A Fire Service Pantheon

"Kinda quiet today..."

"Whuuups! What did you say?."

"Whuh?"

"You angered the Gods. We're going to get our asses kicked now."

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High above, drifting on the ever-present layer of stratus, floats a row of thrones, constructed from broken bones, the mangled wreckage of cars and motorcycles, glucometers, fire alarms, and a thousand failed human hearts. Tonus, the God of Dispatch, rears back and lets loose a deep and mighty belly laugh. Leaning on his elbow, he had been combing the surface of the earth for a foolish and prideful firefighter to torment. He motions Meteoro, the God of Natural Disaster, to his side.

'Your bidding, Oh Great One?" Meteoro clasps Tonus' forearm with his damp and cold hand.

"Create a deluge, in this City, on that busy highway." Tonus points to our freeway, "At that curve," stroking his beard, chuckling, "I want to see the horseless wagons spinning."

'It shall be done!"

A piercing wolf whistle summons Gravita, the Goddess of Falls from her perch, mincing in her too-long gown. "Find the infirm, the lame, and play havoc with their walkers. I want broken hips. In the bathroom!"

"Of course, my Lord." She claps her hands above her head, sinking through the carpet of clouds, plummeting toward the planet below, with the falling rain.

Tonus yells down after her: "And look for humans on ladders, cleaning their gutters!" Craning to see around his celestial lair, his long white hair flying, he bellows, "Bubba!"

Bubba, the lesser God of Bad Judgement, rolls in on a unicycle, juggling bottles of high-gravity beer, catching the spraying drops of brew in his mouth. His eyes are red, and his bare feet work the wheel back and forth, idling before the God of Dispatch.

"Bubba, find some, ah, vulnerable, humans. Goad them into dangerous activity. You know, the usual."

"You betcha, boss!" Bubba downs a beer, springs off of the unicycle, and cartwheels out of sight.

The mighty and fearsome God, Tonus, leans forward eagerly, rubbing his huge palms together, watching the mayhem unsue.

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And so it goes... The Gods are easily offended. Unspoken, yet understood, rules govern our behavior in the station and on duty. Never boast about a quiet shift. Never laugh at another rig's number or type of calls. Before sitting down to a meal, it's good form to acknowledge the probability of the tones going off, if only silently. Go to bed, but don't expect to sleep.

It is widely believed that one can curry favor with the Gods by taking calls for other crews, but methinks it folly to endeavor to please such capricious beings. Regardless of personal spirituality, this magical thinking pervades the station, and no one is immune. At any moment, horrible disaster could occur; It's a way of preparing your self.

Smoothie

Right now, if I run my hand across my cropped scalp, my fingers come away with an honest, earthy sort of aroma. Faintly familiar, yet muted by repeated washings, first with anti-bacterial soap, later by several shampooings. Lisa bent to kiss me this morning and was repelled by the odor. She said it reminded her of getting carsick, as a child, in her family's red Mustang. My new Airlift Northwest baseball cap may very well retain a permanent olfactory reminder of this morning. You learn some lessons the hard way.

Almost three years on the job, I claim the dubious distinction of being the lowest-ranking person on "B" shift. I have about a dozen guys below me, but none of our probies have been assigned to my shift. As befits such a dubiously distinguished fellow, completely lacking in any measure of seniority, I am the person who lays down, in the dirt, for the drill. I am the one with the dead-last vacation pick. And when there's a hole in the schedule, I pack up my box of bedding, my bunker gear, and I move it all somewhere new. I find myself scheduled to work on an aid car fairly regularly, but owing to my transient position, I seldom do. I can't claim more than a couple of continuous months on any one rig, at any one station. I ache for a permanent assignment; Constantly moving is a subtle extension of probation.

I have become versatile - I work on engines, aid cars, and, sometimes, the ladder truck. I have a broad knowledge of the City, whereas Seth, hired same day as me, has worked his entire, short tenure in the north end. I have worked with every captain, and more than 90 per cent of the suppression staff, in the same station, if not the same company (vehicle crew). This nomadism is a great way to meet people, but sometimes makes it difficult to find your groove, to cultivate that mix of partnership and smoothness that a seasoned crew possesses.

Smooth is good. A probational rite of passage, measured annually, is donning your airpack for time. The goal is to be packed-up, masked-up, in less than a minute. It's a standard in the fire service. It's a fairly simple process, anyone can do it, but it takes practised finesse to beat the thirty second mark. As a new recruit, your continued employment hangs on your being facile with your equipment, and you're tested regularly on this task. The stress of being timed, coupled with the importance of your perfomance, make it harder than really it is. A minor bungle can cost you valuable seconds that you might not have. The best and wisest advice I received was: "Slow is smooth; Smooth is fast." This scales to everything we do, especially when learning a new skill.

There's a dozen ways to tackle many of the calls to which we respond, but the smooth crew will effortlessly handle the situation. It takes a few shifts, and many calls, to polish the nuances of working together as a team, negotiating roles and responsibilities. You grow into each other, strengths complimenting weaknesses, flexibility accommodating rigidity. It takes time, time I seldom spend in a given assignment.

With six stations and a dozen assorted rigs, the details of my job change weekly. Even though the Department has standardized our engines, there are minor differences in equipment and storage, and every fire station is unique. Knowing which compartment contains the chain saw is smooth. Knowing where the toilet paper or batteries are stored is smooth. Knowing how to get to an address, through traffic and around obstacles, is smooth.

We get exhaustive training on the particulars of the BIG parts of our job: firefighting, CPR and EMT skills, deploying ladders and power equipment. Little things, details, are frequently taught by your peers, and often left as an exercise for the new recruit. When you move around a lot, it's easy to feel a little lost, to feel like the new guy. It can seem like navigating a pitch-black warehouse - you cautiously move in a straight line until you trip over something, walk into a wall, or bump your head.

I worked at station 42 yesterday, a comparatively rare duty on the aid car. I've spent enough time there for it to feel like home, but driving the aid car is a rusty skill. I turned south on the way to an address in the north, headed to the wrong hospital, made the bonehead mistakes everyone makes. My partner was a little rigid in his expectation of smooth. Every time I work with this guy, I come away from my shift feeling like a clueless newbie. It used to bother me greatly, until I realized it wasn't personal - he's critical of every partner. But I'd rather laugh over a minor misstep than defend it.

As driver, my responsibilities include maintaining the aid car, checking the fluids, aid kits, oxygen tanks, sundry supplies. This morning, we rolled on a call for difficulty breathing, just before 0700, which the medics transported to the hospital, on frosty streets. When we returned to the station, I backed the rig up to the fuel pump to top off the tank for the next shift. The hose wouldn't quite reach and I pulled about twelve feet of hose from the reel. After filling up, intending to save the next guy some effort, I made to leave the hose on the ground, rather than retracting it into the drum. To get the extra hose out of the way, I whipped the nozzle in my hand, neatly laying the hose along the station wall. In my mind, a slick and sensible technique - smooth.
The thimble-full of diesel remaining in the nozzle launched into the cold air, flying in a precise arc, splattering on my hair. Suuuunn of uuuuh... I hastily scrubbed my head in the bathroom sink, later laughing about my goof, over coffee, in the kitchen. And so now my hair stinks, and I continue to learn some lessons the hard way.

"Slow is smooth; Smooth is fast."

Rituals

I have, apparently, a psychic rooster - a faithful, imaginary bird. He's not keyed to the sunrise, like the roosters I remember. Usually, he wakes me up just before the alarm clock goes off, irrespective of its setting. I'll lay in bed, pondering the time, when the clock sounds. I wonder if there's some change in the sound the clock makes, as it approaches the designated moment, but I set the alarm, all the same, every night.

And so my eyes came open in the dark and quiet ward, ears strained to detect the tell-tale breathing of my brothers. The face of my watch glowed faintly, too faintly to read in the gloom, when I bent my wrist close. I was too awake to roll over and go back to sleep; the rooster had crowed. I wriggled out from under my sleeping bag and stood up, swaying, leaning against the bed, using it as a landmark. My clogs waited where I had kicked them off in the night, when we had gotten back from the low blood sugar call. A thin blue light, the other colors wrung from it, filtered around the curtains, and I shuffled to the door, pushing it open.

Squinting from the fluorescent glare, I scuffed into the tiled bathroom. I never flush the urinal if anyone's sleeping, and I washed my hands in a pencil stream of hot water. I could make out the squeal of an opening bay door above the splashing, and I felt, more than heard, the cough of the fire engine starting up.

On the stairs, I could taste the burnt coffee in the bottom of a pot, stewing on a burner. Instead of simply pouring myself a cup, I'd have to find coffee somewhere and brew a fresh batch. Guys are gonna want some coffee... I pulled aside the sliding door to the kitchen / TV room, reached for the light switches, noting a sleeping body in a recliner, under a blanket - one of the medics - I dropped my hand. I quietly slid the door closed again, and blinked my eyes until I could see better in the dark.

The Bunn's switches both glowed red in the gloom, and I crept to the fridge, opening the door half-way for some light. Back at the coffee machine, the foul dregs of a pot sat on the top burner, but fresh coffee was tinkling in the pot under the basket. I flipped off the top burner and washed out the carafe in the sink. I grabbed a pair of cups from the cupboard, returned the clean pot to the still-sizzling burner. I was a Ninja in the dark, deftly pullng the pot and replacing it with a cup. As the cup slowly filled, I topped off the other with the pot. Another Ninja move, and the pot was back under the basket, two cups held in one hand, and the fridge nudged closed with a toe. I only lost a drop or two as I opened, then closed, the sliding door.

Out in the app bay, I ducked into the hose tower to grab a long-handled brush. I stepped into the drizzle where Geoff was already hosing the grime from the previous day's work off the engine. A bucket of suds, a brush tipping out, sat at the tailboard. I dropped my brush into it, and handed a cup of coffee to Geoff. Inside the station, the morning tones went off, rousing the sleeping crew, lights coming on automatically.

"Thanks, Schlem!"

"My pleasure."

I gulped a hot mouthful, balanced the mug on top of one of the concrete-filled steel bollards that guard the garage wall, and grabbed a brush. I scrubbed the fire engine in the rain, Geoff rinsed.

Siren Song

The lights flash red on the backs of street signs, shop windows, the wet asphalt, a hundred shiny surfaces. Trees, poles, fences are frozen in a moment, the strobing suspends our relative motion as we pass in the dark. The siren screams high, then drops low. My hand reaches down, turns the switch to "wail", as we roll up to an intersection.

"Clear right." Any cars approaching on the passenger side are stopped. My partner returns to the map book in his lap, searching for the right apartment complex.

"Clear right," I repeat. "Thank you." Still, I double-check with a quick glance to the right. Pedal down, and we take off through our green light.

The aid car is heavy, and ponderous on corners. My eyes are narrowed, I focus into the distance for vehicles, pedestrians, any hazards on the road. Hyper-alert, I enjoy the challenges of driving priority through traffic. It's not speed that will get us to our destination quickly, but rather the dialogue of lights, sirens and the response by other drivers on the road.

A car is trapped between the median and a barrier, unable to pull out of the way. The driver panics, maybe freaks out, stopping in the road, right in front of us. Their turn signal is flashing left, but there is no left turn for them. Good Schlem is on my left shoulder, wipes off his milk mustache, whispers in my ear, Patience... I am slamming on my brakes, but I resist the urge to hit the air horn. My partner, Matt, is bracing against the dashboard. But Bad Schlem is on the right shoulder, swilling his martini, roaring, Dumbass! Move it! I agree, "Dumbass." The driver, apparently, solves this small problem, and accelerates past the barrier and pulls to the right. Bad Schlem coaxes me to hit the air horn, just a bit, as we pass the car. Let that be a lesson to ye!

Driving code, with flashing lights and blaring siren, is not a license to speed or break traffic laws. These visible and audible warning devices are our voice in the night, in the street, around the corner, begging your permission to take the necessary exceptions to the normal rules of the road, in this emergency situation. If you don't, can't or won't yield, I can't take those exceptions:
-Proceed past a red or stop signal or stop sign, but only after slowing down as may be necessary for safe operation;
-Exceed the maximum speed limits so long as I do not endanger life or property;
-Disregard regulations governing direction of movement or turning in specified directions.

It should be obvious that there's a lot of leeway for some chaos in those exceptions. Given, that all traffic has stopped, meaning: granted us the necessary permission, I can do whatever I need to do to get through or around traffic, provided, I drive with due regard for the safety of all persons. If I should cause an accident, there is no legal protection from the consequences of my reckless disregard for the safety of others. And that's the fine print in the Revised Code of Washington (RCW 46.61.035), the yin to the yang in the state law. An accident would comprise absolute proof that the safety of others was recklessly disregarded, and expect a lawsuit - against the City, the Department, and me. A fire engine weighs about twenty-two tons, an aid or medic unit seven and half tons- imagine a passenger car under that mass in a collision. When I check the speedometer, I am rarely exceeding the speed limit.

In addition to the two-dozen flashing lights and the 140 decibel siren, we have a secret weapon called an Opticom. Centered in the light bar, the Opticom strobes at a special frequency and traffic lights magically turn green for us when they detect it. This is what gets us through intersections and the associated traffic. The latest generation of Opticom utilizes infra-red pulses of light, coded to provide information about agency and emergency vehicle, but our system is old-school, just a strobing light. Urban legend has it that you can flash your high-beams quickly and trigger a detector at an intersection, but my experiments leave me thinking this is possible, but unpredictable. Suffice it to say, stopping oncoming and cross-traffic is a great tool for rapidly getting from point A to point B when shit happens.

About one hundred American firefighters are killed on the job each year. Sometimes more, sometimes less, but (barring unique tragedies like 9-11, which killed 343) the number oscillates around the one hundred mark. Of those deaths, roughly two-thirds are volunteers, the balance being paid, career staff. Firefighting is dangerous, but few firefighters are actually killed by fire. Most fatalities are directly related to cardiac issues, followed by vehicle or roadway accidents.

Arguably, the most dangerous thing we do is driving to the scene of an emergency, followed by working in the street or freeway. My kids, family, and friends worry about my safety whenever they see or hear about a firefighter getting injured in a movie, or on the news. They tell me, "Please be careful..." But they don't really understand the reality of the risks we face.

I think my department has a strong culture of traffic safety - we have the reflective vests and seat belt alarms to prove it. Every time someone gets behind the wheel and drives code, that culture is tested. Every time we operate on a busy freeway, assisting a driver, maybe cutting him out of his mangled car, mopping up the spilled life-blood of a vehicle, we put our lives on that very real line. We do it daily, and far more frequently than running into a burning building. We've been lucky, or careful, or strategic, so far. I try to keep it front and center in my brain, and both Good Schlem and Bad Schlem sit on their respective shoulders and kibitz.

Please, please, please, yield to lights and sirens. Your life, my life, my brother's lives, could depend on it.

NY State FF LODD Study: http://www.dos.state.ny.us/fire/LODDStats/LODDStats.pdf

Spittin' Image

I was born there, and I still lay claim to her as my original home. Plucked, up and away, to Bellingham, from Billings, when I was just four; the subsequent biannual drives, there and back, are etched deeply onto my memory. Montana is vast, and driving for hours, between points just inches apart on a map, lends a scale to the Earth that still inspires both awe and a little terror. Sawtooth mountains reach above the weather, ever on the horizon, as you slowly creep across the valley floors. There is no dust, no water in the air, and when you crane your neck, peering straight up, your gaze penetrates the stratosphere, to the edge of space.

A promotional pamphlet, published in 1895, touted Montana as The Treasure State, a reference to her abundant gold, silver, and especially copper, production. This name stuck until 1961, when, life imitating art, a representative of the state advertising department asked A. B. Guthrie, the author of The Big Sky, at his remote ranch, permission to use the title as a catchphrase to promote tourism. He reportedly agreed on the spot. The Big Sky sounds more like an ancient, reverent name for a holy place than a best seller about the fur trade, and for years I assumed it was. That Guthrie's editor suggested the title shouldn't prejudice your appreciation for the poetry in the words.

But the sky. The blue, blue sky. So deep, so rich, so full of promise, serenity, happiness, optimism, and over-arching love. I have various snapshots: bucking hay, driving the Beartooth, Christmas '76 - the sky is exactly the same, a perfect indigo that grabs me by the glands and whispers, "Welcome home." The landscape in Montana is writ with the American mythologies of Cowboys, Indians, of liquor and tobacco. The road to my Grandma's house is writ with irony, plastered onto a billboard.

This is my confession: I am a tobacco user. Not cigarettes, not anymore, not for a long time- I flirted with those in college, and gave them up easily enough when a certain young lady expressed interest, although I flirted with them for a while during the divorce - a sort of a relational bookend. I'm talking smokeless tobacco... the rough sawn, hard luck, boom town cult of chewin' tobacco. Chaw. Snoose. Yuck, yeah, right. Gross.

The fire service is thick with chew enthusiasts. More than you might expect. For every firefighter you see with a Cope ring on the back pocket of his jeans, there's several that have a habit they maintain covertly. The rationalization goes like so: "At least I can run the stairs." And they can. It doesn't affect their pulmonary function; they're not inhaling tar and all the lung-clogging crap associated with burning tobacco. But it will probably eventually affect their health.

Some guys always have a dip in, but it might be so small as to not require the signature spitting. Others just suck it up and swallow the poison. Might be the spouse, might be a private shame, but people, in general, frown on the whole spitting thing. Which I don't quite understand. Smoking exposes other people to your smoke when you exhale, but spitting in a coffee cup, or even on the asphalt, can be pretty benign when gracefully executed. The first time you empty a garbage can full of someone's tobacco spit, however, is a memory to savor and share.

At the state fire academy, I took a righteous stance against my fellow recruits' use of chew, and composed an anti-dippin' cadence. When they sang it I convinced myself that I was helping them, but no one quit dipping.

tell me when you've had enough /
eatin without teeth is rough /
why don't you have a nuther snuff?

the scariest thing I ever saw/
was the cancer that killed my grandpa/
why don't you have a nuther chaw?

I can't tell you what to do /
but I don't think you'll be able to sue /
why not have a nuther chew?

'fore you go I got a tip /
I don't think you need your lips /
why not have a nuther dip?

My friend, Dave, has probably been dipping for thirty or more years. He's my age, but only I started chewing tobacco less than a year ago, spurred by the boredom and privacy of working on my rental home. Ennui and a convenient 7-Eleven conspired to deliver a tin of Kodiak to my mucous membranes. I've known dozens of smokeless tobacco, chew, users, but I never understood the compulsion to pack the dip in the lower lip until I tried it.

There is a learning curve, and I advise the curious to avoid dipping while driving, during the early stages of skill acquisition. Retching in a cup, at sixty MPH, eyes streaming, is probably slightly more dangerous than talking on a cell phone while driving - with your eyes closed. -with no hands. -from the passenger seat.

Remember the blue, blue, blue, Big Sky of the Treasure State? That's the color of nicotine. That's the promise, the optimism, the warmth, friendship, and love that the drug vowed to me. For a while. Then I started to dip more, and it never again lived up to the initial promise of happiness. The tin of chew virtually buzzed in my pocket, reminded me of the lost euphoria, like fading Kodachrome vacation slides. The indigo existed outside my daily experience, and to even conceptualize the indigo required nicotine. Indigo became unobtainable. The world started to render in shades of brown, tans, washed-out slate tones.

I missed the indigo, and so I haven't had a dip in almost two weeks. The physical pain of nicotine withdrawal is really just a few days discomfort: headache, tension, grouchiness. Ibuprofen and beer help. So does exercise. It helps that dipping is a private endeavor; there's no second-hand smoke to taunt you when others indulge around you. I found it easy to refuse the offers of a shared dip. When asked if I was "packing", I explained how I was on the wagon, and had none to share. Don't come round here, no more.

I have my motives for staying off tobacco, but, foremost, stuffing carcinogens into my mouth seems ill-advised, given my family's history of cancers. I don't want my kids to take up tobacco, in the way kids inherit their parents' behaviors and values. And I don't like that I respond so easily, so willingly, to a nagging, whining addiction voluntarily carried in my pocket, with my change.

Lost and Found

Why not Velcro? The thought occurs to me once again, in this urgent moment. I'm fumbling with the zippers on top of the red oh-two kit, knowing the woman on the carpet needs to be ventilated. Right now. I've pulled the oxygen cylinder from the compartment in the kit, spun the valve on the regulator open. I'm ripping open the plastic bag containing the bag-valve mask, but the tubing is secured with a "quick release" tie that does neither. Randy has started compressions, but my world is reduced to this act of wrestling with the equipment in my hand.

The paramedics arrive right behind us, kits in hand. "Get oh-two and a BVM going!"

The BVM is finally assembled, and I'm trying to get air into our patient's lungs. Her head is between my knees on the stained carpet, and I am holding her head back and up, to straighten her throat, forcing the mask against her face with my fingers. Her cheeks are puffing out with each squeeze of the bag, but I see no chest rise under Randy's hands.

The same medic wants to know if she's getting air. "Randy, hold off for a sec, I want to see if this is working." He rears back from her chest, I squeeze the bag, her mouth inflates, nothing's getting in. Crap. "I need an OPA!" The oropharyngeal airway is the quickest way to get the air past her tongue, to her trachea, before one of the medics gets to the task of tubing her. Randy is pumping her chest again.

Off to my right, I see Brian, our newest medic, the man running this code, twist and pluck something from his kit. Engine 43 is on scene for manpower, and he hands Mike the OPA kit. After ripping the zipper open (another zipper), Mikes's comparing the length of an OPA against her jawline, ensuring we use the best size for her anatomy.

I open her mouth to find toothless gums. Ah, shit. Dentures? I scoop my gloved finger into her mouth, but her false teeth are not there. I imagine them bobbing in a glass of water beside the bed where we found her. I'm holding her mouth open like a trophy trout, and Mike is twisting the OPA into place, past the back of her tongue. The tabs are supposed to rest against her incisors, keeping the device from sliding deeper into her throat, but without teeth, it will just float in place. Good enough.
Randy's watching us, and pauses his chest compressions long enough to verify the tell-tale rise of her chest when I squeeze the bag again. I can literally watch the pure oxygen inflating her starving lungs. "Good air!" I announce to everyone.

I look around, timing the delivery of life-saving breaths to Randy's rhythm from the corner of my vision. Brian is almost done with the IV, and Eric, the other medic, has already slapped the patches on her chest, is taking a 12-lead, a recording of the this woman's heart's electrical activity.

Two minutes

Eric analyzes the patient's cardiac rhythm. We all cease what we're doing and move back from our patient, isolating ourselves from her. The monitor indicates that a shock is warranted. "Shocking." Her body barely twitches when he pushes the button. "Resume CPR." We start our second round.

Brian finishes hooking up the IV, and moves to the head, Eric pushing a syringe of drugs into the port on the plastic tubing. "Stop bagging, I'm getting the tube." He has the laryngoscope in one hand and an endotracheal tube and stylet in the other. He rips open the stylet package, inserts the flexible wire into the tube, and lays at her head, on the living room floor, on his stomach. He quickly shapes the tube into a graceful curve, the inserted wire holding the shape. Brian cranks her mouth open, the blades of the scope slips past her tongue.

He's looking through a fiber-optic eyepiece. "Cords!" I've never heard this announced by a medic inserting a tube, but I assume he sees her vocal cords, a critical factor in the successful placement of an ETT. It's in and Brian is trying to pull the stylet out of the tube, but his fingers are slipping on the plastic, threatening to pull the whole thing back out. I grab the loop of the stylet, as he holds the tube with both hands, and the wire comes out easily. A syringe inflates the cuff at the tip, and it's in.

Before the BVM is connected to the tube, Brian slips a short collar over the end. This collar is connected by a long, spaghetti-like hose to the monitor, screwed into the capnography port. The monitor generates a wave form, either on the screen or a printed chart, allowing the medics to observe their interventions' effects on the respiratory efficiency of the patient. The bag-valve assembly slips onto the collar, and I commence squeezing. Brian borrows my stethoscope, verifies that the tube is properly place.

"That's two minutes." My captain is timing this code with my watch's second hand, the clasp of which I had struggled to release through my glove. It's on a doily-draped table, and he's been glancing at it, between notations on the patient report.

Four minutes

Brian calls to stop CPR. "Check for a pulse."

Several arms reach for the woman's neck, competing for the task of palpating her carotid artery. Randy wins, "I've got a pulse..." His fingers rest a moment on her throat. "Sixty-four."

Eric turns to address the husband, perched on the couch across the room. He was in the kitchen, hyperventilating, when we arrived, and I don't know how or when he moved past us, to his current vantage point. "Sir, we have a pulse!"

"Is that good?"

"Yes, my friend. That's very good."

"I See Drunk People..."

"Hey Buddy." I shake his shoulder, firmly. "HEY BUDDY!" He's slumped in the stall, pants down, on the shitter. A small gash seeps on his forehead, probably from hitting his head on the toilet paper holder. A laptop case lies at his feet. Outside, behind me, several police officers and my crew chat in the train station restroom. My right hand seeks a radial pulse... ah, there it is. Not dead. My left hand cracks the ampule of ammonia inhalant, soaking the wrapper with pink foulness. I hold the sachet under my patient's nose for a long moment. He gently bats at it, the vapors plumb the depths of his addled mind. We call them Silver Bullets, the only tool for the job of rousing the poisoned, intoxicated, unresponsive zombie. At last, the odor finds purchase on his brain and pries the stupor out of the way, like a heavy door.

"Cut that shit out, man!" He swats again, this time his hand is pushing the ammonia away. I pull it away for a second and then firmly press it under his nostrils.

"Wake up. What's your name? Talk to me."

"Whatdaya want?" His eyes are open, unfocused, he grabs my hand. I withdraw, replaced by a police officer. A rambling conversation ensues. "Oh, a few beers," he allows. Humorless chuckles from the crowd. The station is closed. He is drunk, broke, homeless. A plan is formulated. I'm gloved up, closest, least senior; it falls to me to hoist his drawers, get him moving to a bench outside the men's toilet. This is, in fact, more difficult in practice than theory might predict.

He can barely stand, his pants are still fastened, belted, and catch on his skinny hips. He sways, I lift and steer him past urinals, sinks, out the door. His bare ass is covered by his coat, but I keep him at arm's length anyway. If he collapses I'll keep his head from hitting the tiles, but I will not get poop on me.

He's on a bench now, and I wonder if the cleaning lady who found him will scrub the oak after he's gone. The police are asking him questions again, while I collect vital signs. Does he have a medical emergency? Where does he want to go?

He wants a place to sleep, and the fire department is not needed. I pack up my kit, snapping the case closed, clack, clack. We stride out the doors, into the autumn night, to our idling fire engine.

Several times a day, miscellaneous fire department vehicles are dispatched to man down calls, usually called in by a well-intentioned driver with a cell phone. These alarms are routed to Fire instead of Police, despite an historical record demonstrating "man down" equals "public intoxication." Aid cars, engines, ladder trucks roll up on the address, searching for the patient, taking clues from the information relayed by the (frequently confused) passerby. Frequently, no patient can be found, or a blast from the air horn rouses them from their nap, and they move on, to seek a more private retreat. But, more often, we find ourselves standing above a drunk, shaking him by the shoulder, reaching for the trusty Silver Bullet.

In addition to blood pressure, pulse, and respiration rate, we assess our patient's level of consciousness, as a matter of course. If he answers questions appropriately, he's alert. As his LOC decreases, a response may require shouting or painful stimuli. Genuine unresponsiveness, an emergency in itself, makes the situation, instantly, more serious. Our assessment becomes more critical, and, in certain circumstances, perhaps a tad cynical.

It's not unheard of, to be called for a Police incident in which the subject suddenly goes limp, feigning injury or illness. In EMT school, we were taught to grind our knuckles vigorously into the sternum to elicit a response from the verbally unresponsive. It's old school, and requires no special skill. The sternal rub might reveal the BS in the BLS (Basic Life Support), but it looks bad when executed properly. "Why would that nice firefighter hurt that poor man like that?" an on-looker might ask. Try doing it to yourself, and see how much effort it takes to provoke a grimace. A better technique is to place your fingers behind the jaw, at the neck, and dig a finger into the hollow on both sides. This is innocuous, appearing to the casual observer as a tender, caring touch. Alternatively, a limp arm can be lifted over the patient's face, dropped, and observed. The arm of a patient faking coma will not hit his face, but falls adjacent to his head.

We go on these calls on the off chance that a real medical emergency has occurred. Last night we were dispatched to see a woman at a bus stop. "Unconscious, breathing, pants around knees." We arrived to find her draped sideways over the bus stop structure, bare butt in the air. Handing off an ammonia sachet, I sprinted to fetch a blanket from the rig, while Randy, our driver and former paramedic, checked her carotid pulse. I returned to find my captain and Randy lowering her onto the sidewalk. I covered her nakedness with the blanket and Randy set up the bag valve mask to assist respirations. He asked for an oral airway, a curved beam of plastic, "H"-shaped in cross-section, that keeps the back of the throat from collapsing, and closing off the air supply. She didn't gag on the device as it was twisted into position. That's a bad sign.

An empty bottle of vodka lay on the grass where her head had rested, and pills were found in her purse. Her clothes and shoes looked reasonably expensive, not the usual man down attire. Medics arrived, an IV was started, Narcan administered. One of the medics expressed doubt that the Narcan, a anti-narcotic, would have, with this patient, its magic effect. Sometimes, it sucks to be right. After they tubed the patient, I drove the medic rig to the ER, the engine following. We don't know what happened, we don't know her outcome. Seldom do we.

But, this I know: There will be man down calls. I make sure the kit is always stocked with barf bags and Silver Bullets.