The Fire Within, Movie One- Page Fifteen Patti Keiper NREMT-B

The Fire Within

Movie One

Page Fifteen

*Attention*- The following casualties are all mock exercise images.

"Hmmm. Might be a preexisting or escalating condition causing this
fever. That would explain a lot. Isolate him into the quarantine area
with their staff."

"Okay." Chris said, waving at one of the nurses by the information
table over to set that up. "Want anything given past this normal saline
I.V.?" Rorchek said, placing the bag under one of the boy's shoulders.

"No, not for now. We're only first line of care. Our job is to stabilize
after fixing any life threats. He'll hold until he reaches another doc off
the airport." Dr. Almstedt said. "Once the nurse gets here to handle
him, tackle the next patient after disinfecting yourself for safety."

"Yes, ma'am."

Joanne looked up to see Steven Beck busy at work loading treated
patients into his ambulance for the trip to Stony Brook Medical Center.
He caught her eye and shared some information. "There's an alternative
treatment area being set up in Holbrook Park."

"How can folks get there from here?" Almstedt asked to file away for
later. "I don't know where any damage is out there except what I've
seen." she said heavily, remembering the exploding plane.

Beck didn't miss a beat.
"Take Furrows to Patchogue Rd/Main St. to Broadway Avenue. Once
past the Patchogue exit, follow the Holbrook Road out to 495. We're
setting up at the park end next to the football stadium in the parking lot."
Beck told her. "There's a big building there we're taking over."

"Will I be asked there if I go?"

"Yes. The infield's no longer safe because of a burning pipeline."

Joanne sighed. "When will it end?" she murmured to herself, mutely
returning a wave at his farewell nod.

Dr. Brackett looked up from the man he and Johnny Gage were
treating who was suffering from acute smoke inhalation. "Johnny,
listen to his chest once more. I don't believe he's out of the woods yet
in spite of the fact that we got him breathing again. I want to know if any
superheated air got inside. Rales and pulmonary edema might mean
we'll have to rapid sequence intubate him to prevent tracheal adhesion.
Let me know if you hear and see any signs of soot or burns in his airway."

Right then, the oxygen masked man awakened, struggling to breathe
with suddenly flailing arms and legs. He was choking with pain as he
tried to grab for his throat.

Kel shouted.
"He is burned! Sedate him with 20 mg etomidate I.V. I'll follow up
with a paralytic for that RSI asap." he said, waving over some firefighters
to help hold the man down. Only sitting on the man's arm kept the already in
place I.V. catheter from being ripped out. Soon, the sedative returned the
man to a protective unconsciousness. "Ready with an endotracheal tube?"

"I've got him sized." Johnny reported, holding up one as he tore open its
packaging. "Succinylcholine as the paralytic?"

"Yeah. 1.5 mg/kg IVP. Then preoxygenate him for three with a bag. If we don't
get him tubed in thirty seconds find somebody to keep up that ambu until
he snaps out of it. I'm only going to try this once." Brackett said, his face
twitching in concentration.

Nearby, Roy stopped at the side of a yellow triage tagged teenager, who
seemed to be unconscious. Kneeling, he felt for a pulse. Finding none, he
checked her eyes. She had dilated pupils. ::Been hypoxic for too long.:: he
realized. ::We've lost another one. There are just too many to see fast enough.::
he mourned. Reaching down, he tore her tag from yellow to black swiftly. Wiping
away emotion watery eyes, Roy rose.

Without looking back, DeSoto headed for another red tag who didn't yet
have a nurse or doctor care-given clipboard lying on their stomach and got to work.

**************************************************
Subject: Circle Of Flame..
From: patti k (pattik1@hotmail.com)
Sent: Sun 11/29/09 11:33 AM

Ted Rorchek was ever so glad to be back at the scene. He made
headway over to the situation table where he saw Al Martelli and Greg
Hicks making a noisy case for a hypothetical.

Martelli shouted. "What do you mean there's nobody left to go searching?!
I'm telling you, we've got a man trapped near ticketting. A security supervisor!
He's also the one who warned us all about that g*dd*mned AVgas leak! He
probably saved hundreds of lives in doing so. Doesn't that amount to anything?!"

Greg was calmer. "Sir," he addressed the lieutenant from Holbrook facing them
who was assigned logistics and supplies. "It's true. We ARE available. Chief
Rorchek pulled us from the station personally to take an active assignment along
with the others not half an hour ago, but we're more than done now. We were
posted at the middle plane, and there's no way in h*ll you don't know how that
turned out."

The lieutenant winced and frowned but held firm. "This is why I can't let you guys
go back in. And this is straight from the book. You've no safety with you to watch
both of your *sses."

"They do now." said a voice from behind them. It was Ted Rorchek. "I'm
fresh back from Brookhaven Airport. I was picking up that doctor from California."

The lieutenant threw up his hands. "Okay! All right!" he said sarcastically.
"I guess protocol's satisfied then. Go ahead and go." But then he whipped
out a warning finger. "But not until every one of you hands me an accountibility
tag first." he warned. "The chief's gonna wanna know exactly who went back in,
and a why."

Three metal tags were unsnapped from turnout jackets and slammed firmly
down on the table in a neat row.

Al started beaming. "You won't regret this, bro. If you doubt that there's
still a proven victim in there, just listen to our ham radio logs from an hour
ago from the dispatcher. You'll hear we were cut off in mid morse."

Ted, Al and Greg went running for their idling fire truck after waving down
a just refilled and breakfast fed foam crew company to follow them.

The lieutenant watched them go. "I honestly hope you find him." he said softly
to himself. Then he turned back to his pile of note scribbled headaches. Sighing,
he refocused on the worst of the supply problems still facing him, where to find
more ambulances to move all of their half treated victims out of their old but newly
classified as dangerous green area, the quickest way possible to Holbrook Park,
the new safe zone, a half mile away.

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

Hallie Green and Chris Rorchek, along with Marco Lopez and Mike Stoker,
were the third assigned team getting ready to make an attempt at a valve shut
off upstream of the ruptured flaming pipe crater that was slowly reducing a fifty
foot round area of the airport's floor, to slag.

"Summer's returned with a vengeance." Green commented, fit testing her
faceplate. She could feel the heat from the fuel fire from their position three
hundred feet away. The ground in between was absolutely dry and snow free
and some parts of the concrete tarmack steamed in the daylight from underground
chimneys where the pavement had already cracked from heat stresses.

"Not quite the same." said Marco. "I don't see any palm trees waving in the gentle
breezes over there."

Mike joked. "Squint a little. Kinda looks like the beach at sunset."

"Maybe in July." Lopez said, grinning right back in his scba.

Hallie Green turned to Chris as all four slowly advanced towards a substation hut
by the fire with their pair of hoses on wide fan for some cooling protection. "So how's
triage going at the medical center?" Green asked.

"Slowly. A lot of cases moving through aren't even directly related to fire or any of
the crashes. I saw DeSoto and Gage working a birth, and I had an infectious case of
some kind."

"Oooo, what?"

"Maybe meningitis. He had the rash and the symptomology almost point for point."

"How old?"

"Oh, eight or so." Chris replied.

"He'll make it." Green told him. "Somebody has to. We've lost enough today." Hallie
said as if her statement made fact happen.

Chris grinned. "Hear, hear." he agreed.

Soon, they were close enough for tools.

A quick lock snipper cut the padlock over the latch but the door soon showed
itself as heat warped and jammed. Over the roar of the fire to their right, Chris
and Stoker grabbed out halligans to try and force the metal door's hinges off.
Hallie and Marco kept their joined fanning spray arches directed over the fire
radiant geyser, deflecting its killer heat away from themselves.

Glowing red hot metal groaned, but didn't give way to heavily applied crowbars.

Mike grunted. "I wish... I had...a Hurst tool right now.." he strained as he and Chris
threw their backs into the door, side by side and shoulder to shoulder, gripping
their bars with their thick thermal gloves.

"Why? And ruin a good workout?" Rorchek grimaced. "Aren't you having any fun
yet?"

"No.." Mike gasped through his mask.

Suddenly, there was an explosion from the geyser when it surged into regrowth.
The four firefighters were forced to hide in the hut's meager outline shadow for
protection.

But paint even on the shadowed side of the sizzling metal shingling before them,
started to flake off and burn.

"Retreat!" Rorchek shouted to all of them. "It's too hot now! We gotta find another
valve we can get to more easily."

Rushing backwards, still in a double fanning hose attack, Hallie, Chris, Marco and Stoker
got out of there.

Once at the snowline, Stoker lifted his HT as he pulled off his smoking rubber mask.
"HT-1A to IC2. The east hut's just become inaccessible!"

##10-4. Try the one in ticketting. One of the other teams says there's a partial wall
still standing between that valve access closet and the fire.## said Stanley.

"Roger. Heading over there." Mike told Cap.

------------------------------------------------------------------------------------------------------
Al Martelli and Greg Hicks picked up their pace as they reentered the silent,
dark airport terminal. They were a long distance away, but they could still
hear the steaming loud hiss of the burning fuel line geyser at the other end of the
concourse. "This feels d*mned good. There's nothing like the freedom of a
search and rescue team." Martelli exclaimed. "Ticketting's this way. The
security office is just around the corner."

Ted Rorchek called another halt as he checked and rechecked the ceilings, floors,
surrounding walls and their air bottles, for problems. "Yeah, but we're getting
there in one piece all right? Slow down."

Greg Hicks nodded. "You're right. We're acting like rookies, rushing in."

"But I have to know if he's all right." Al insisted.

"We'll find out soon enough. He's not going anywhere." Ted told his crewmate.
"Now turn around. I want to check your regulator again. The gas sniffer says
the air's breathable in here, but still a little toxic even though the roof's collapsed."

Martelli huffed under his breath but obeyed the youngest Rorchek.

Nearby, the conveyor belt panel under a ticketting counter was kicked out with a
tiny foot. "Help!" cried a voice. "I can't get out. The suitcases fell on top of me."

Al whirled in his tracks. "Is that a kid?!"

Greg said, "Yeah, I think it came from over there." he said.

All three of them redirected flashlights and saw a pair of flailing legs, stomach
down.

They hurried over and flipped up the counter's access section. Crawling in,
they began throwing toppled suitcase after suitcase off of the conveyor belt,
getting to the pile they saw lying on top of a little boy. "Easy kid! Don't move.
We're getting you out!"

The kicking stopped.

Ted shouted. "What's your name?"

"Danny! *cough* *cough*."

"Are you hurt?"

"No... I can't breathe! They're falling!" Then he screamed, the sound abruptly
cutting off.

The firefighters began uncovering debris and roofing sections even faster.
Greg shouted. "Danny?! Keep talking to us!"

There was no reply. Rorchek dove into the hole and crawled forward onto
the belt as Greg and Al continued to unbury and toss away fallen suitcases,
exposing an open route.

Ted's flashlight finally found the silhouette of a body in the smoke.
He scooted forward on his belly and quickly, he reached up an arm and pulled
the limp boy towards his chest and out from under a large heavy box. Danny
wasn't moving or breathing where he lay face down.

Pressing a resuscitator mask attached to his air bottle to the boy's face, Ted
thumb triggered a few short manual breaths after securing an open airway.
"Danny? Can you hear me? Start breathing again. Guys, get in here! He's in
respiratory trouble."

Al squeezed into the space with Ted. "How long down?"

"Just now." Ted replied, keeping the resuscitator mask sealed
tightly over the boy's face while he pressed button regulated air
into his lungs.

Martelli reached for the boy's neck. "He's still got a pulse. Give
him a few more shots. His color's not that bad yet."

Ted complied, holding Danny's head firm as he made sure he
was getting chest rise. Then a few of the boy's fingers twitched
and he started coughing.

"There you go. Take another breath." Rorchek encouraged. "Breathe
this in."

Weakily, Danny tried to push the air regulator from his face as he
started to panic at feeling his nose and mouth covered up.

"Easy, just relax. You need this. Suck it in! If you can't yet, I'll be right
here to help you." Ted told him. "Just try and keep awake for us okay?"

Danny groaned and opened his eyes. "I-I ...*gasp* I can't find Mom and Dad."
he whispered, out of breath. "Last I remember, we were in the restaurant."

Al and Ted both looked at each other. Then Martelli got close to the boy.
"People will look for them, Danny, I promise. But first we need to get you
someplace safe and to a doctor. You took in a lot of smoke."

Outside behind the counter, Greg hollered. "Got to move! The fuel's burning
brighter down there. Just started happening."

"Okay, we'll get Danny out to triage, and then we'll circle around the other way
to the security office." Martelli agreed.

"Let's go." Ted Rorchek said, gathering up Danny into his arms.
The boy's eyes were unfocused slits again. "He's not doing so well."

Al Martelli gave one last longing look down the glowing hallway that led to the
security wing, but then he raised his HT to his lips. "HT-1B to IC2. We found a
semi-conscious male pediatric victim. Severe smoke inhalation. Respond another
paramedic team with full resuscitation gear to the yellow zone nearest our
entry point."

##10-4.## replied Captain Stanley. ##Contacting the medical center now.##

**************************************************
Subject: Life On The Line..
From: patti k (pattik1@hotmail.com)
Sent: Mon 11/30/09 12:18 AM

Ted Rorchek ran for the open air and the relative safety of the airport
tarmack apron, carrying his tiny living burden. Greg Hicks and Al Martelli were
close behind, only breaking off for a few moments to flag down a passing
fire engine to accost their oxygen apparatus and airway kit.

That crew volunteered a wool blanket as well before continuing on their
way to go off duty for a food and rest break and a fresh top off of fuel,
water and foam.

Ted Rorchek peeled out of his air bottle just as its low air warning
began to sound. Frustrated, he threw away the secondary
air mask he was using to protect Danny's lungs.

Chief Joe Rorchek knelt by the boy Ted had just leaned into
a sitting up position against his knees. "This the lad you reported?"

"Yeah, dad." said Ted. "Name's Danny. Don't know the last."

"Hmmm. Danny.. do you know where you are?" asked Joe, his breath
steaming in the chilly daylight as he attempted to get a new status.

The boy just articulated nonsensical sounds and he only coughed weakly
when tapped lightly.

Greg Hicks wrapped him up snugly into the warm blanket.
"He's pretty out of it. Might be hypoxia working on him." Greg
suggested. "Ted said a fallen box almost suffocated him."

"There were only a few fumes from the area near the pipe fire." Al shared,
handing the chief the case he and Greg had pilfered which contained oxygen
gear. "But that's not saying much if he was stuck in there for a long time."

"Was the heat real bad?" the Chief asked as he strung out
the resuscitator mask and turned on the oxygen flow from the tank.

"No. It was pretty cool from a hole in the roof." Ted said, loosening
the boy's shirt more away from his throat. "Let's keep him upright. It'll
help him breathe a little better."

Greg Hicks shared more history. "He respiratory arrested on us for
about half a minute, Chief." he said, searching the boy's pants
for I.D. "Nothing's here. His pockets are empty."

Danny moaned, only half awake, twitching in his arms and legs.

The blue shirted boy's head lulled around in a daze, so Ted and Joe
set the new mask against the child's face with a couple of palms
to maintain a tight enough fit to deliver as close to one hundred percent
O2 as they could manage.

The ragdoll spasming continued.

"Danny?" Joe shared. "You're outside and safe. This is oxygen.
Breathe deeply so it can clear out your chest. Can you understand me?"

But Danny didn't reply. His limbs fell still. And his lips began to suddenly
turn chalk as a cold sheen of sweat peppered his face.

"Ah, he's going out. Set him flat. Something's wrong." the airport
paramedic worried. Quickly, Al did as Ted bid and lay Danny down.
Martelli tilted back his head for a listen, and laid a hand on the boy's chest
to feel for movement. "D*mn. He's quit again."

"Pulse?" Ted asked, grabbing an oropharyngeal airway from the pack.

"There. But it's very irregular. " Al confirmed as he started to ventilate
the boy gently using the demand valve resuscitator. "Just like the last
time."

Joe Rorchek rose to his feet and got on the radio. "IC1 to IC2, where
are those paramedics for the male minor on Tarmack Three? Condition
is going critical."

##IC2 to IC1, their E.TA. is two minutes. Code Three.## replied Captain
Stanley. ## I'm on my way over there myself with a peds AED from a doctor.
Everybody else is tied up.##

"Best speed possible, then better, captain." Joe transmitted.

##Understood. My pedal's in China.## Hank replied.

"What's he at?" Ted ordered, after he had gotten a short breathing tube
placed over the boy's tongue.

"Around 120-130 best guess." Hicks said. "At the carotid only."

"Sinus tachycardia? Shock with a dropping B.P.? This has gotta be more
than just smoke inhalation."

Al was honest. "Whatever it is, it's not being nice at all." he exclaimed in
frustration.

Ted mumbled. "I wish I had my med kit with me or even just an EKG monitor."

"All of that's on the way, son." Joe said, placing a hand on Ted's shoulder.
"Any chance this might be a chemical poisoning?" the chief wondered.

"Whoa!"
Beside them, Hicks startled. "It's gone. I-I just lost it." he said, shifted
suddenly from his crouched toes to his knees as he refumbled for a correct
groping grip on Danny's neck.

"You sure?" Al asked Greg, not stopping his mechanical ventilations.

Ted waved an attention gesture. "Martelli, hold off a second."

Al froze his trigger fingers, and his whole body.

Ted quickly lowered his head to the boy's chest. "That's odd. I'm hearing a
very rapid heartbeat." he said in puzzlement, with an ear to Danny's skin.

"Yeah? Well, I'm not feeling one!" Greg insisted.

Ted tightened his lips and immediately placed fast palms over Danny's
chest and started aggressive CPR. "Pulseless V-Tach then. Explains a lot.
Dad, we got real trouble here. This boy's gonna die if we don't see some
cardiac drugs or a defib inside the next minute and a half."

**************************************************
Subject : Code
From: patti k (pattik1@hotmail.com)
Sent: Mon 11/30/09 1:26 PM

Al glanced up. "Hyperventilation?"

"Flood him." Ted grunted as he continued to deliver chest compressions.
"No such thing as too much oxygen for him any more."

Greg Hicks felt for the boy's pulse point in his neck. "I'm getting a good pulse
with those compressions, Ted."

"Okay." Rorchek stated, concentrating on pressing down evenly and regular,
but fast. "Keeping it at one hundred a minute. Any cyanosis?"

Martelli peeled back Danny's lip in between breaths. "Nope, none."

Ted sighed. "Good. He's not gonna be acidotic at all."

A yellow fire engine barrelled down and squealed to a halt next to Joe's
red flashing lit battalion car. Captain Stanley leaped out of the passenger
cab with a soft shelled red case, the AED. He ran to the others' sides
and immediately, he and Joe began cutting away the rest of Danny's shirt.

"Joanne says this one's fresh. It wasn't used today yet." Stanley shouted.

Hank turned on the unit as he and Joe strung and connected the wires to
the unit. Then they peeled the protector paper off of the two electrode pads.
One Joe placed on the right side of Danny's chest, the other, Hank stuck onto
the boy's back below a shoulder blade by slipping a fast hand underneath him.

"Okay, everybody clear. Let it analyze." Joe ordered. Al lifted away the resuscitator
and Ted stopped compressions. ##Do not touch patient. Analyzing rhythm.##
Seconds crawled by like eons when it finally sounded a message.
##Shock advised.## the AED's module declared. ##Stand clear of patient.##

"Yep. Pulseless V-tach around 163. See that?" he said pointing
to the digital display in green showing on the AED's small window. "This first shock
will be 2 joules/kg." Ted told them all. "Don't touch him until after it analyzes and gives
him a shock, if it needs to, a third time."

A strong jolt coursed through Danny's limbs softly. ##Shocked delivered.## the AED said.
##Do not touch patient. Analyzing rhythm.##

"Come on." Ted urged when the boy didn't convert afterwards. "All right, 4 joules/kg.
Double strength."

##Shock advised.## it said, still displaying the deadly dysrhythmia on its screen.
##Stand clear of patient.## A second spasm wracked Danny's body, then it relaxed
again into stillness. ##Shock delivered.##

"Nothing yet." Hank said, watching Danny closely. "No reaction."

##Do not touch patient. Analyzing rhythm.## the machine stated a third time.

Ted studied its screen. "He's slipping a bit. It's coarse v-fib now."

##Shock advised. Stand clear of patient.##

All five firefighters held their breaths. Again a surge of electricity jolted Danny.

##Shock delivered. Check patient. Check breathing. Check pulse. If no
pulse, resume CPR.## the AED transmitted.

Al and Greg examined Danny swiftly. "It didn't work. Still nothing."

"Start CPR." Joe told them as Ted started compressions once more.

Hank said, "Joanne told me this one will automatically reanalyze again after two
minutes of CPR." he said, pointing to the AED lying open in its case.

"All right." Ted nodded. "Take over?" he said to Cap.

"Yep." and Hank started in after knocking Ted's hands away neatly.
"Just so you all know, every red tag's been seen. That's why we're
being allowed to work this boy. Triage restrictions have officially been lifted.
Dr. Brackett's orders."

Ted shook his head where he was maintaining a Sellick's hold
below Danny's adam's apple to prevent distention and chance vomiting
from Al's ventilations. "Wish I could talk to the man."

"You can." Joe said, pulling out an HT and switching channels. "IC1 to
Triage2. Respond on this frequency. This is an emergency communication."

##This is Dr. Brackett..##

Ted smiled, reaching for the handy talkie eagerly with his free hand.
"Doc, boy am I glad to hear you." he began.

Right then, a red rescue squad bearing the logo of the airport hurried
across a runway full tilt, avoiding still smoldering piles of debris. Behind
her, ran Sophie the fire dog. The lights and sirens cut off when they
reached the scene.

Roy DeSoto and Johnny Gage rushed out, grabbing every piece of
airport fire station medical gear they could find from the vehicle's
storage holds. They ran to the boy.

"What happened?" Johnny asked.

Image of gagegrimacecrawlturnoutclose.jpg

Ted told him. "At first, smoke inhalation. But now an unknown cause.
Initially pulseless V-tach, now showing V-Fib. Three shocks unsuccessful.
He was a witnessed arrest. Never lost oxygenation. Found near the
restaurant."

"How long has he been down?" Roy asked.

"Four minutes, twenty eight seconds." Al replied, still watching the timer
on the watch he had started.

"Keep hyperventilating him." Johnny ordered Martelli. "We're going
to tube him next for medications."

Roy was already preparing the intubation gear. "He's about eight years
old, Johnny. I'm going with a 6.0 cuffed French." he said bending
a stylet into a curving shape. "In case he ate dinner last night."

Gage nodded, tearing open a lubricant pack with his teeth. He
tossed an empty syringe to Greg. "Draw up ten cc's air into that."
he requested.

Roy tore off a long piece of tape and stuck it onto his leg. Then
he assembled and locked a curved blade the right size onto a
laryngoscope.

Johnny took the ET tube Roy had laid out on Danny's stomach
and tested the bulb on the end by inflating and deflating it with Greg's
syringe to check for leaks. There were none. He left the phalange
dangling off the airway's tubing.

Roy threaded the stylet down the lubricated ET tube part way and
bend off the tip at the top so it wouldn't fall down further.

He nodded at Al. "Any head or neck trauma?"

"No.." everybody said. "He fainted."

"Hyperventilate him more." Gage told Al.

Martelli did for a minute while Cap's CPR still went on.
Then both backed off to give Roy and Johnny room to work.

Roy tipped back Danny's head and opened his mouth with
a few crossed fingers. Then he removed the oral airway neatly
while Ted still maintained the cricoid pressure hold.

He used the blade of the scope to sweep away Danny's tongue
to the side with his left hand and threaded down the ET tube
and stylet to just below Danny's vocal cords with his right. "I'm in."
Roy said, throwing away the blade and handle and guiding stylet wire.
He held the tube firmly with both hands so it couldn't move. "Al?"

Al reattached a bag valve mask on high flow to the top of the tube's
port and gave the boy a few breaths.

Gage threw on a stethoscope and began listening at all points on
Danny's chest for breath sounds. "You're in the right bronchial tree,
Roy." he frowned. "Pull up a bit."

Roy started withdrawing the tube slightly, centimeter by centimeter,
waiting for Johnny's word.

"Okay, stop. Right there. Breath sounds equal and clear on both sides.
Tape it off. Start in on CPR again, guys, we're set."

Hank began his one handed compressions once more.

Roy announced a finding. "He's at 15 cm." he said, taping off
the tube so it couldn't slip up or down with the piece of tape he
wrapped around its end port and the back of Danny's head
and neck.

Ted let go of the Sellick's maneuver, sighing in relief.
"Doc, that's about as much as we know so far. He's just
been ET intubated." he transmitted over radio.

The AED began to cycle once more in analysis. While it
was doing so, with another halt in CPR, Johnny accepted the
HT Ted handed to him.

##51, I've been told your victim's still in a shockable rhythm,
administer 0.1 mg/kg of 1:1,000 Epinephrine solution followed by
10 ml Normal Saline wash by ET. Skip attempting any intravenous
access. That'll just waste time. I'm also passing on using sodium
bicarbonate. That'll only neutralize his epi on us. It's probably
unnecessary as he's been given CPR since the onset. Shock
him one more time and get back to me.## ordered Brackett.

"10-4, Triage 2. Administer 0.1 mg/kg of 1:1,000 Epinephrine with
a 10 ml NS bolus ET. Then shock 4 joules/kp times one." Gage
reaffirmed.

##Standing by.##

Roy checked his glass ampoule of medication for its amount and identity.
It was clear in color still and way before its expiration date. "Concentration
1/1,000." he called out to Johnny.

Gage handed Roy a 20cc syringe fitted with a sterile 21 gauge needle
and uncapped it.

Quickly, Roy drew up the epinephrine and saline and shot it quickly
down the endotracheal tube that Al had already detached from his
ambu bag. "Okay, vent him twice, fast, to aerosolize that med." DeSoto
told him as he threw away the spent syringe and needle into a sharps
bin.

Johnny wrote down everything they were doing and time stamped each
step onto a rescue clipboard before he handed it over to Ted to add
his own care notes.

##Shock advised. Stand clear of patient.## the AED droned.

Danny jumped a little higher this time. But the display screen still showed
coarse ventricular fibrillation.

"Start in again, guys." Roy sighed.

Al and Cap continued CPR.

"Doc, no conversion." Johnny shared with Dr. Brackett over the handy talkie.

##Give him Lidocaine 1 mg/kg ET. And defibrillate. If that doesn't work,
repeat with a second and then any subsequent doses of epinephrine ET
at 0.1 mg/kg of 1:1,000 solution. Do CPR for a minute. Then give a shock.
If no conversion, use Lidocaine again, at the same dose up to three doses,
every twelve minutes. The pattern will be shock/med/CPR for 60/shock/med/
CPR for 60,..until you reach both your medications' maximum dosages.
Repeat the epi every 3 to 5 minutes. Bring him in as soon as you can,
51. Maintain that CPR if he stays pulseless or if the AED doesn't indicate
a shockable rhythm and you still can't detect a palpable heartbeat. We'll work
with additional meds once he gets here after a full leads ekg reading so
we can better see what's going on with his conductivity.##

"10-4, doc. We're on it." said Johnny, passing the HT to Greg.

They set to work with a vengeance as the sun climbed higher and clearer
in the cold winter sky.

Its beauty in the heavens went unnoticed amid the scene of a H*ll on Earth
by the rescue team surrounding the boy.

**********************************************************
Subject: The Real World
From: patti k (pattik1@hotmail.com)
Sent: Tue 12/01/09 1:12 PM

"Right there!" pointed Hallie, shouting through the roar of the air circulating
in her scba mask. "The back door into ticketting!"

"Where are we? I don't recognize anything any more." the oldest Rorchek
son asked, eyeing up all the black and steaming, charred remains of
buildings and vehicles around them in the bright daylight. The heavy snow
that had fallen in the night had completely evaporated away in the heat of
the fuel fire's geyser that they could see in the distance.

Green answered. "A&P Aircraft Maintenance, Inc. North side and east
of the taxi stands according to our GPS."

Mike Stoker and Marco Lopez aimed their water hose at the fire scorched
door to cool it down. Licks of fire were dying all around them on tar
melted pavement. When the steam lessened, Chris Rorchek felt the door
with a bare hand pulled from a glove. "Can't tell if this heat's internal
or external." he said, gingerly testing the soot pocked metal surface.

"Only one way to tell." Stoker said. "I'm opening it."

Immediately, the others framed into a V shape with fanning hose sprays
while Mike eased to the side of the door frame, out of range.

"Ready?" Mike asked, hefting up the halligan from his fire jacket.

"Yeah." they said.

Mike popped open the door and ducked, but no punishing flames
burst out. The interior was dark and no longer smoky.

Chris grinned. "Maybe that hole in the roof of the building's cooled
things down enough to start putting the fire out. I can't imagine carpetting
burning for long in there. The floor underneath's all concrete." he said,
readjusting his faceplate when they had their hoses turned off again.

Marco Lopez nodded an invite in. "Tell that to the fuel leak. Just look
at that fire column. It must be at least three hundred feet high."

Chris merely glanced at it.
"We'll be nowhere near it. How hard can it be? One quick in, turn a valve,
one quick out and we'll be heroes. Anything's got to be easier than that
red hot hut we just attempted. This is easy street with no burn, man." Rorchek
grinned, hefting up his strapped on air bottle onto his shoulders a little higher
to ease the ache in his back.

Hallie looked automatically over her shoulder and wiped water droplets off her
mask with a soggy glove. "Where's our foam crew?"

"They're all converging on the mother fire at ground zero. Everything else
has been contained." Lopez told her. "They're going to try and smother
the burning fuel feeders flowing away from it along the runway. One's
been threatening the medical center and runway 24A. That's why the green
zone's been moved out to a nearby city park."

"Red zone, one block, or one mile big... doesn't matter to me." said Chris.
"All I know is that I wanna be in it." he laughed.

The others chuckled and together they dragged their hoses, in defense of
fire tricks, into the building.

Chris reported in. "GPS on, IC1. P.A.S.S.'s are active. We're going in."

##10-4, HT-1B. Tracking you on live monitor.## replied Joe Rorchek.

Helmet lights barely traced the path to ticketting. Fresh firefighter footprints
marred the sooty carpetting where signs of a rescue lay around one luggage
check in counter. Ted peered at one bootprint. "Number 7." he read, seeing
a company number stamped into dirt. "That's my bro. They must have found
that victim they went after." he said, eyeing up a used air bottle resuscitator tab.

"Who?" Hallie asked as they hurried to the back of the public area towards
the furnace room and fuel line control closet they wanted.

"A security supe. The one who warned us about the fuel rupture on the ham
radio." Rorchek replied.

"Good. That man deserves all the credit for saving our rears. If we hadn't
known about that, we could have all been fried inside the terminal when the
gas fumes started building up high and one of us sparked them off by using
a radio." Green said firmly.

Stoker was thoughtful. "Wait a minute. There's daylight down there. A lot of
it."

The others stopped and looked up at the ceiling. Large sections of roofing
were hanging by ruptured struts and ripped insulation and wiring. Here and
there, bright chrome heating ducts lay fallen and twisted through ragged
tears.

Lopez tried experimentally poking a loose section ahead of them with his pike
hook. "It's holding." he said when nothing but small debris fell down.
"At least this part is."

"We'll keep an eye on it." said Chris as they passed it by.

Flipping their two charged hoses around a corner, the four firefighters
headed down a red glowing, emergency battery alighted hallway.

A low rumbling roar shook the foundations and caused a miniquake
around them that made pieces of debris fall all around them. The air
filled with fresh falling embers.

They protectively huddled onto the floor underneath a table while they
waited for the distant explosion around the fuel fire to fade.

When it was over, they got to their feet.

Mike Stoker looked uneasy. "We'd better hurry. Sounds like it's growing."

-----------------------------------------------------------------------------------------
The tremor running through the medical center's foundation, died away.

The active scanner at the desk, went wild. It started broadcasting
fire department speak out over the treatment area where Dr. Brackett and
Dr. Almstedt was still working over yellow triage tagged victims.

They both looked up to listen. Chief Joe Rorchek's voice soon spoke.
## Units 9 through 17. Form an active foam attack upwind of the hotspot.
Ladder 9, check out Ambulance 2. She was passing downwind when that new
activity began. Let me know a status.##

Joanne looked up from the little girl she was treating with a gasp. Ambulance
2 was flight paramedic Steven Beck's assigned rig for victim evacuations.

Dr. Brackett glanced at her. "Joanne?" he asked, thinking the crying little
girl was the cause of Joanne's reaction.

"A friend out there.. if ...you know what I mean." she said vaguely so she
wouldn't alarm the parents watching her work on splinting their daughter's
broken arm.

Kel nodded, understanding.

Then the radio scanner burst into life once again. It was Ladder 9. ##L9 to
IC1, we've a confirmed FD rollover MVA with a Code I. Ejected, with a
pulse.##

Joanne shot to her feet. "Steve!" she shouted, tears of surprise spilling
down her cheek. "Dr. Brackett, you're in charge! This girl's done."

Stunned by her reaction, Dr. Brackett clambored to his feet to hold onto
her arm. He spoke softly so only the two of them could hear.
"Joanne, think again. We still have a lot of untreated people here."

"They can wait, remember? That's the beauty of yellow and green triage
tags. Don't tell me that an ejected will be one of those and without significant
trauma." Dr. Almstedt snapped.

Kel's cheek twitched. "That's true. There's only one red tag coming in and he's
in full arrest. All right. At least take a radio." he barked, tossing her one. "We'll
stay in touch with one another."

Joanne fled the medical center through the basement garage ramp with
a full medical bag flung over her shoulder. "I'll let you know his condition
as soon as I know." she shouted back.

Joanne buttoned up her EMS turnout against the cold as she hurried to the
only triage area she knew, the one she could see out the mylar taped
windows of the medical center. Vaguely, she wondered why it was so
sparsely populated by stretchered victims. She got a few curious stares
from running air bottled firefighters rushing towards the fuel fire but that
was all. She was flanking the marked off area around the cold middle plane
burn when she heard a loud man's groan to the right.

Stopping and turning, she spied a crawling man in security gray floundering
in the foam. She whipped her radio to her mouth. "This is Dr. Almstedt, near
the airplanes. I've a conscious male victim spotted. I need immediate help."

She paused, staying where she was, torn between remaining a visual flag for
an arriving fire team or rushing in the short twenty yards it would take to
reach the airport worker and help him out.

##This is IC1 to the civilian on triage channel. You are in a red zone. Evacuate
immediately! ## warned Chief Rorchek.

The security supervisor collapsed suddenly, face down in the foam.

Joanne reacted and ran towards him into the smoke. ::He'll suffocate in that!::
she thought.

She got about ten steps into the strange fog when she started choking and
coughing violently. She dropped to her knees and the world started swimming
before her eyes. The air around her became thin and sharp.

Suddenly, a pair of strong hands grabbed her by the shoulders and yanked her
to her feet. It was Joe Rorchek, wearing full scba. One of his gloves pressed
a mask of medical oxygen tightly to her face as he hauled her back the way she
had come and into open daylight, her under one arm and the second around the
bottle of oxygen.

"Now that's the dumbest thing I've ever seen! The air's poison in there, doctor!"

She didn't reply and only choked as she staggered after him where he led.

"Keep breathing this in." he ordered. Once they were in clear air, he sat her
down on the runner of his car. A firefighter rushed up to offer aid, but the chief
waved him away. "She's fine, firefighter. A few seconds inside only. This is just
some active stupid."

Joanne could finally speak. "I'm sorry. Nobody else seemed to see him and he
didn't look that far away to me." she said, finally holding the oxygen mask herself.

Nearby, a team of air bottled silver suited firefighters bore away the semiconscious
security supervisor in a stokes, heading for the hazmat showers in Holbrook Park.

"A fire zone's no place for civilians!" Joe roared. "What is it with you nurses and
doctors? Always thinking that you can do it all. You want to play firefighter? I
suggest you join the fire department legally!"

"I'm sorry, Joe." she coughed, clinging to the oxygen. "I was actually... really
trying to find Steven Beck. He-- "

"Yeah, he was in Ambulance 2, but he's not here. We're evacuating this triage position
for obvious reasons. Didn't you notice? We immobilized him and sent him
to Holbrook Park." Joe pursed his lips. "D*mn it, doctor. The last thing we need is
an M.D. out of commission! Just what were you thinking?!"

"I-- Steve's a good friend. I'm s-sorry.." Joanne said, finally unballing her free fist,
still coughing.

Joe's ire finally cooled. He studied her thoughtfully as she shivered in her coat
and tried to slow her breathing rate for him. Then he said. "I'd be lying if I said I've
never done the same thing you just did. Every rookie falls for that trap.. until he
learns better." He let go of her arm. "Steadier now?"

She nodded as her coughing subsided.

"Okay, hop in." he said, indicating his car. "I'll take you to where Steve is. The
paramedics are calling for a doctor."

"No sh*t." she hissed, angry at herself, taking the oxygen bottle he handed her.

"By the time we get there, you'll be cleaned out lungwise. Those fumes were just some
CO and irritants. You were lucky." he told her. "Keep that oxygen strapped to your
face until we get there." He tossed her foam covered radio into her lap where it
landed with a squishy plop. "And guess what? It didn't break when you dropped it."

Joanne raised her eyebrows, properly chastened as the bite of a raw throat began
around shock trembling muscles. She busied herself with cleaning the stickiness off
the radio with a nimble parka sleeve. Then she looked up. "Are you going to tell
anyone about this?"

"About what? You're not hurt so nobody has to know." he glared. "Officially."

Dr. Almstedt started to focus on unzipping crucial pockets on her trauma bag.
"I can live with you and your men lecturing me for the next decade about my sheer
stupidity." she grinned. "Thanks, Joe."

He just harrumphed as he turned his lights and sirens on for the trip across the
boulevard. He picked up his car mic. "IC1 to IC2. I'll be 10-7 for three dropping
off a doctor to Holbrook staging for a red tag."

##10-4, IC1. I'm available from that peds resuscitation. I'll assume complete
operations until you get back.## replied Captain Stanley.

"I stand relieved." Joe confirmed through the transmission.

Click the blowing leaves
to go to Page Sixteen

The Fire Within

Movie One