By Larry Johnson, NRP, CHW
Sunday shifts have a particular rhythm to them. Slower. A little quieter. I walked into the CareFlite Dallas dispatch center on the morning of Feb. 28, 1993, expecting exactly that. I was the senior flight paramedic with over a decade in emergency medicine behind me at that time. I thought I had a pretty good idea of what the day had in store.
I did not.
The call came in that morning. Mass casualty. Federal law enforcement. Multiple gunshot wounds. Head toward Waco.
I would not return to a normal shift for 51 days.
Into the fire: More than three decades later, I have written a book about it. “Into the fire: A paramedic’s battle with Waco and the aftermath “is the first firsthand account of the Waco siege told from inside the medical response. You have read the tactical story, the legal story, the political story. Nobody has ever told the EMS story. This is it.
The morning everything changed
When “mass casualty” and “multiple shooters” stop being training-exercise words and become a real-time dispatch call, something shifts inside you. A narrowing. Everything that is not immediately relevant just clears out. I have tried to describe that feeling in the book, and I am still not sure I got it right.
We lifted off and we flew south, piecing together fragments of radio traffic on the way down. The ATF had raided the Branch Davidian compound at Mount Carmel. The operation had gone catastrophically wrong.
Four ATF Special Agents were dead on arrival: Conway LeBleu, Todd McKeehan, Robert Williams and Steven Willis. More than 20 others were wounded.
I have responded under conditions no training course fully prepares you for. You make decisions in seconds, and you move through them as fast as you can. You do not let yourself feel the weight of any single one until later.
Later always comes. That is really the whole story, right there.
Fifty-one days on the perimeter
Most people think of Waco as a single dramatic event. For me, it was 51 days of showing up.
After the FBI assumed operational control and the standoff stretched on, I was told to maintain the medical perimeter. I rotated shifts. I staged pediatric equipment. I calculated medication dosages for patients who were not yet in front of me and might never be. Every morning, I arrived with the same professional composure EMS demands of you. Every evening, I carried something in my mind that training never taught me to set down.
In the first 6 days, 21 children were released from the compound. Most had been born inside Mount Carmel and had never left. I watched a 5-year-old girl encounter a flushing toilet for the first time. She approached it with total focus, working out how it functioned, not frightened, not delighted, just carefully processing a world she had never seen. I have thought about her many times over the years.
After 6 days, the releases stopped. The remaining children stayed inside. Twenty-two of them died in the fire on April 19, 1993.
That number has never gotten easier to write.
“Into the fire”
I chose “Into the fire” as the title of my book. It works on two levels, and if you have spent any time in this profession, you will catch the second one immediately.
The literal fire was April 19, 1993. The day the compound burned. The day seventy-six people died.
But the job itself is another fire. Every shift. Every call. Every time you cross the distance between safety and emergency and step into the middle of someone else’s worst moment. Flight paramedic, street paramedic, rural EMT running solo at 2 a.m. — it does not matter. You know what that threshold feels like.
I have been crossing it for nearly five decades. And somewhere along the way, I started thinking about the weight we carry across it, and what the profession owes the people who keep going back.
That is the other story inside this book. Not a lecture. Not a list of statistics. Just an honest conversation, from someone who has been there, about what this work actually costs, and why that is worth talking about.
For anyone who has had that call
Every provider who has worked the street long enough has one — the call that does not settle the way the others do. The one that surfaces without warning years later, because of a sound, or the way light hits something, or the smell of smoke on a particular kind of morning.
By naming Waco as mine, I am hoping to give every reader permission to name their own. The scale is different. The history is different. But the structure of the experience, crossing a threshold, carrying something home you did not arrive with, is the same whether you ran that call last week or 30 years ago.
This is the book I wish someone had handed me a long time ago. I hope it finds the people who need it.
And when the next call comes, you go again. Not because it is simple. Not because it is safe. Because going is the commitment. Because the person on the other end of that call needs someone who made that commitment and will keep it.
Additional resources
- 8 ways to support your own mental health. These tips, tools, products and services are designed to promote emotional and psychological resilience
- Mental wellness check-ins: What they are and how they help. The primary goal of mental wellness check-ins is to provide public safety employees with increased quality of life as well as tools to manage their response to stress and trauma
- How to build mental health resilience in EMS. Identify the risk factors that can diminish resilience and learn how to address six key areas of life that impact health and wellbeing
- Reset between the tones: Micro-practices medics can use on shift. When call volume is relentless, these 5-15 minute resets fit inside real workflows — helping EMTs and paramedics lower stress, stay present and carry less from call to call
- How to recognize, help a struggling team member. Identify and aid team members facing depression, burnout or compassion fatigue to foster an emotionally safe organizational environment
ABOUT THE AUTHOR
Larry Johnson is a nationally registered paramedic and veteran EMS executive with nearly five decades in emergency medical services. On Feb. 28, 1993, he was the senior flight paramedic for CareFlite Dallas when the ATF raid on the Branch Davidian compound in Waco, Texas, went wrong. He treated the wounded, flew the dying and maintained the medical perimeter for all 51 days of the standoff. He was there when the compound burned on April 19, 1993.
Johnson helped build Columbia One Dallas, the nation’s first all-paramedic critical care transport program, and coauthored the first Critical Care Paramedic textbook with Dr. Bryan Bledsoe. He served as adjunct faculty at the University of Nevada, Las Vegas School of Medicine; held national leadership roles with NAEMT; and currently serves on the Board of Directors for the National Association of Mobile Integrated Healthcare Providers and as Commander at Albuquerque Ambulance Services, Presbyterian Healthcare Services.
