By DECKER WILLIAMS and TIM SIMMONS

"Channel 2. EMS assignment. A shooting. Engine 22, Battalion 5. 6820 South Elm. Gunman possibly on the scene. Stage for police."

The lights come on and the tone goes off in the station, and you realize you dozed off while watching Barney arrest someone in Mayberry. You're up from the couch and following the other three crew members to the truck. It's Friday night. Things are a lot busier than the days when you responded only to fires.

On the way to the call, you hear, "Battalion 5 on the scene and staged south. Battalion 5 will be Elm command waiting for scene clearance from police."

As the captain of Engine 22, you need to think about this EMS call with the same basic safety considerations you would a fire call. There could be multiple patients and plenty of blood. Each member of your crew needs to have splash protection – glass es, gloves, a mask and other garments to protect eyes, mouth and skin. Even if it turns out there is little blood, you know from the International Association of Fire Fighters (IAFF) inflection control class and the National Fire Protection Association (NFPA) 1581 infection control standard things you can't see can still contaminate and hurt you.

"Engine 22 on the scene and staged north," you report.

Everybody waits for the police to secure the scene. The alarm room has given you the police incident radio channel so you can monitor and contact the police on the scene. But you'll leave that to the chiefs. You do hear, however, that the cops have got a 22-year-old male patient with a gunshot wound to the right shoulder. Then they claim the scene has been secured.

Battalion 5 (Elm command) was put on this call to assist with firefighter safety. Once he hears the cops have secured the scene and he verifies the immediate danger of unbridled guns is gone, he directs you in. You check to see that all your people are in full protection. This call is somewhat like a hazmat incident where you may not be sure what you have, but you are not going to take any unnecessary risks.

You roll in and a police officer in front of the small single-family house directs you to the backyard and says, "It's a mess back there. It's a crime scene. Don't touch anything."

In the backyard, you see four police officers – two of them have a suspect handcuffed. The handcuffed man and the cops have blood all over them. Another man is lying on the ground with an obvious gunshot wound to his shoulder. How many patients do you have at that moment? The guy those cops are holding is their suspect, but he's your customer. And those two cops with blood all over them are also customers at this point. The answer is four.

Now you can start the process of elimination and very, very basic triage by simply asking the handcuffed man, "Are you hurt?"

As the medical representative on the scene, it's your responsibility. You also need to ask the cops the same question. Obviously, you are likely to get a variety of answers. If the police officers tell you they are fine, that takes care of that. If one or both sustained some sort of injury, see to it. Advise them about infection exposure follow-up. If the man in handcuffs claims to have an injury, check it out. Get at least two sets of vitals (pulse, breathing rate, pupil reaction, skin condition and bloo d pressure).

Suppose, however, you ask him, "Are you hurt?" and he says, "No." You look him over. Does he look OK? There are four pretty good questions to ask such a patient: What's your name? Do you know where you are? What's today's date? Who is the President of the United States? Make a decision based on the answers.

Your obvious patient is the guy with the gunshot wound to his shoulder. Your firefighters have already started their assessment of him. He has his ABCs (open airway, breathing and blood circulation). They have taken their first set of vitals. They start s tripping clothing from him to look for other wounds and for an exit wound. A bullet can travel around inside a human body like a frightened rabbit.

There are no other wounds and no exit wound. You know the bullet is still invading his body. During the course of all this, you hear him say he is a drug user. It's up to you to note this on the patient encounter form and assume the patient may have hepat itis or any other blood-borne diseases. Once again, you look at all your people to be sure they have their protective equipment on.

A second set of vitals is taken. Blood loss or shock shows up as a faster pulse and respiration along with dilating pupils and decreased blood pressure. He probably has internal bleeding. The ambulance is on its way. You need to package him for transport. Get him on a backboard as soon as possible.

Treat him for shock. First, control the bleeding. Elevate the legs 12 to 18 inches. This causes the blood that is still in the body to stay toward the vital organs. You also need to stop the flow of blood at the open wound by using dressing and bandages. Dressing is any material applied to a wound to stem the flow of blood. Preferably, it is sterile. The most popular dressing is gauze pads. Apply as many as is necessary. In an emergency, cloth, towels, sheets, handkerchiefs or other material can be used. Bandages are what's used to hold the dressing in place. Be sure he maintains a clear airway. Give him nothing by mouth. Administer oxygen. Avoid rough handling. Keep the patient still on the backboard and prevent loss of body heat. Be sure to get a new se t of vitals every five minutes.

When the ambulance arrives, the crew will find the patient packaged well and you can hand over the patient encounter form with a history of vitals and all pertinent information. The red bio-hazard bags are taken out and the scene is cleaned up of all blood-infected items. Your contaminated station uniform goes into the station clothes washer and the red bio-hazard bag goes into the contaminated waste container for special disposal.

It's a bit different than hanging hose and washing helmets.

Courtney blurted out what was happening to her father upstairs. Mahoney told his own daughter to "call 911 and report a choking victim" at their address, then he and Courtney ran upstairs. Mahoney knew Garrett was in trouble. With 28 years of experience and the Boston Fire Department's EMS training clear in his mind, he reacted without hesitation. He told Courtney to "call 911 and tell the operator that this is a cardiac arrest and not a choking victim." He then proceeded to evaluate Garrett's vital signs and "ABCs." Finding no breathin g or pulse, he lowered Garrett onto the floor and began CPR. This he continued until the arrival of firefighters from Engine 2 and the district fire chief.

The Boston fire alarm office received the call from the 911 call taker and instantly dispatched District Fire Chief David B. LeBrun Jr. and his aide, Firefighter Roger Denn, along with Engine 2 staffed by Fire Lieutenant Frederick T. Murphy and Firefighte rs Kenneth Berk, James MacDonald and Steve Sullivan. They arrived in under three minutes and ran upstairs carrying a semi-automated external defibrillator (SAED) and other EMS equipment. Murphy and his crew, all trained and certified in SAED use, quickly set up the SAED and attached its electrodes to Garrett's chest. The machine analyzed the victim and indicated a "shock" to be administered. This was done, but with no resumption of heart rhythm. The crew continued with CPR and readied the SAED for another "shock."

Boston EMS (BEMS) Ambulance A-6 responded with EMTs Joe Kalil and Richard O'Connell. Also responding were BEMS Paramedic Unit 1 with Paramedics Rick Covino and Bill Miraglia and a BEMS supervisor, Lieutenant Brian Pomodoro. LeBrun then arrived on scene an d took charge. The fire and EMS crews worked in concert to restore Garrett's vital signs. The paramedics set up a cardiac monitor/defibrillator, intubated and inserted an IV. Another "shock" was given. Finally heart rhythm was restored, but Garrett was fa r from being out of danger.

Family Rushes To Scene
Leo Sr. lives only a few blocks from Garrett. Courtney called him on the telephone to alert him to the situation. Leo Sr.'s wife then called Leo Jr., who also lives in South Boston. Both hurried to the scene before Garrett was transported to the hospital.

Leo Sr. said, "In my many years on the job, I've seen many cases like this one and I thought my son Garrett was gone." Leo Jr. said he had the same thought. Leo Sr. asked that a priest be summoned to the scene. Father Richard Clancy of St. Brigid's Church , only a few blocks away, responded in minutes and gave Garrett Stapleton last rites.

Closely monitoring Garrett's heart rhythms, the fire and EMS crews backboarded Garrett and struggled to carry him down the building's three flights of narrow, winding stairs. He was carefully put into the waiting ambulance for further stabilization and tr ansport. The hospital of choice was University Hospital, about three miles away.

The Boston Fire Department's chief chaplain, Father Dan Mahoney, was quickly notified. He immediately began a prayer vigil and responded to the University Hospital to comfort the family. Doctors and nurses worked to further stabilize Garrett's vitals. It was not clear to anyone whether he would pull through. It was Leo Jr. in his frustration at seeing his brother lying motionless who suddenly screamed at Garrett, "Come on, Big-G! We've got a tee time for golf!" (Both are golf enthusiasts.)

Garrett opened his eyes and sat up in bed. He was going to make it.

Leo Sr. said in an interview, "I just want to thank everyone involved with saving Garrett's life. His daughters Courtney and Jan did everything that they were supposed to do and if they weren't there...well, they saved their father's life too. I can't exp ress my gratitude enough to the members in the BFD, Chief LeBrun, Lieutenant Murphy and his crew, the fire alarm office, all of the BEMS members, the hospital and staff, friends and concerned firefighters. And I wish to especially thank our good friend Li eutenant Leo Mahoney, who performed the initial CPR."

Mahoney: "I give all of the credit to Garrett's girls, the members of Engine 2, Car 6 and the EMTs and paramedics."On June 10, Boston Fire Commissioner Martin E. Pierce Jr. announced in general orders that, "Because of his quick response and efforts to re vive Firefighter Garrett Stapleton, they were able to get a pulse and restore his breathing. The fire commissioner is pleased to highly commend Fire Lieutenant Leo K. Mahoney of Ladder Company 19, and refers his case to the board of merit."

Pierce later said, "To Garrett and the entire Stapleton family, I am pleased that the lifesaving technology and training were in place. Happy endings in cases like Garrett's are few and far between."

Garrett added, "I would like to thank my two daughters, the members of the Boston Fire Department, the BEMS crews, the University Hospital and the New England Medical Center for acting in such a quick and knowledgeable manner that saved my life. In particular, I wish to thank Lieutenant Leo Mahoney, whose actions during this ord eal were crucial to my having any hope of survival until 'the cavalry' arrived. I am forever grateful."