A siren screamed as Engine 66 raced down El Camino Real on its way to a medical call. Once there, the three-man crew jumped out of the fire truck packed with hundreds of gallons of water and thousands of feet of hoses.
Lugging potentially life-saving equipment, they made their way to the third floor of the Clark Building of Palo Alto Medical Foundation, where a 51-year-old woman was lightheaded, sweating and feeling like her heart was racing symptoms of supraventricular tachycardia.
Seconds count with most medical emergencies, so the firefighters quickly took the woman's history, monitored her heart rate and breathing, set up an IV to deliver fluids and treated her with a fast-acting antiarrhythmic drug, which essentially stopped her heart for less than a minute and restarted it.
"I feel weird," the woman said.
"That means it's working," a firefighter told her, adding that people who are treated with adenosine often say they feel weird after the drug takes effect.
After treating the woman, paramedic and firefighter Tyler Ecoffey sighed with relief as he peeled off his latex gloves.
"You don't get to do that every day," he said of administering the shot of adenosine.
It wasn't the first medical call the three were deployed to that September day, and it wouldn't be their last.
In the next 24 hours, the Palo Alto firefighters would respond to four calls involving chest pains or shortness of breath, one person who fell due to a medical issue and one residential carbon-monoxide incident.
While many people maintain an image of firefighters hanging around the fire station waiting for a blaze, today's firefighters do far more than battle infernos. They are the first ones to respond to chemical and environmental emergencies, including suspected chemical odors or a natural gas leak. They are called to rescue a hiker who has fallen off a steep embankment and people trapped in cars after a crash. They also assist victims of heart attacks, strokes and other trauma.
Fire departments across the Bay Area, including the Palo Alto Fire Department, have evolved into multifaceted agencies in which firefighters are expected to have knowledge of and maintain adept skills in emergency medical services, technical rescue, hazardous materials, firefighting apparatus and equipment operation and maintenance, public education, disaster preparedness and, of course, fire fighting.
And because of this, there is no "typical day" for Palo Alto firefighters each 24-hour shift brings new kinds of training exercises as well as new challenges.
Medical calls dominate
Palo Alto firefighters know well the ebb and flow of fire service: One minute, they're watching TV or chowing down on lunch, the next they're racing toward an emergency. And when the printer churns out a call sheet, chances are it's some kind of medical problem.
More than 60 percent of the fire department's calls for service are medical in nature, Fire Chief Eric Nickel said. The calls have been increasing due to a growing and aging population, he added.
"Palo Alto is a very vibrant community, but we also have a large portion of the community that is older," he said. "Seventeen percent of the community is aged 65 and older, and that's considered a high-risk group not only for fires but also medical emergencies.
"We fully expect to see in the next 10 to 15 years our emergency medical calls for service to increase, and that's where we're trying to position the department," he said.
In response to the rising demand, city officials have made several changes in the department, which is the only one in Santa Clara County that provides ambulance service. Changes include an expanded medical-response operation and a greater emphasis on emergency planning.
In January, the department adjusted its staffing so that every fire apparatus and station (there are six year-round stations in the city; a seventh operates during the summer months) has at least one Advanced Life Support paramedic to handle serious emergency calls. That's in addition to crews of firefighters who are trained as emergency medical technicians, capable of administering oxygen, using automated external defibrillators and performing CPR and other basic life support.
The City Council, in October, approved the purchase of two Type III ambulances to add to the city's existing three full-time ambulances, which are strategically positioned in northern, central and southern portions of the city. The goal, Nickel said, is to reduce the city's reliance on the county's ambulance provider and continue to meet the department's target of getting to medical emergencies within 12 minutes, 99 percent of the time.
"My ultimate goal is to have an ambulance at every fire station that's cross-staffed by the engine company," Nickel said.
Firefighters responded to 7,829 calls in fiscal year 2014, according to the City of Palo Alto 2014 Performance Report. Of those calls, 4,757 were medical/rescue-related a 31 percent increase from fiscal year 2005, when the department responded to 3,633 medical/rescue situations.
And while medical calls have shot up, the frequency of residential structure fires has decreased dramatically. In 2005, the department responded to 58 structure fires compared to 15 in 2014.
Firefighters at Station 6, located on the Stanford University campus, will respond to on average six calls in a 24-hour period. And when Eric Heller, a paramedic and truck driver, arrives on the scene of a call, it's not a fire hose he pulls out, it's a pair of latex gloves and a medical bag.
A majority of the medical calls he gets dispatched to are alcohol-related "Students who are intoxicated," Heller said. Other frequent incidents include car-versus-bicycle crashes and sports injuries.
"Often times, we respond to the elderly population," Heller added. "We have a lot of convalescent homes that seem like they're only increasing over time, so our calls to those are very frequent."
Heart attacks, strokes, falls and chronic respiratory issues are common refrains on the dispatch radio, so the practice of sending both a fire truck equipped with oxygen, defibrillators and other first-aid essentials and an ambulance is commonplace.
It takes Palo Alto firefighters eight minutes or less, 90 percent of the time, to respond to a medical call, according to department statistics. The fire department uses a system that relies on GPS to dispatch the closest available unit (ambulance, fire engine or ladder truck). The system can also look at traffic patterns.
"If it's a critical call, the paramedic usually takes the lead and the EMT-trained firefighter will assist the paramedic," Heller said.
Cardiac arrest is a common call. Typically, a fire engine with three firefighters and an ambulance with two medics will be dispatched.
"We never know exactly what the situation will be until we arrive on scene," said Mike Espeland, a paramedic and firefighter on Truck 66.
At a cardiac-arrest incident, they are performing multiple vital tasks: controlling the person's airway, performing chest compressions, watching the heart monitor and getting the defibrillator ready, putting an IV together, getting the appropriate drugs, supervising the patient, documenting the scene and explaining what's going on to the patient's loved ones and comforting them.
"It's not enough. Five people on a full arrest, in my opinion, is not enough. We need another two bodies, at least," said David Villarreal, another firefighter on Truck 66.
Extra hands and bodies may look excessive, but it is important in addressing the critical needs of the patient, the firefighters said.
"I can't walk away from a patient to get stuff and bring it back, so I need to delegate to other people," Heller said. "Everything is done simultaneously ... and all the steps are done peripherally while I'm dealing with the patient."
Responding to a medical call is no different than responding to a structure fire or motor vehicle accident, the firefighters said.
"There's so much going through your head, and you're filtering it through real quick," Heller said. "You're thinking about the same kinds of things (how many victims, what kind of injuries, what kind of equipment to bring in, etc.) ... so you can get an idea in your head even before you get to the scene."
There are also medical calls that require not just medical skills but also rescue skills, like car crashes and industrial accidents, Fire Captain Barry Marchisio said.
"We not only have the skills and abilities to extricate the person from the problem but ... also the ability to treat that person medically," he said.
When Villarreal responds to a car crash, the first thing he thinks about, he said, is where to park the 60-foot truck he's driving.
"It has to be in a location that is suitable and useable," he said.
Then Villarreal assesses the situation: Is extrication needed, in which case they use hydraulic shears and cutters, or medical aid?
"Usually when we get called, it's a big wreck and we're cutting people out of cars," he said. "So when I'm driving in, I'm trying to figure out where I want to put the truck. Then second is how bad is the wreck, how many cars are involved and what kind of car is it.
"The training I have goes into play now. I feel like I've been doing this for so long (that) when I start cutting up a car ... the technique is so far removed; it just happens. It's second nature," he said.
In a multivehicle crash, the firefighters have to assess the victims and decide who needs to get to the hospital first, which isn't always the most critical victim, the firefighters said.
"The worst-off patient generally isn't really the one we want to get out first," Villarreal said. "It could be the person that is not as badly injured but is viable. We have to make those decisions ... and it's difficult."
Training never stops
For the firefighters at Station 6, their 24 hours on is also spent in training exercises to prepare for potential emergencies: building collapses, vehicle accidents, structure fires and the like.
"We do a lot of drills," said Manny Macias, a firefighter on Truck 66. "We set aside two to three hours a day just to do training, and we don't do the same training every day because we want to be diverse in what we do."
On this particular day, the crew staged a mock rescue in the San Francisquito Creek to practice how to rescue someone in steep terrain.
"One of the reasons we do drills is to keep our skills up," Marchisio said. "A real call won't happen exactly the way it will happen during a drill, so we have to be able to modify our operations and recover from the mistakes we might make, and training gives us the opportunity to practice that."
When the firefighters and paramedics arrive on scene of the mock rescue, they assess the situation with urgency quickly locating the victim and considering the best approach for access and rescue.
In this case, the firefighters performed a high-angle rescue, using the aerial ladder on Truck 66 as a high point to lift the victim out of the creek.
"Obviously the rescue of the person is important, but you have to go in and figure out what's going on and make the scene safe before you go in and do what has to be done," Truck 66's Fire Captain Will Crump said.
The paramedics made their way down to the victim, a 40-year-old male with a head wound (played by a dummy), to give him initial medical care while the firefighters set up the hauling system.
Extending Truck 66's 100-foot aerial ladder skyward to its full height, a stokes basket was suspended from a rope that was passed over a pulley system, which itself was attached to the top rung of the ladder. The process called for precision, as the firefighters made sure every rope, knot and pulley was secured in place.
The victim, strapped to a backboard to prevent possible spinal and neck injuries, was placed in the stokes basket.
Slowly and methodically the firefighters pulled the victim up with commands from a point person. Once the victim was out of the creek and on level ground, the firefighters and paramedics gathered around to review the training session.
"I like to give everyone an opportunity to share what they saw, what they did, what went well, and what they could have done better," said Crump, who has been a firefighter for almost 20 years and was a corpsman in the Navy. "To me, everyone's voice is valuable. I think when you do a drill and after the drill you talk about it, what you learn is more ingrained."
Other hands-on exercises the firefighters perform include high-rise structure fires (which are done in a training tower at Station 6), ventilation, forcible entry, auto extrication and confined space and trench rescues.
Practicing the life-saving skills and techniques until they become instinctive is critically important, Crump said.
Still, no matter how many drills and training sessions they conduct, Macias said he is mindful that each real call they get could be the single worst moment for the person on the other end of the line.
"We see people on their worst day," he said. "Our job is to do whatever we can to make things better."
And the biggest thing firefighters can do, Macias said, is to be compassionate, as well as prepared to "go above the call of duty" when emergencies strike.
"We have a downtown area that has high-rise buildings. We have two major hospitals, a major university that creates its own problems, and we have thousands of acres of wildland, and that's a whole different type of fire problem," Marchisio said. "We have a railroad that goes through town and two major freeways and the baylands and all the rescue issues that happen out there."
A state of readiness
Aside from responding to calls and training, personnel at Station 6 wait for calls, write reports, exercise, eat and watch TV. (Read "Working, living together forges bond at 'home way from home'")
For dinner, the crew pools money for groceries, and on this day, Marchisio made one of his specialty dishes: chicken marsala. The firefighters dined like family on the hearty pasta dish, Caesar salad and bread, sharing stories, laughing and poking fun at one another.
"Everyone gets along," said Macias, who has been a firefighter for 22 years. "We're having fun, but I guarantee you when those bells ring, everyone switches to a different mode, and it's completely business. And that's how it has to be because we have to have a way to relieve our minds, and I think we do it by joking around and laughing."
After the dishes were done, the crew wound down. Some of the firefighters called home; others took showers or watched TV (Their favorite show: "Cops"). Heading for bed, some went to private rooms and others to dormitory-type sleeping quarters furnished with twin beds and old-fashioned tube TVs. (The firefighters bring their own pillows and sleeping bags or sheets and comforters.)
If there's a call in the middle of the night, bells and lights go off in the sleeping area, and the firefighters have to jump out of bed and be on the fire apparatus, ready to go.
"We're always in a state of readiness," Ecoffey said. "We sleep, but it's not a deep sleep."
After dinner, on occasion, the firefighters go out together to get ice cream or frozen yogurt, which also gives them the opportunity to meet the public.
"Most of the time when we're interacting with the community it's during an emergency," Crump said. "We actually get a lot of positive feedback for being out in the community on non-emergencies. People will see us out, and they always come up and strike up a conversation with us."
Macias, who is a self-described "people-person," said he enjoys talking to people and educating them on what being in the fire service entails because people may not know what firefighters actually do "just like how we don't know what a lot of people in the city do for a living."
"That's how I like to connect with people," he said. "And the best way to connect with parents is through their children. You get the kids interested about firefighting and fire prevention, and their parents will want to know too."
Building a rapport with the community is especially difficult for the firefighters because none of the department's more than 90 firefighters (members working in the six fire stations as well as supervising chief officers) call Palo Alto home.
"Most firefighters live outside of the area and commute in, unlike a lot of places where the firefighters are able to live in the city they work in and are able to be a part of the community," said Crump, who commutes from Burlingame.
Statistics from the fire department show only 32 firefighters live in Santa Clara County (in cities including Campbell, Cupertino, Gilroy, Los Altos Hills, Morgan Hill, Mountain View, San Jose, Santa Clara and Sunnyvale), 14 live in Alameda County, 13 in Contra Costa County, 12 in Santa Cruz County, and the rest are scattered around the Bay Area or even outside of it.
To build a bond with the community, the firefighters take part in events like block parties, the city's Art and Wine Festival and Chili Cook Off, as well as union-sponsored events, they said.
But the high numbers of out-of-town firefighters could matter tremendously after a natural disaster like an earthquake, if emergency responders aren't able to make it into the city, Fire Chief Nickel said.
"It's an issue that all fire departments in the Bay Area are facing right now," he said. "Particularly in Palo Alto and on the Peninsula, the home values here are so steep, even with salaries and benefits firefighters get, they can't afford to live in Palo Alto."
A majority of the firefighters live one-and-a-half to two hours away, Nickel said, "so you have to drive a great distance and when a disaster strikes, it's going to be probably days before our crews can get back into the city."
Fortunately, Palo Alto has active neighborhood preparedness groups that are trained and prepared, so if an emergency does strike, community members are able to step up, he added.
Regardless of where they reside, longtime firefighters like Crump, Espeland and Macias said they wouldn't leave Palo Alto to work for a department closer to home or for one that pays more because they're too invested in the community they serve.
"It's a generational thing," Espeland said. "We came from a generation where our parents worked somewhere for 30 years, and we grew up knowing that and that's what we do. We've committed a lot of time, energy, blood, sweat and tears to this place, so it's a little hard to walk away."