Wednesday, June 24, 2009

A Shred of Dignity

The solitude of an otherwise empty captain's office is shattered by the tones, then dispatch sending us to assist Engine 19 on a reported medical aid. This is odd, because Engine 19 has 4 persons on it, one of whom is a medic. Further compounding the oddity is that we were reduced to code 2 shortly after leaving the station.

I tell the engineer to kill the lights as I turn off the siren. The drive to 19's district is across town and takes a few minutes.

We arrive on scene and found E19 parked in front of a small house. The ambulance and a couple of cop cars are parked on the darkened street. There are a few sobbing people standing in the front yard. We enter through front door, where we find 6 or 7 more people standing in the living room. They are in various levels of composure. A couple of the engine guys are standing in the door that leads into a hallway. The hallway has a few bedrooms off of it and ends at a bathroom.

The captain from E19 and the ambulance guys are discussing something as I enter the hallway. Through a partially opened door, I can see the lifeless form of a huge man laying on the floor of a small bathroom.

Rocky, E19's captain, tells me that their patient had been determined to be dead. The chore now was to remove him from the bathroom. The patient weighed well over 450 lbs. and had fallen in a way which prevented the door from opening fully. There was no way to get a good grip on him and definitely no way to get enough people in the bathroom to move him. It doesn't look like he fit through the door to begin with. He is wearing only his underwear.

Rocky tells me that he called us out to assist, as he thinks that we are going to need to remove the wall that separates the bathroom from the hallway. The toilet will have to be removed as well. I understand the reasoning of his plan, but I have a problem with the amount of destruction that we are going to cause.

As I look at this small home and the ever increasing assembly of family members, I get the feeling that the cost of reconstructing the wall, at least of reconstructing it properly, is probably beyond their reach. I imagined that every time they went into the bathroom, they would see a partially repaired wall and they would think of their loved one and the destruction required to remove him.

Even if we remove the wall, we are still going to have to find a way to move him down the hall and out into the living room. There just isn't enough room in the hallway for us to get six people on this guy to move him properly.

Rocky, my crew and I have a conference in the hallway. I present my position to Rocky, as it his incident. I tell him that our victim fit through that door before he collapsed and that he will likely fit through it now. I explain that we will have to use webbing to raise up the victim then open the door and remove it from the hinges. That will by us a few more inches. Then, we will use the webbing to drag our victim through the doorway and down the hall. A 90 degree turn, another doorway and we will be done. The length of the webbing allows us to get four people pulling at once, two per side. Another will be used to help guide and force the victim through the doors. We reach a consnsus, the plan is born.

The image of a deceased person being dragged down a hall and stuffed through two doors is not a pleasant one. I would not want to treat one of my pets this way, let alone one of my relatives. However, I felt that this was our best option.

Rock and I take a look at the people in the living room and pick out the person who looked the most composed and maybe the one with some influence in the family.

We approach him. "Listen, we are going to move Raffe into the living room. We are going to try and be as gentle and dignified as possible, but Raffe is a big man and it's going to be a big job. You and your family don't need to see this. Do us a favor, try and get everybody into the front yard. Give us 10 maybe 15 minutes and we will move him. As soon as we get him into the living room, we'll cover him up and then we will let you back in".

This family member agrees and is able to get everyone outside without too much trouble. We begin the operation and after twelnty minutes and a lot of work, our victim arrives at his destination.

We have to replace his underwear, it had partially come off during the operation. We get a pillow from somewhere and place it under his head. We try to position him in one of comfort and finally cover him with a blanket pulled off of a bed.

We go outside and I find the family member. I tell him that we are done and I explain to him that we tried to be respectful. He thanks us as he and a couple of other people enter the house. One of the deputies agrees to wait for the coroner and we return to service.

I have conflicting feelings as I recall this incident. I regret that we could not treat our victim with a little more dignity, but am somewhat happy that we were able to move him without tearing up the house. I also feel that we spared the family a lot of grief and that somehow, we lessened the impact of losing a loved one. I guess that is the best we can hope for.

Thanks for reading,


  1. Cap,

    You guys did good. I've taken my crew back to the scene to clean up stuff (in service) after a couple of really bad calls, just to make things easier on the family. We do what we hope thers would do forus if it had been our family involved.


  2. Hey Cap,
    Nice work on recruiting a family member and your approach to them. I will be sure to keep it in my toolbox. The fact that you were concerned about Raffe's dignity and his family's feelings must have been a real comfort to them.
    We once had a 725lb live patient that required a 3:1 rig and a stokes basket to get down a narrow hallway to the ambulance. We were afraid to lift the stokes off the floor/ground anymore than absolutely necessary so we just used cribbing to slide the stokes up over the normal stretcher holder to safely transport her to the hospital at low speed over surface streets.
    These calls are challenging on so many different levels: Pt safety, FF safety, customer service, special resources (bariatric hospital beds, special tools/rope, extra lifting at the scene/hospital, etc. that it is easy to forget about the pt's dignity and the concerns of family.
    You and your crew made a terrible day a little better for your citizens...

    and that's why they pay us the big bucks. :)

    P.S. Now I have another blog to check...sigh... thanks FireGeezer!

  3. Just found your blog through another that I read daily ('Cockpit Conversation'), thanks for writing. I plan on checking back every few days to see what is new!

  4. Thanks for the kind words. I am going to add F.N. Dave, that we are much better equipped for these types of calls these days. We have heavy duty mats with 4 straps along each side - much easier to move someone in a dignified manner. AMR has purchased a special ambulance as well.

    Thanks again for reading.

  5. Hey Cap'n --

    I think a good many of us have been in similar situations, what with the American lifestyle having become what it has, various medical conditions contributing to obesity, and all that. I thought the decision you made and the way you guys handled things was smart, and probably the best you could've done given the circumstances.

  6. A few years after I started in EMS we had a call with 500+ lb patient who could not walk. We live in a remote, small town without a large resource pool to draw from. Naturally the house was small with narrow doorways. Several 90 degree turns stood between the patient and the rig, but thankfully, few stairs. Try as we might, there was no way our crew could move this woman. I ended up going to the local hospital and returning with a PA and RN, who we assisted in starting IV therapy. The hope was to get her well enough that she would be able to help us get her to the hospital. A visiting RN would continue therapy and hopefully things would improve. The plan didn't work.

    A few days later our agency received a second call to the same residence. The patient was worse, the ulcer on the lower leg was looking gangrenous and now there was no choice about transport. I was not on the call but I was told that the end result was a fiasco. As we had no equipment that could handle that weight, a local moving company was called in to assist. They brought a device they used for moving large refrigerators and freezers. The woman, conscious, was strapped to it's deck and doorframes and parts of walls were removed to liberate her from her home. The movers, not trained in EMS, were not delicate in their wording, and man-handled the woman with little regard for her or her watching family.

    Ultimately she was loaded into a moving van (our rigs couldn't handle the load) and delivered to the hospital. She arrived, an emotional wreck, traumatized more by the experience of moving her than by her injury, which would finally kill her about three weeks later.

    I have often thought about that last call and tried to put myself in her shoes. Her last memory of her home would be of the destruction that was caused and the sometimes cruel comments uttered by persons who didn't know any better. Her family witnessed the whole horrid event. My friend who later told me about the call, said he was almost sick when the woman's husband walked over and thanked him for all that was done to get his wife (of over 40 years) to the hospital.

    Thank you for making your opinions known and giving that family the dignity that they deserved. We are not all as fortunate in the choices that we are forced to make. But, we learn as we go along and hopefully don't make those mistakes as often.

  7. Just brilliant. It's nice to see that they're still compassion and pride. I love the fire/ems service and I love open minded straight forward thinking. Great job brother.. great job. Sleep easy - you made the best possible decision.

  8. While there is something to be said for contributing to a large person's dignity, there is also something to be said for personal responsibility for preventing said diabesity also. Good post.