Case Studies

CASE STUDY 1

On September 8, 2008, at 9:20 PM, Battalion Chief Roberto Olivio watched with satisfaction as the heavy black smoke pouring from the back of the building started to turn gray, then white. The Colony Apartments were older, built in 1974, and were not equipped with sprinklers, allowing a simple back deck fire to extend into the attic and burn across three units. Olivio had called a second alarm, bringing the total number of units on scene to eight engines, two trucks, one heavy rescue, and one safety officer in addition to himself and some folks from the Fire Investigations Bureau.

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North Valley Fire Engine 118 and Ladder 83 had been first on scene, and Olivio observed that they would likely be one of the last to leave, based on their position at the front of the structure. Once the fire had been contained and overhaul started, BC Olivio started releasing crews to return home. In the postincident investigation, Olivio mentioned that he regretted not keeping a few more units on scene to help in the final overhaul, since he knew the crews from Engine 118 and Ladder 83 were tired.

Once the scene was secured, Olivio turned it over to the investigators and the last of the fire fighters returned to their stations. A total of six units had been damaged or destroyed, and the entire fire building was vacated as a result.

At 1:33 AM on September 9, 2008, Olivio awoke to the sound of his fire pager. He recognized the address on the screen: it was the Colony Apartments. As he responded, dispatchers reported that the original fire building was heavily involved, and that fire had spread to the adjacent apartments where four people were reportedly trapped on a second-floor balcony.

Battalion Chief Olivio ordered a second alarm, and again Engine 118 and Ladder 83 were first on scene. Crews from both units rescued all four trapped residents, but the company officer on Ladder 83 was seriously injured when he fell from a 36-ft (11-m) ground ladder while getting ready to perform a primary search. After the second fire, an investigation showed that the original fire had not been completely extinguished and that crews had not performed a careful final walk-through with a thermal imaging camera in accordance with North Valley Fire policy.

CASE STUDY 2

Fire Fighter/Paramedic Jeff Jinks rolled over in bed at the sound of the tones: “Rescue 61, respond to a diabetic problem, 1616 South Twenty-Sixth Avenue, Apartment 9.” “Jesse again!” Jinks yelled, to no one in particular.

He and partner Stacey Wendall, also a fire fighter/paramedic, rolled to the address and discussed Jesse Reldman, whom they had seen nearly every night for the previous month. “Why won’t he eat like he’s supposed to?” Wendall asked. As they pulled up, they noted that the ambulance had not yet arrived. They walked into Jesse’s apartment on the second floor. Ignoring the fact that the apartment looked in disarray, which was unusual, both approached Jesse, who laid on the living room floor fighting attempts by his girlfriend to hold him down. The girlfriend told Wendall and Jinks that Jesse had eaten a late dinner after coming home from work and was watching TV when he suddenly rolled onto the floor, screamed out in pain, and started babbling incoherently. When she tried to keep him from crashing into a nearby table, he became mildly combative.

Certain that Jesse was having yet another hypoglycemic reaction (“He always takes too much insulin and forgets to eat,” Jinks said later), the two medics started an intravenous line with some difficulty and administered 50 g of dextrose. As they finished administering the medication, Jesse suddenly became unresponsive and held his arms out rigidly. The medics noted that his eyes were deviated to the right, and that it looked like he was having a seizure.

Before Jinks could grab the airway box, Jesse went limp and Wendall noticed that he was now in cardiac and respiratory arrest. They began resuscitation efforts, and Jesse was transported to a nearby hospital where he was diagnosed as having an intracranial bleed caused by a ruptured aneurysm.

CASE STUDY 3

Engine 20 heard the speakers “go live” at the same moment the lights started to slowly come up. It was 2:00 AM, and all four crew members heard the dispatcher announce an address they were extremely familiar with. “Engine 20, code 3, 6767 Sage Drive, apartment number 56, on a patient with shortness of breath.” Engine 20 had been to this address, home of Julie Rider, nine times in the previous two weeks. Julie had an anxiety disorder, and everyone on the crew knew what to expect: They would have to sit and calm Julie down; she would refuse transport (along with her medications); and another hour of their life would be spent helping someone who refused to manage her own medical problems.

As they drove to the address, Captain Thaler listened to his crew complain over the intercom. “Why can’t she take her meds?” “Let’s help her move to Engine 31’s first due area.” Thaler then recalled his recent CRM refresher training, where his team was asked how they would maintain awareness for risk during routine, day-to-day events. His team had determined that they needed to openly discuss any issues that may affect their performance, including fatigue, distractions, and the simple habitual things they all did while working an incident.

Captain Thaler recognized that his crew on Engine 20, himself included, had become biased about what they would see when they arrived at Julie’s residence. So, he spoke up, saying to his crew, “You know, I’m tired of going to Julie’s house as well. It’s frustrating that she won’t care for herself and that she appears to use the system to her advantage. However, I think it’s important that we work her up like any other respiratory distress patient. It’s good experience, it will help keep us sharp, and we may learn something. We all need to be aware of how our feelings toward Julie have affected our judgment, and how these feelings have closed our minds to any other medical alternatives.”

Thaler’s crew responded positively, commenting that they were glad someone had mentioned the risks involved. Although they still were not happy about having to respond to Julie’s house at 2 o’clock in the morning and, in fact, Julie was having yet another anxiety attack, the example had been set: The crew of Engine 20 was less likely to make a mistake associated with bias and complacency because of this experience.

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