Paramedic Kevin Hook's vehicle speeds up Lombard Street, weaving through traffic. His 7 a.m. shift as acting lieutenant at Baltimore's John F. Steadman Fire Station has just begun and Hook is monitoring dozens of calls scrolling down a monitor mounted on the dashboard of his SUV.
There's an oil spill requiring a hazardous materials team to the east, a car crash to the west and a victim suffering from a stroke ahead on West Baltimore Street. Hook decides to respond to the stroke victim, radios in, turns on his siren and takes off. When he starts a shift, he never knows what kind of calls will come through — he's delivered babies twice, including a set of twins in Hampden — but he knows they won't stop.
"Once you start running, you probably won't be back at the station again that day," says Hook, 37, a 10-year veteran of the department.
This is just an average day at Baltimore's John F. Steadman station, located at the base of downtown's Bromo Seltzer Arts Tower and named the nation's busiest firehouse. For a paramedic, Steadman is nonstop action. An emergency medical worker could drive from fires to stabbings to elevator rescues all in the span of a few hours.
In 2010, Steadman's nine vehicles made 21,921 runs — 3,000 more calls than any other firehouse, according to Firehouse Magazine, a national trade publication that compiles data from fire departments. The station was also named the busiest in the country in 2008. Its three medical units, which perform most of the station's runs, each respond to about 6,000 calls annually. Last year, one of the station's vehicles rolled out an average of 60 times per day.
"That house has always been known in the city as basically an insane asylum," says Rick Hoffman, president of Baltimore's International Association of Firefighters, who served at Steadman for two decades. "It's a whirlwind of activity and fun and camaraderie and hard work.
"The amount of fun is only because the guys take the job so seriously. The other houses in the city, you're assigned to. When you come to Steadman house, you're committed."
Hook responds to the stroke call in the 2000 block of W. Baltimore St. and finds a elderly woman inside, bleeding from her head after a fall. She's lost strength in her hands and is drooling uncontrollably.
Other paramedics are already on the scene, trying to help the woman into a stretcher. At first, they plan to bring her out of the back of the rowhouse, but quickly decide that the back porch is too dilapidated to risk walking on. The woman begins to moan. She's speaking, but not making sense.
Paramedic Clarence Johnson leans down to pick her up.
"Give me a hug, sweetie," he says, placing her onto the stretcher. "Trust the big black man with the bald head."
Outside in the ambulance, the paramedics become increasingly concerned about the woman's high blood pressure. They need to get her to the hospital. Fast.
Johnson runs to the driver's seat, leaving his partner, Paramedic Chris Johnson, to tend to the woman's ailments.
Hook, who supervises paramedics in the area, hops out of the ambulance, gets back in his SUV and starts, once again, analyzing the screen.
Another call comes over the screen, and Hook is off again.
Fires: A barometer of society's health
Founded in 1973, Steadman station is named after a longtime deputy chief who died in 1940 after 27 years with the fire department.
Close to 20 firefighters and paramedics are stationed there at any time, as well as a rotating cast of fire department employees from throughout the city. Its nine vehicles include fire engines, emergency medical services units, a hazmat team and a rescue unit that saves people stuck in elevators or on the water. Some calls are more intense than others, but everyone wants to be part of a big call.
"There are calls medics will fight for," Hook says. "Shootings, stabbings, rescues and fires."
Hoffman says Steadman's central location and its variety of specialties contribute to the frenetic pace.
"It's a house that does a lot of different things," he says. "They got their hands in a lot more of a mix than most firehouses in the country."
But there's another reason for Steadman's high rate of emergency calls, firefighters say. In a city where one in four residents lives below the poverty line, problems are bound to occur in high numbers. Fires, they say, are a byproduct of societal decay.
"Fires are a barometer of a society's health," says Battalion Chief Frank Hazzard, who works at Steadman. "If you see a neighborhood with a lot of fires, I'll show you a neighborhood with a lot of problems with poverty and crime. …
"We get calls for asthma attacks because roach eggs cause asthma. We get calls for fires because people use candles because they can't afford heat. We get a lot of calls because of heroin. Baltimore is the heroin city. There's no way to explain our per capita heroin use."
Indeed, poverty and dilapidated housing often contribute to fire rates, fire officials and studies say.
"Virtually every study of socioeconomic characteristics has shown that lower levels of income are either directly or indirectly tied to an increased risk of fire," the Federal Emergency Management Agency wrote in a report linking poverty levels to fire rates.
Hook says he's frequently responding to houses most would deem unlivable.
"Some houses don't have lights," he says. "It's not uncommon to see bugs crawling all over the place."
Minutes after leaving the scene of the stroke victim, Hook responds to a call for an assault. The perpetrator is a young man being held at the Western District Police Station. An officer struck him in the shoulder with a Taser after he threatened her, police tell Hook upon arrival.
Officers bring the young man out of his jail cell. He looks at Hook with disdain. "No I don't want to go to no hospital," he says.
This confrontational attitude is yet another problem Hook says he encounters around Baltimore. He says it's not uncommon for paramedics to be harassed as they try to help a victim in the street.
While riding on some calls, "you're not supposed to wear your badge," Hook says. "You don't want to be confused for police."
Once the man at the police station refuses treatment, the paramedics leave, and within a few minutes another call comes across the radio — this one for a car accident. Hook and a team from Steadman arrive at the scene and carry two women away in stretchers.
Throughout the day, Hook sees a heart attack victim and a woman who needs to be transported between hospitals, and answers several false alarms.
It's not even lunch time.
There's an excitement to the job, but there's also a sense of duty, of helping some of the most troubled people in a troubled city.
"They just roll and roll and roll," Hazzard says of the medics. "There are only a few other cities that get our kind of volume. There aren't a lot of cities around the U.S. that have our kind of vulnerable population."
Hoffman says the volume at Steadman on this day is no different than years ago. They just have fewer firefighters to help out, as the department has shrunk and stations have been closed.
Steadman employees, he says, are no different from their colleagues at other stations, but it takes a special breed to work at the nation's busiest fire station.
"They're not better," he says of Steadman's staff. "They're a little more insane."
Top five busiest fire stations in U.S.
1. John F. Steadman, Baltimore — 21,921 calls
2. The Heights, Washington, D.C. — 18,531
3. Station 1, San Francisco, Cal. — 16,009
4. Station E50, Philadelphia, Pa. — 15,979
5. Station 29, Miami-Dade County, Fla. — 15,844
Source: Firehouse Magazine