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Captain Bob Spangler, 50, has been a San Diego Firefighter for 27 years. He is also licensed as a paramedic and a nurse.

A former lifeguard, Spangler's career encompasses lifesaving in one form or another. Since 1994 he has led the crew of Station 26 at 54th and Krenning in Oak Park. Station 26 has one fire truck and one ambulance.

Tall and muscular, Spangler's steady calmness sets the tone for the other firemen at Station 26. A Point Loma native, you can still hear the surfer in his voice. "Not all firefighters are paramedics, but all are EMT [emergency medical technician]-trained and EMTD trained, which means working semi-automatic defribulators. It requires about 110 hours' training. To become a paramedic requires between 1000 and 1500 hours in the classroom -- depending on which program you go through. Then you do a month clinical in an emergency room, then two months of ride-alongs under a preceptor, doing paramedic skills, being observed and evaluated every day.

"Everyone that works here is a trained paramedic. You have a paramedic captain, a paramedic engineer, and two paramedic firefighters on engine 26 and two paramedic firefighters on medic [ambulance] 26." It's no coincidence that his crew consists of trained paramedics. "Back in the '70s and '80s, we used to go to a lot of fires. Then when building construction and fire prevention improved, the whole thing got safer. The number of fires decreased, but the number of medical calls started increasing tremendously. Between 55 and 80 percent of the calls we go on are emergency medical calls. Of those, maybe 20 percent are major traumas -- people who have been shot, stabbed, or severely injured. The other 20 to 25 percent are fire calls and rescue calls. Now our lion's share is emergency medical."

Spangler sees the medical problems he and his crew respond to as just another day's work. "Weekends tend to be a little busier, because people are out partying more, and we're real close to City Heights. But it can happen anywhere in the city. You have a lot of shootings and gang activity. Just to show you the type of calls we went on in the last two days: We had a CPR yesterday when an elderly gentleman had a heart attack eating breakfast; today we had a seizure with a child; we had a drug overdose -- a young adult male; we've had traffic accidents where you have to C-spine people. We had a lady, 34 years old, having an asthmatic attack where we got there before the ambulance, so we went ahead and started the breathing treatment, gave her some sub-Q epinephrine to open up her passageways so she could breathe. We run about 8 to 10 calls a day on this engine, but our ambulance out of here's even busier. They'll run 15-plus calls a day.

"San Diego is a great place to study emergency medicine. We have the same amount of cardiac arrests year in and year out. It's a place where they come to study heart attacks...because we tend to hold pretty steady on everything. Of course, with the population, things are increasing. Right now in our county, we're the only ones in the state of California that are allowed to do what we call rapid sequence innovation, or RSI, where if we have someone with a head injury, whose level of consciousness is very low, who needs to have oxygen, we go ahead and paralyze them and put an endotracheal tube in and ventilate them. There's a primary injury that occurs from the accident -- damage to the skull -- but there's secondary injuries: hypotension, or low blood pressure, from low oxygenation or hypoxia. So the neurosurgeons here said, 'You know, if we could get these people intubated and keep their O2 sets up high and keep their blood pressure near normal levels, we'll do less damage to the brain.' Time is actually brain tissue; just like in heart attacks, when time is cardiac tissue. We've been doing that here as a test study. The only other people who do that are flight nurses for critical air or doctors who do RSIs. We've definitely been able to reduce mortality.

"As we gain the trust of the doctors and the nurses, they allow us to do more procedures out here. Before, we had to ask to do certain things, whereas now they're just standing orders when we get there, and we can do them on our own -- like the asthmatic. Years ago, we would have had to get permission to do all that stuff before we could treat her. With cardiac arrests, we can do a lot of things on our own before we even have to get on the radio and talk to the hospital."

Even though Station 26 is located between Encanto, College Grove, and City Heights, Spangler doesn't think gang violence makes much of a difference in the frequency of calls. "Actually, the communities around here and even these gang members are really...well, when we come in, they don't hassle us. We get in there and get our job done. They show a lot of respect to us. The amount of violent incidents has held pretty steady. It still occurs, but not to the degree it used to occur. I think what made a difference is over in City Heights where they made that big public park and put the nice library in -- the biggest thing was the police. They put that big police department substation right in the center of it. It's an area they've been trying to improve, and I think they've been doing a good job. The P.D. is in large numbers around here, and I think people are becoming a little more responsible. The center of the city's doing a lot better."

Like other doctors and nurses, Spangler is not queasy at the sight of blood. "I've seen enough of my own and everybody else's!" He talks as if he has seen it all, and his experience is one reason for the calm he exudes. There is one thing, however, he has never adjusted to. "Anything that deals with children. The last call, the baby was burned over 90 percent of his body from scalding. We were the first ones at the scene. We walked in and the gentleman said, 'The baby's over there.' We walked over, and it was like a lobster. You know how dark red a lobster is, and when you put it in boiling water, it's bright red? I looked at the baby and couldn't believe it. I thought, 'It has to be dye, paint -- something.' The only part that wasn't burned was the baby's head and a little of the neck. It was the boyfriend of the mother who was there, and he was the one who did it. We're getting a subpoena to go to court here soon on it.

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