This excerpt is reprinted with permission from “Trauma Sponges: Dispatches from the Scarred Heart of Emergency Response,” by Jeremy Norton. Early in his career, Norton, a captain with the Minneapolis Fire Department, realized that while waiting for the big fires that everyone said defined firefighters, the EMS calls that filled their shifts provided their best and most-frequent opportunities to help the public. These calls also tool a significant emotional and psychological toll on responders. Norton believes understanding that EMS work provides a direct engagement with the complicated sociological factors that shape our society allows a deeper connection to the people we serve and forces us to see people as individuals rather than types and stereotypes.
Ante up
I am the last member of our department to do mouth-to-mouth on an adult patient. No pocket mask, no plastic barrier: straight-up lips to lips.
It was Christmas Eve 2001 and we were called out to “one unresponsive” in a car in a garage. We arrived in front of a house festooned, like many on the block, with flashing holiday lights. Our flashing emergency red-and-blues blended with theirs. At the end of a well-shoveled driveway was a man waving frantically from the attached garage. I beelined toward the wan yellow light and whirling mist of exhaust. The car was still running. There was our patient, slumped against the car’s half-opened door. He was youngish, under forty. I turned off the engine, pulled him from the driver’s seat and onto the floor between the car’s rear tire and some yard tools. No pulse. Not breathing. Inside, I could hear the noises of a Christmas family gathering. No one but the adult relative who found the guy and called 911 knew what was happening. He was begging me to help, begging the patient to be okay.
With the distraught family member standing over me, and my sluggish crew members seeming miles away with the 02 and AED, I began breathing for him. Pinched his nose, tilted back his forehead, puffed two breaths into his mouth. I knew it wasn’t protocol—that, in fact, it was considered highly risky due to the possibility of infectious transmissions.
But I had to do something.
I gave a few breaths, checked for chest rise or pulse, and started compressions. Pressed down hard and firm in the center of his chest fifteen times, then pinched his nose, adjusted his head, put my mouth on his, and blew two breaths. I did several rounds of this before the crew assembled and we used our proper tools. We worked him on the floor of the garage for a long while. Slowly the noise from the Christmas party died out. Soon, there were family members crammed in the service doorway behind us, their wailing and cries mixing with the holiday aromas coming from the kitchen.
The man didn’t make it. The family’s Christmas joy (and many subsequent ones) was obliterated by his death. I didn’t get infected with anything. I haven’t done mouth-to-mouth since.
And nor should you.
Secondhand respirations are pretty ineffective in getting oxygen to a person’s brain—and a great way to suck in poison or infectious saliva. Compressions are the key to freelance CPR.
This was long after mouth-to-mouth was prohibited, mind you. I was rightly chastised for it, a few shifts later—by a captain who cared enough to pull me aside and read me the riot act.
“But”—I began my righteous defense—“he was down, and the others were so slow, and his poor family was standing right there. I had to do something!”
The captain shook her head. “Nope. Good intentions with bad actions are not how we do our job. You endangered yourself.”
I tried to argue that my noble intentions made it all right. That the guy needed me. That it’s our job: taking risks to help others. I puffed up: I’d do it again because it was the right thing to do.
All of which were wrong.
I put myself at unnecessary risk. I was no longer a rookie but I was sophomoric, headstrong. Confronted with a problem, I felt compelled to act: I had to do something. So, I did something. And that’s how I ducked under the safety rope and launched myself off a cliff in the Danger: Avalanche Hazard area of a mountain. Anything bad that occurred subsequently—as a direct result of my dumb action—was entirely predictable. I defiantly wielded the invisible mantle of hero: “I’m trying to help someone! This is my job! I’ll risk my life for another!”
In the moment, I wasn’t thinking, I was acting—without clarity of purpose. And that is precisely the danger. Our duty is to protect life and property: to risk a lot to save a lot; and, importantly, to risk little for that which is already lost. A suicidal (dead) man deserves help, but my putting myself at risk to deliver essentially useless breaths for him helps neither of us. Grandiose, futile gestures should not be part of any operations manual or any organization’s unofficial culture. In fact, it is our active refusal to use relevant contextual information that puts us in pointless danger. When we persist with unnecessary, unjustifiable, risky behaviors, and when those actions produce predictably dire consequences, we fall back on the Heroes’ Sacrificial Duty: “That’s our job!”
Firefighters employ an unspoken, likely unconscious rationalization: that because we help people, we magically accrue good karma. That because we put ourselves out there, into the fire and catastrophe, helping strangers, we are paying indulgences against our own foolishness and mortality. As if our good works will balance the ledger against our own risky actions. Thus, when an emergency responder falls—to bad decisions, unjustifiable risks, gravity—we collectively shudder and cry, and the news anchors drop into their very-somber-inflection voices: “Tragic news out of Fireville today, a forty-five-year-old firefighter fell through a hole in the clouds. He was base-jumping in a hurricane. A shocking, unexpected tragedy. Things like this shouldn’t happen. He was a firefighter, after all.”
It is not based on anything—no guarantee from God or payroll or the union. Nowhere in any of our contracts does it say that “for every seven shifts worked, member will be granted .33 of an extra year of life.” But we, a bunch of thrill-seeking, risk-taking, adrenaline junkies, seem to believe that our good works protect against the forces of nature—and our dubious choices. Your number, my number, everyone’s number comes up, eventually. In the same way many of our patients are truly surprised that something has happened to them, we’re surprised that nature and the laws of physics—gravity in particular—aren’t swayed by our badges and swell mustaches.
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Excerpted with permission from “Trauma Sponges: Dispatches from the Scarred Heart of Emergency Response,” by Jeremy Norton. All rights reserved. Used by permission.
Published by the University of Minnesota Press (2023).
Copyright (2023) by Jeremy Norton.
Available from the University of Minnesota Press.
About the author
Jeremy Norton joined the Minneapolis Fire Department in 2000, promoted to captain in 2007 and to battalion chief in 2015. He missed running EMS calls and returned to the rigs in 2017, where he remains captain of Engine 17 in South Minneapolis. He is a native of Washington, D.C., educated in the Boston area; he taught high school in Chattanooga, Tennessee, before moving to Minneapolis in the mid-90s.