
green bottle of Phisoderm and along with another surgical towel.
"Oh, sorry. I didn't mean to startle you."

"It's ok. Today's the kind of day that'll make anyone jumpy. Including me."

"But you're so... experienced, Miss McCall.. I thought..."

"Well, you thought wrong. I may be wearing these collar insignias but
I'm still human and can still feel everything happening around me just
as acutely as you can." Dixie told her, a little harshly. Then it was her
turn to apologize. "Sorry right back. I don't need to vent just yet. The fact
that I just did's freaking me out a little. How's Ned doing?"

"Dr. Theilen says that the bullet missed the descending aorta and only
lodged in a section of his large intestine without damaging the liver
or bladder. He's earmarked for surgery and he's very stable.
A surgical resident's monitoring him while we wait for an outcome
in case he needs to be moved from three for someone more critical."
said Karen.

"Good girl. Now how about pouring us a round of coffee?" Dixie smiled,
fingering the hand held radio that she had craftily turned to Squad 51's
band. Know-how told her that she could always flip back to the main
incident channel if a battalion chief wanted to speak with her by listening
to the scanner that was still on behind her for their hail. Right now, she
wanted nothing better than to be able to see through four hospital floors
to the nightmare drama probably unfolding over all their heads.

"Can we even think about drinking these during a time like this?"
she said, pouring two cups from a well heated coffee pot.

"Sure, why not?" Dixie asked. "I'm afraid this whole mess will be with us
for a long while before it's finally over. It'll do our patients no good if
we get overtired and exhausted for not eating or hydrating properly
like we have to do anyway. Just think about it, if we get out of
commission, then who'll be left to help all of them?" she asked, throwing
a chin out at those moving by the desk for the exits.

The very young student nurse, Karen, smiled nervously. "That makes
a whole lot of sense, Dixie. I- I'm sorry I questioned you."

"Go right on asking questions, Karen. After all, I'm still one of
the senior preceptors for you, even though I'm now wearing this
triage vest."

"Speaking of that.. why aren't the top end fire chiefs in here inside
the hospital, coordinating efforts to solve our alarm and evacuation
problems?" she asked.

Dixie sat down on her desk stool, dragging the radio, ivory and black phones
a little closer to her.  She invited Karen to take the one next to her from its
storing place underneath the pharmaceutical cabinet.
"Well, because in this case, a paramedic outranks any senior ranked fire
chief wearing a white helmet. You see, when the first units arrive at a
multi-casualty incident, they are certainly going to be overwhelmed.
Just look around you." Dixie said casting a hand at the ambulance doors
where a confusion of fire fighters, police officers and reporters, milled about.

"There is a temptation to set up the management levels of the
organization first, so the operational levels will have supervision when
they are assigned.  Like what you thought, on their current absence
in the building.  

"If they wanted to do this, most organizations have to use personnel
from the first or second wave of responding stations. This removes
them from the triage / transportation / treatment provider role, creating
a delay in getting patients to primary care. After 10 to 20 minutes, it would
be a sad sight to see many rescuers in ICS vests, setting up their operations
and no one attending to the victims.  

"Remember that it is not necessary to assign mid-management
positions until the maximum span of control is exceeded. An incident
commander like me in an ER triage role, can easily handle 5 to 7
direct reporting positions before an Operations Chief or medical group
supervisor from upstairs or outside, is needed. Assigning your first
arriving operational units to hands-on functions as much as possible
will speed up your ability to triage, transport and treat your patients.
That is why Johnny, Roy, Craig and only one fire captain, Hank, was
sent inside to rendevous with us."

The young nurse to be just frowned, biting her lip.

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Dixie smiled and closed the young woman's hand around her untouched
coffee cup.  "Karen, if you think about the things that need to be done
before you can transport a patient, it becomes clear where you need to
assign your initial resources.  Here's the most critical mantra of triage.
Learn it, because Dr. Brackett will expect you to know this better than
you know CPR...

      "Before you can send a patient to a hospital, you must have an
       ambulance available and get a destination from an area coordinator.

     " Before you can get a destination, you need to know how many of what
       category of patients are loaded in the ambulance.

     " Before you can identify what category a patient is in, they must be
       tagged and carried to the ambulance loading area.

      "Before they can be tagged, they must be triaged...."

Karen's eyes got a little wider. "And no one is better trained to triage
already,.. than a..."

"...a paramedic." Dixie said with a little bow of her head in a knowing grin.
"That's right. They're better than doctors. In that respect. They won't
get tripped up on diagnoses when sorting out any sick or injured. They stick with
just the basics on determining survivability and nothing more. Now let
me tell you how our triage system works now. This is a new system our
administrators just accepted from the fire department.. That is why those
condition orange lights are flashing over all our work stations. Ready?"

Karen nodded her head.


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Pete Malloy hit the top stair and dropped onto his stomach after
turning the knob ajar on the stairway door above him. He glanced down
to make sure that Brice and Johnny were well below him by two full landing
turns, before he cracked the door open with his night stick.

The door swung open with a creak onto a pitch black fifth floor to his
great dismay and chagrin, absolutely nobody appeared to be around.

Malloy squinted in the dimness, eyes casting around for the
nurse's station, where the hospital operator had said that four staff
members and one injured nurse were trapped behind.

From: Patti or Jeff or Cassidy <>
Date: Fri Sep 30, 2005  9:46 pm
Subject: Endgame..

The Los Angeles County police officer risked
speaking softly. "Hey..." he stage whispered. "You
behind the desk. Where are they?"

He heard the sound of a woman's muffled moan and
that made him duck his head even lower against
the floor between the frame and the door.

"He's down the north wing. We think by the surgical
store closet." came back another whisper. Pete Malloy
saw the glint of glasses in the dark reflecting the bright
light of the stairwell. It was Dr. Morton.

Pete put the safety back on his handgun, and belly
crawled to the desk and then, he, too, took cover
beneath its high edge. "You put the lights out?"

"Yeah, figured we'd make less visible targets."

"That was smart thinking."

Another moan made Malloy look down and the policeman
saw a penlight briefly turn on in someone's hand that
illuminated the face of a dazed nurse. "How is she?"

"She'll be okay. Hit her head when Stephan decided
that he had had enough of his expensive hospital stay."
Mike whispered, still cradling her head in his lap with a
few fingers monitoring Carol Evan's neck pulse. "I don't
know where his wife is. This surgical tech swears up
and down that she hasn't left the room yet."

The young man huddled next to the african american
doctor nodded, vigorously. "One of our doctors may
still be in there. No one's seen him since the first shots
were fired." he fretted, keeping his voice low.

Pete set his lips in a thin line, holstering his gun for
the moment. "First things first. We should get this
nurse and all of you, out of danger. Can we move her?"

"Yeah, her back and neck weren't injured..." declared
the tech, while Morton worked to soothe Carol into
keeping quiet.

Pete pulled his hand held radio off his belt and turned the
volume way down. "744 to Squad 51. The coast's clear
so far. Beeline only from the stairwell straight to
the desk. Eat the floor coming over so you're not
spotted. Tell your firefighters friends that we need some
way to get an adult female who can't walk down the
stairwell. She's breathing and semi-conscious. I'll watch
your back while the two of you get this nurse and the
other staff here to safety."

Morton grinned when he recognized Gage's voice
over the handy talkie. ##Already got that covered with
a stokes. Here we come....##

"Anyone else up here with us?" Malloy asked the
frightened hospital workers.

Morton shook his head. "They all got out except for
our missing doctor."

"Ok, we'll look for him next." Pete promised.

Pete saw Brice briefly stand to unscrew the light bulb
inside the stairwell on their level so that they could
open the door without being exposed by back lighting.

Then he saw Gage prop open the door with a jacket halligan.

The two paramedics softly stomach dragged their bare
stokes across the open space of the dim hallway between
them, taking care not to rattle the straps inside the
chicken wire mesh. They quickly got under the cover of the
nurses' station and the eerie condition orange beacon
flashing there and they drew their legs up protectively
to their chins.

Pete motioned ahead of them. "Wait to get them outta
here until I give the high sign. I'm gonna make sure our
friends out there don't get any more bright ideas about
shooting anyone else."

"How's Ned, the orderly?" Mike asked.

"He's still alive last I heard." Malloy told Morton. "Ok, hold
fast until you hear me tap my nightstick on the floor."

Morton and the others nodded.

Pete turned and spoke once more into his radio on the quietest
volume. "744 to 2430.."

##Reed here.##

"I'm making my move from the nurses' station, headed your
way, on the north side of the wall along the bottom. Firemen
behind me will be getting the desk nurse and medical staff outta
here down the same stairwell I came up in. Then Brice and Gage
are gonna take cover back behind the desk..."

##10-4. I'll cover you. Any sign of those other doctors or the two
suspects?## asked Jim, Pete's partner.

"No, 'fraid not..." Malloy sighed. "Here I come.."  

##Go.. I see you now.##

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Brice and Gage froze in place with their fire gloves on Carol to
keep watch over her while Pete scrambled over to the cover
of a tipped over gurney and then further down towards the
south wing at the crossing intersection of the two fifth floor

They held their breaths and Johnny tried to shush Evans
in her half state with a hand over her mouth while they tried
to keep an ear out for Malloy's sharp signal.

From what seemed like an eternity later, came three taps
and the flash of dull blue metal of Pete's shotgun as he
redrew it and pointed it towards the deeper shadows of
the south wing.

"Ok..that's us. All right. Ready?...I got her shoulders,
Craig..." whispered Johnny as he and Brice and Morton
lifted Carol up and placed her into the stokes basket
on the floor. Then they began the slow process of dragging
her stretcher across the tiles, keeping on both of their
stomachs. Fortunately, the waxed linoleum made it
relatively easy for them.

A minute later, and Carol was firmly in the hands of a
series of firefighters in the stairwell, being passed down
hand to hand as she was conducted to Emergency
as fast as they could move her out of danger.

Gage reluctantly let her go. Brice got his attention
with a tap on the shoulder as the rest of the fifth floor
staff passed by him.

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"Be careful you two. Here." said Dr. Morton, shoving a
small airways and emergency kit into the paramedics
arms. "For when you find him.." Mike said about Joe Early.
"And Kel's being stupid, too. He's somewhere up there
trying to find Joe."

"We know.." said Johnny unhappily. "Dixie told us.
We'll find em. After all, we are experts on search and
rescue, remember?" Gage whispered sarcastically.

That only made Morton grin as he disappeared
down the stairs. Then the doctor's face was all business
as he once again got ready to focus on Carol Evans'
well being and care.

The false bravado Johnny put on for Morton's benefit washed
away in a wave of nervousness that made him jittery. He
ducked back down to the floor imitating Brice for their trip
back to the nurses' station. "When I joined the department
and said I wanted some excitement, I didn't mean this
particular kind of 'fire' fighting." he complained to dump
a little stress.

"That's what the men in blue are for, Johnny. To run us some
interference so we don't have to worry about it." Craig smiled
back."...much." he added. "Officer Malloy wouldn't have told us
to stay in a place that he felt wasn't safe. As long as we remain
here, nothing'll happen to us."

"We hope.." Gage mumbled.

A flash of gold white light and the thunderous barrage of two fired
shots in close quarters startled the firemen, who kissed the ground
underneath the counter. The echoing violent whines died away
into a frightening silence.

Swallowing around his dry throat, Brice lifted his radio to his ear
for word of an outcome. No voices came out of it.

Johnny stayed Craig's hand when he wanted to speak aloud to
the two officers on the band with them. Gage put a finger to
his lips, listening to an area just ahead of the desk.

A man in white, vivid enough to see, stumbled barefoot down the hall
in front of them, trailing a torn I.V. line. It was Mr. Stephan! And the
shadow Brice and Johnny could see coming from him,
showed the outline of a small revolver clearly..

Johnny's breath whistled loudly in his throat as numbing near panic
almost crippled him. But the two firefighters didn't move a muscle,
instinctively locked into a freeze.

Grunting in anger, Mr. Stephan staggered past the desk and down
the stairwell propped open by Johnny's jacket tool.

Brice didn't wait. He got on the radio. "He just went past us down
our stairwell!" he whispered sharply.

##Understood. Reed's gonna follow! Hang tight. And get ready
for the lights to come back on. We're gonna start evening the odds!##

The whole floor re-illuminated in a hum of power, right down to the
ringing telephones.

Brice reached up over the counter, and yanked them, one by one
off their receivers with fast tosses to re-silence them for the two
policemen still deep in their hunt for the Stephans. Jim Reed
ran by in a duck as he began his careful chase after Georgio.
"It's safe up to Room 601. Let Malloy check out 602 before you
search down the hall any farther than that first room!"

The two paramedics nodded, still staring at the ceiling
pointed gun in Reed's hands.

Johnny managed a little bravery. "Were those shots yours or

"Theirs.." Jim grinned craftily. "We wouldn't have missed."

And then he was gone, leaving the two paramedics alone
and huddled on the floor in each other's arms.

Slowly, Brice and Gage unfolded to begin searching for
Brackett and Early within the area Reed told them to.


Dixie was still doing a fine job keeping Karen, the student nurse,
calm. "Managing a scene with multiple patients can be
frustrating and difficult. There are just a few steps needed that
will help you systematically triage and treat each patient. Now I'm
sure you're familiar with the red tags, those suffering from life threatening
conditions that might die if not treated as soon as possible. Well, there
are two other colors, yellow/delayed, and green/minor..."

Karen began to shift uncomfortably on her seat.

Dixie immediately soothed her.
"It is important to recognize that you are not abandoning patients by
assigning them the Delayed or Minor category tags. Remember
that they will be directed to the rescuers that have been assigned to
handle those kinds of patients.  They will also continually monitor
all the yellows and the greens and re-assign them to the red/immediate
category if they start to deteriorate, ok?"

Karen nodded nervously.

Dixie went on.. "Now, yellow is delayed, strictly for those patients
whose respirations are under 30 per minute, with capillary
refill under 2 seconds and able to follow simple commands. Now
for the green tags. Remember that patients with minor injuries
are still patients. Some of them may be frightened and in pain. Reassure
them as much as you can that they will get help and transport as soon
as the more severely injured patients have been transported first...
Lastly,.. black tags are for the deceased.." Dixie shared. "Now....
For triage sorting..ask those who are not injured or who have only minor
injuries to identify themselves. If they can,..tag those with minor injuries
as minor/green..."

Karen tried very hard not to fidget as the noise in the ward began
to grow from some kind of new development down the hall..

Dixie drew back her attention gently.. "Go to your next victim..
and think.. respiration first. Determine if the patient is breathing.
If yes, immediately check the respiration rate.

"If there's none, reposition the patient. If he or she does not start breathing
spontaneously, do not start CPR. Any patient not breathing after
repositioning, you'll tag deceased/black. Move on to the next victim.
Not starting CPR may be the hardest thing you must do at a multiple
casualty scene. But if you perform CPR on one patient, many others
may die for the sliver of a chance that your pulseless victim may have.
It isn't worth the price to pay in stopping to help that kind of
physical finding." Dixie told her.

"Even with so many doctors and others around to help us figure things
out?" the student nurse asked.

"Even then. You can only run a code on a triage scene if you have the
personnel to cover it and still do what needs to be done without pause."
Dixie said.

"But what if they have a neck injury.. or--"

"You will have to position the airway without manually stabilizing the
cervical spine. This is counter to what you have been taught and may
result in worsening a cervical spine injury. But if you don't reposition
the victim immediately, the person will die in the field. You won't have
the personnel to carefully stabilize the C-spine and you can't afford to
let other victims die while you take time to do it yourself.
If the patient begins breathing spontaneously after repositioning, tag
the person immediate/red and move on. If necessary, ask an uninjured
victim to help maintain the open-airway position. So, to reiterate...
if a person begins breathing after repositioning, tag immediate/red."

Karen tried not to pay attention to the police officers suddenly rushing
in from surrounding areas around their desk. She stared only at
Dixie's face for a small measure of calm that she wasn't feeling herself.

McCall was a rock. "Next victim.. If the victim is breathing when you
approach, but has a respiratory rate of more than 30, tag immediate/red
and move on. Don't take time to formally count the respirations.
If the rate seems too fast, tag the victim red and go to the next person.
So... a respiratory rate greater than thirty is a...."

Karen parroted mechanically, trying not to panic outwardly at the commotion
going on near them. "Red tag, immediate.."

"Right... Good." Dixie said. "We're not in danger, Karen, so ignore
all the fuss over there. It's not our concern right now. Triaging is. Let's
continue... Umm, where was I? Oh, yes...perfusion.
If you can feel a radial pulse, move on to the mental status assessment.

"If you can't feel it, the blood pressure's at shock levels below 90 systolic.
Tag the patient immediate/red. If you have an uninjured victim near you
then, have them put direct pressure on any visible, serious bleeding
and then move on to the next patient. In sum at this step:
No radial pulse at the wrist means.... red tag/immediate.

"Next, check for capillary refill by squeezing a nailbed.
If capillary refill takes more than 2 seconds to return to normal,
tag the patient immediate/red and have another put direct
pressure on any visible, serious bleeding so you can
move on to the next patient.  Capillary refill that takes greater
than 2 seconds to normalize is a red tag/immediate.
But, If capillary refill is less than 2 seconds, move to getting
a mental status..

"If the victim is unconscious or can't follow simple commands,
tag them immediate/red and move on to the next victim.
Now, you're probably wondering about these yellow tags, huh?"
Dixie said, fingering those in her kit.

Image of flowchart.jpg Image of triagetag.jpg

Karen nodded.

Dixie completed her thought. "If the victim can follow simple
commands, tag them  yellow/delayed and move on to the next victim.
And that's all there is to it.." she smiled.

"That's all?" Karen gaped.

"That's all. Triage isn't rocket science, it's one hundred percent
common sense. And this new system of the fire department really
works. Now we may not have to use it today, there's always hoping."
Dixie said, her eyes getting a little wide with irony.

"And how.." gushed Karen with stress. "Now that I know what to do,
I hope not to have to."

"Good girl. Drink your coffee.." Dixie told her.

Karen gulped it down.

"Ok, do you have any questions for me about this triaging system?"

Before Karen could open her mouth, Carol was brought in via stokes
and then there was no more time for talking.


They found Joe Early where he lay in 602 by line of sight but
nobody couldn't approach him, for Mrs. Stephan was standing
over him with a gun.

Malloy was all cop, his nose barely sticking around the edge
of the doorframe. He motioned Brice and Gage to get into
the flanking rooms to open both connecting doors ajoined on
opposite sides of Room 602 so that all three of them could see
each other yet still be out of the line of fire from the very upset
woman. "What's the problem Philomena? Your husband was
receiving the best care possible for his cancer.." the cop

"You american peoples! All you care about is the money in
your pockets! My husband is in pain! Not the kind that hurts
him here.." she pointed to her stomach where Georgio's stitches
were. "But the kind that hurts him here!" and she pointed to
her temple, alarmingly, using the same gun she was brandishing.
"And I don't think I can take much more either.." she weeped.

Pure fury consumed her and she picked up a steel bedpan
and hurled it randomly across the room. It clattered with a racket
and bounced right in front of Craig Brice's hiding place in
the side doorway. Johnny Gage ducked in sympathy on his
side of the room in the mirroring alcove entryway as Craig caught
the flying thing before it nailed him.

"Easy, Philomena, take it easy! Now let's relax and think about this,
shall we?" Pete asked her without showing himself once iota from
around the door frame. "Acting hasty will only get more people hurt.."

That acted like a pistol shot in Philomena and her mouth flopped
clean open. "My Georgio hurt somebody?" she asked in her
thick Greek accent. The gun in her hand fluttered from her temple,
back down to at her side.

Malloy used the distraction to motion the firefighters to take a
better look at Joe who was still motionless on his back, lying
partially underneath the crash cart, his face full of blood from
a freely bleeding head wound and split lip.

Gage cocked his head and was alarmed to find that the semi
comatose doctor was gurgling. "Doc! Hey! Roll over!" he
shouted, unable to stop himself. "Or you're gonna suffocate
and choke to death on all the blood!"

Philomena startled, whipping up her gun to point at the source
of the sound. Malloy, just as fast, whirled into the main doorway
from the hallway, pointing his own gun straight at her. "Hold it
right there. I don't want to hurt you. That's just a friend wanting
to help that man right over there.." Pete told her, throwing his eyes
at the strangling Dr. Early.

Philomena's hand never wavered. Neither did Malloy's.
She didn't even seem to care that a gun, just as lethal as
her own, was aimed right back at her chest in a line of kill shot.
"What man?" she asked.  She didn't seem able to comprehend
that her husband's doctor was lying in a pool of blood at
her feet. All she cared about was her husband.

Malloy changed tactics and he left the two firemen paramedics
to figure out Joe's urgent dilemma on their own. He had to worry
about his own skin, first. "Where's Georgio, Phila? Can you tell
me that? It wouldn't be right if he keeps on trying to hurt the
people who are only trying to help him, would it?"

Philomena tipped her head in high emotional distress."No,
it wouldn't be right. But I have to protect him.. don't you see? I'm
his wife." she sobbed.

It was then the police officer and two paramedics realized
that Philomena was deep in the early stages of a complete
acute, nervous breakdown.

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Johnny snapped his mind back to the present. ::Joe'll die
if I don't do something fast..::  He continued to shout. "Joe!
Roll over! You're bleeding real bad into your mouth. Can
you hear me?! Joe?!"

But Joe only choked, his breathing attempts growing weaker
as he drown in blood. Then he stilled, turning blue.

Thinking fast, Gage retreated back into 601 and fumbled
with that room's crash cart, grabbing up a whole box of
endotracheal tube guide wires. He ripped it open and
began to twist them together. "I'm gonna hook his belt,
Brice, to drag him over here! But I'm gonna need a distraction

"What kind of distraction?" Craig asked him.

"I don't know! Think of something. You always tell everybody
indirectly how smart you live up to it." Johnny grunted,
groping cross the floor with his swifty improvised tether, still
keeping under heavy cover away from Mrs. Stephan's line
of sight.

The hooked end of the wire flipped open Joe's white lab
coat almost instantly, but complete missed snagging
a belt loop.

Groaning, Gage tried again while tuning out the desperate
dialogue carrying on between Malloy and Philomena, still
locked one on one beneath mutually pointing gun muzzles.


Captain Stanley felt alone in the crowd of e.r. folk. He cast
about, only half listening to his HT when he caught word that
Mr. Stephan was on his way down the west stairwell, still armed.
And that, cast pure lead into his chest. "This has to stop. This
has to stop now.." he mumbled.

Not considering his own safety in his emotional turmoil, Cap
snuck by the security guards and started jogging up that
same stairwell to take matters into his own hands.


Jim Reed was pure stealth on the stairs. He took the steps
quietly, one by one, letting his gun's muzzle aim whereever his
eyes were looking as he pursued Mr. Stephan down the landing.
He didn't say a word, knowing that any noise he made might be
rewarded with the snapping crack of a bullet sent his way. He
didn't like going downwards in an active gun pursuit. He never did.
Going in a downward direction was never good because
balance wasn't preserved.

Maybe it was because he was thinking so hard, but the next
turn, brought him face to face with a charging madman in a patient

Jim Reed raised his gun and braced on the steps to fire at
Mr. Stephan at point blank range. But he didn't pull the trigger.
Not yet. He began to search for a reason for a need to shoot
in those few precious seconds while he looked for the telltale glint
of blue black metal Georgio's hand.

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On the third try, Johnny did it, snagging Joe's belt firmly with
his improvised dragging wire. "Craig! I got him! Distract her
while I move him over to me!"

Brice, looked around desperately for some means but then his
eyes alighted on the bedpan next to him. He picked it up.


Malloy told Philomena a simple thing.

A lie.

"Mrs. Stephan, your husband has given up to our officers."
he told her, holding up the radio he carried in his other hand
slowly. "I just heard him do it." said Pete, keeping his bead
on the distraught woman.

"What?" Philomena blinked. "No..." she started to fret, suddenly
dropping her gun's muzzle away from her silver badged target.
"That's impossible! We agreed that we would not do this thing
until the doctors promised to help him using assistance from
your government for all the bills. They... they are growing
too much.." she wailed.

From out in the hall, the sound of distant shots fired, drifted into the room.

The effect on Philomena was dramatic. "Georgio?! Why are you killing
people?! The war was over twenty five years ago..." she whispered in
agony, dropping her eyes away from Reed while her chin lifted in
an attempt to peer down the hallway.

Brice reacted, and threw the bedpan at the code blue button over
the patient rumpled bed. It activated and soon the hospital operator
began her urgent page. ##Code blue. Code blue. Room 602. Code
blue. Code blue. ##

At the same moment, Gage pulled back on the wire, dragging Joe
Early swiftly across the floor toward him.

Startled at the sudden activity, Philomena whirled and fired blindly.
Two bullets bounced off the floor in between Joe's shoes as
he was dragged to safety.

"Drop it!" roared Malloy, taking the safety off of his gun.

With a sob, Philomena cast down her gun and fled out the open
window onto the ledge outside the hospital.

Malloy just as quickly ran over to the fallen gun, and disarmed it.
He got on his radio. "744 to Battalion One. We've got a woman
on the east side of the building on a window ledge. Possibly suicidal.
The gun threat in room 602, is over." he told them.

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##10-4, LAPD. Sending up a ladder and bucket team a.s.a.p.##

Brice saw that the coast was clear and he ignored the drama unfolding
outside the window. He got to Gage's side as fast as he could.

Gage had Joe Early flipped over onto his side, draining out
a lot of free blood and saliva. "He's able to
Just gotta get some more of this out." he added more
sarcastically. "What about Philomena?"

"She's no longer our problem." Craig said as he and Johnny
helped Early.

They held his mouth open while he worked liquid free, mouthful
by coughed mouthful as he began to wake up under their

Soon, the code blue team arrived from an emergency freight
elevator into 602 to assist the relieved paramedics on managing
Joe's recovery.


Jim Reed's finger was just about to press on the trigger when
a sudden blast of water from a fire hose suddenly pinned the
crazed man against the wall.

The completely surprised officer whirled to find a determined
Captain Stanley standing next to an equally pissed off Dr.
Brackett, helping him on the firehose nozzle.

A huge smile filled the young officer's face when they finally
turned the water off. Mr. Stephan dropped his gun and started
clutching his side where the water had stung his surgical stitches
and tore a few open. "Now's that's a novel way to clean up the
picture." said Reed.

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Kel started to laugh. So did Cap, until a spasm gripped him around
his throat and chest. He bent over and fell against the wall, dropping
the charged firehose.

Dr. Brackett grabbed him. "Captain Stanley? What is it?"

"My chest.." Hank hissed. "It's been hurting since last night.."

"Put your arm over my shoulder. Let's get you downstairs and I'll
take a look at you. Can you walk?" Dr. Brackett asked. He motioned
for a firefighter to help him with Cap even as a whole slew of cops
ran up past them to help Officer Reed cuff Mr. Stephan.

"Yeah..yeah. I think so.. This is weird.." he gasped. "I'm healthy
as an ox I tell you."

"Maybe so. But if this is a new problem, I wanna know all about it.
Let me run a few tests on you?"

"Fine by me.. Oooo." Cap grimaced.

Brackett caught more of the captain's weight. "Orderly! Get a
gurney over here on the double!" he said as they exited the


Roy DeSoto had been the first firefighter on the ledge to handle
Mrs. Stephan's situation. And he was still talking to her as she
cried, holding onto the ledge's thin steel safety railing, the only
barrier between herself and the five story fall to the ground.

"Mrs. Stephan. Your husband is fine. I don't know what you
thought earlier in the room, but..I- I just got word that he's
been taken into safe custody by the police. He hasn't been
killed like you say you think he has. No one else has been
shot. Just the one orderly. And he's gonna be fine."

"Georgio...?" she whispered. "My Georgio..."

"He's ok. Please, d- don't do anything hasty. We all just wanna help
ya." Roy said from the window,stalling, as he watched the
bucket, still three stories below, rise slowly up towards them.

Philomena made a face and suddenly saw down the front of
her blouse, noticing the splatters of blood just then on her hands
and sleeves. "What...what did I do?.. " she asked softly, trembling.
"Did I hurt someone?"

DeSoto carefully turned up his radio as he listened to Johnny
and Brice give a care report to those down in the e.r. base station
through the HT. He heard his partners mention the fact that Joe
wasn't shot anywhere, only beaned from something that had
inflicted blunt trauma. Johnny guessed over the airwaves
that Joe had been knocked out with a patient's bedpan from
what blood he had remembered seeing on the one Philomena
had thrown. "Uhh,..not badly. Anger does sometimes get the best
of people. It's nothing to be ashamed of. You're under a lot of
stress right now and some of that could just be coming
out in an odd way." DeSoto reasoned with a small smile. "It's
really ok to be feeling the way you are now."

But Philomena wasn't listening. "I... beat up..somebody?" she
asked again, in growing horror. She had very good hearing and
she had listened to every word coming from Johnny and Brice's
HT transmission while they worked on Joe Early, inside.

Without a word, Mrs. Stephan rose up from her crouch on
the window ledge and leaped off the height before anyone
could stop her.

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Joe Early and Captain Stanley lay on matching beds in the same
treatment room. Roy was taking Hank's blood pressure.  
Kel bounced back and forth between his two patients, chattering
worse than Dixie in a firm mother hen mode. Cap's EKG was
on audible and his I.V. was T.K.O.

"I'm seeing nothing out of the ordinary, captain." Kel concluded,
pulling off his stethoscope. He began folding up the cardiac strip
for Hank's patient chart. "You're absolutely fine. Most likely your
symptoms are all just psychosomatic because you're holding in
something that's bothering you, like the chaplain said you were

"Mind caused? Whew.. that's a relief.." sighed Cap on the table.
"For a minute on those stairs, I thought I was a goner. Guess
I'm just feeling old today."

The hospital chaplain stood, acting his role as a CISM
counselor for both Cap and Marco. And they were finally
talking together freely.

The man of the cloth continued his counsel and he chuckled.
"I frequently run into the old 'dinosaurs,' who says, 'I don't need
this, but I'll be here to see you kids through it.' Then, during
debriefing, the dino'll bring up a car accident that happened 30 years
ago, and he'll recall every detail. I can't stress enough the
need to talk it all out, fellas." he says. "I don't care if you talk to your
steering wheel, your dog, your partner or your spouse. Part of the whole
macho image in emergency services is having this mindset about
not taking your work home to the family, but our entire team tells
people, 'When you've had a tough call, your kids know as soon your
foot hits the door that something is different with Dad. They
aren't sure what and don't understand all the ins and outs, but we always
strongly encourage everyone to talk to their spouse and kids about
the call. The more you talk about an event, the easier it is for you to
park it in the right spot. It's having the attitude of, 'I gotta suck it in; I
gotta keep it in my gut; I can't talk about it,' for fear of being a wimp
or not 'one of the boys' that's self-defeating." said the chaplain.

Dr. Brackett agreed with him.
"I see emergency services folks having heart attacks at age 59
and cirrhosis at age 56," said Kel. "They're chewing up their bodies over
20 years of service, because they didn't go park stuff.  Bottling things
up had literally eaten away at them. So keep what the chaplain's telling
you in mind. Every time you talk about an incident, it'll take a little
more of the load off your shoulders."

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"CISM is not a magical thing that cures all. But neither is it a stigma, boys. So
use it. And use me. Now. Both the good doctor and I are after the same thing
here. It's all about keeping healthy people like the both of you,
healthy and strong." said the chaplain. "You see, the principle of all this
is that sometimes decent folks like yourselves just need to get a little mental
overhaul or two done to learn how to handle the emotions which can come
barreling down on a truly bad call.  Please, call me anytime you want to talk about
one of those and I promise, I'll drop everything I'm doing and stop by
the stationhouse or to your own home." and the chaplain handed Captain
Stanley a small light blue business card.

"O.k." promised Marco and Hank.

Joe Early was thoughtful. "So, Johnny. The nurses are telling me that
you signalled my potential code by throwing a bedpan at the code blue
button on the wall?" he chuckled as a nurse cleaned up his face and a
resident got a local ready to stitch up his lip.

"I didn't think of that gem, doc. Brice did." Gage complained.

Cap laughed. "And I thought I was the one acting a little odd with my
reactions. I wouldn't call that a by the book protocol, Craig. What happened
to your personal mantra of being letter perfect in all that you do on the job?"

Brice just shrugged, finding himself at a loss for an answer.

"There's being perfect and then there's being a genuine menace
to society, Cap." sighed Roy DeSoto. "I don't think a flying bed pan'll
count for too much in the long run."

"Guess it won't." Cap agreed.

"Not unless you're dying under another crash cart and we're being
held at bay by gunpoint again." Gage quipped to Joe Early.
"Then, it just might become another standard emergency medical
hospital protocol if people begin to see how useful that little trick is."

Dixie and her student nurse Karen, just rolled their eyes.


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It was three days later,

Gage and Brice were drying the dishes early in the morning in
the kitchen, when the sound of an engine pulling up in the backyard,
garnered their attention. "Shh, here they come.."

Brice snickered. "I wonder how it went. Did Brackett and the others
live up to their word?"

"They must have." laughed Gage, as he peeked through the blinds
at the angry expressions he was seeing on the rest of the gang
as they hopped off the old refurbished engine in their dress uniforms.
"Well, well, well. Looks like this joking stew is well seasoned and
ready to eat."

Brice smiled and handed Johnny another clean towel.

Gil, filling in for Marco while he took a few days off to talk with
the CISM counselors some more, asked. "What did you two do?"

Gage, started smiling. "We didn't do anything. Dixie, Kel and
Joe did all of it for us.." he said, without elaborating.

Gil cracked Johnny in the butt with a wet towel for being evasive.

Gage howled, rubbed a nether cheek, and then, finally, answered.
"They took an empty box, put a couple of full soda cans in it
to weigh it down and tied it to the back bumper of our old engine
with some string. They then wrote on it with black marker
"FREE KITTENS. just before the start of Dixie's parade event.."

"They didn't." chuckled Gil.

"They did." said Brice laughing even louder, his voice barely
a squeak when it came out.

Cap, once he got inside the station, made sure he glared
good and hard at Craig and Johnny.

But no one glared harder at them, than Chet Kelly.

He said. "We left the station this morning and got pulled over
by the fuzz about ten miles down the road I'll have you know.
Clowns, Cap. The both of them!"

"Well, what happened?" asked Gil, fighting to keep from smiling.

Stoker told him. "The cop at first was furious, but then he
saw Johnny and Brice's little joking stunt and couldn't stop laughing.

"And we went through that whole d*mned parade trying to figure
out why people kept pulling up beside us, yelling." Hank scowled.

"Well, well well, Mr. Craig T. Brice. Guess we can rest on our laurels now."
grinned Gage. "That prank of yours, has simply got to be the best joke I've
ever had the pleasure to help sow." Johnny said with a lopsided smirk.
"Congratulations, Craig. I think we pulled it off in grand style,
true masters." and he started to laugh aloud to the point of tears.

Brice had only one thing to say to that. "Phantom, read it and weep."
he told Chet and the others, winking just his left eye..."...for I do
believe that you all......have just been seriously ...had."



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