Incident Command for Dummies (or EMS officers)

I think there are 16 floors, I can’t remember. It’s one of the older housing units in the city. A recent makeover helped, but it is tired. A lady called from the seventh floor, history of COPD and a multitude of other health issues. The call was dispatched as an ALS run, Engine 3 and Rescue 5 to respond.
My overtime shift at R-5 was nearly over. What was the worst that could happen?
Ladder Company 1 was on the air at the time and took the call for Engine 3. They arrived on scene, took the elevator to the seventh floor, and did an assessment of the patient. She was 60 years old, complaining of increased shortness of breath that started a few days ago. She was wheezing, with some jugular vein distention, and really struggling, SPO2 in the low 90s. The guys from Ladder 1 put her on 02 and started to get some vital signs.
Rescue 5 arrived on scene, gathered our gear, and headed for the lobby. I opened the outside door and was greeted by a frantic maintenance man.
“There’s heavy smoke in one of the apartments!”
Heavy smoke in a high-rise? An old high-rise? An old high-rise full of people? An old high-rise full of old people? An old high-rise full of old people with a smoke condition; a ladder company on the seventh floor treating an old person with COPD; and an old firefighter turned rescue officer in the lobby, holding a med bag and an oxygen bottle!
“Pull the box,” I told him, noticing that the fire alarms had yet to be activated. I radioed fire alarm and gave a preliminary size-up: report of smoke, location to follow, box manually activated.
“What apartment?” I asked the maintenance man.
“Is there anybody in the apartment?”
“I don’t know; the smoke is too thick.”
Great. People were milling around the lobby when the fire alarm finally activated. Rather than making an orderly evacuation, they pushed the elevator buttons, angry that they were disabled and annoyed by the sound of the smoke alarms.
“What’s wrong with the elevators?” they asked when they saw me, totally disregarding the fire alarms.
“Fire! Everybody out!” I said. I was the incident commander after all.
The herd looked at me as if I had lost my mind. A fire alarm? What on earth is he talking about? Fire? Here? Never happen! They continued pushing the elevator buttons or headed for the stairs. Nobody evacuated or even considered it.
I’m now the incident commander at a high-rise fire. I’m stranded below the fire floor with inactive elevators and a patient in possible CHF on the seventh floor and a crowd of unruly residents.
What’s the worst that could happen?
John, my partner for the day, took to the stairs with the med bag while I stayed in the lobby. Ladder 1 transmitted that they had the patient stabilized and sent half of their four-member crew down the stairs to investigate the fire.
“Ladder 1 to Incident Command, heavy smoke in apartment 205, Code Red.”
I waited for the incident commander to respond. When he didn’t, I realized why. I keyed the mic.
“Command received.”
Two words. The million other words that were rummaging through my brain stayed there. Sirens closed in, and the cavalry was close. The sight of those big red trucks approaching the building, first Engine Company 3, geared up and off the truck before it had rolled to a complete stop and in the door and past me toward the stairwell; then Division 1, the chief, parking the command car away from the building; Ladder 6 from Olneyville set up on side 2; Engine 14 at the standpipe; and Special Hazards following the 3s was the most beautiful sight I had ever seen.
I gave the real chief a brief size-up as soon as he entered the lobby and relinquished command to him, and he did the chief thing the way it was supposed to be done, as I resumed my role as rescue officer. I got a radio report from the seventh floor, then commandeered some elevator keys from one of the guys and activated one of the cars, loaded my EMS gear and the stretcher into it, and took it above the fire floor toward the original and hopefully only victim. John had made it to the patient on the seventh floor, administered some Albuterol, and had reassessed her vital signs. We packaged her up, calmed her down, and made it to the elevator, to the lobby, past the firefighters, where the firefighters from Ladder 1 joined the firefight, and into the rescue, back where I belong.
God, I love this job!

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