A firefighter's quest to become Colo.'s first above-the-knee amputee firefighter
In March 2016, Berthoud Fire Protection District Fire Investigator Josh Macdonald was injured after falling through the floor at a fatal house fire
On March 25, 2016, Berthoud Fire Protection District Fire Investigator Josh Macdonald was performing inspections when a call came in about a house fire with an occupant trapped.
Once on scene, Macdonald hopped out of the engine and started taking pictures to find a potential origin and to get a clear picture of how the fire was behaving. Firefighters were able to successfully locate the trapped occupant and pulled her out of the fire.
Dispatch sent one ambulance as well as a fire engine. However, the ambulance was parked behind the engine. A paramedic yelled for Macdonald's help; he didn't skip a beat.
He helped the paramedic get the victim on a gurney and was the first one to feel for a pulse. After realizing they had a workable victim, Macdonald started CPR while in the back of the ambulance. Transport time to the hospital was about 20 to 25 minutes, but Macdonald was too focused on saving a life to count the minutes.
The victim was burned on 40 percent of her body. At one point during transport, Macdonald looked down and was shocked to find the victim's burnt skin all over his uniform. He prayed to be able to save her life.
When they arrived at the hospital, staff worked on the victim but ended up pronouncing her.
Family firefighter influence
Macdonald recounts his dad, who was a firefighter in California and Colorado, had a huge influence on his future career path.
"Going to the firehouse as a kid is one of the coolest things that you could ever experience," he said. "Feeling like you're one of the guys at 10 years old is like nothing else."
In high school, he also participated in a fire explorers program. However, one of the firefighters in charge of the program told Macdonald that he wasn't cut out for a firefighting career.
"At the time, I was juggling wrestling, a job and also trying to be a fire explorer. He was just really hard on me. It was a huge motivator for me to be successful in the fire service."
At 19 years old, he was hired at a fire department in Casper, Wyo., and worked there until he was 21. He later moved to Colorado and was hired by Windsor Fire, where he worked as a firefighter and performed investigations. Due to an injury at a structure fire, he was put in fire prevention on light duty. He was taken under the wing of Kerry Koppes and began learning about inspections and investigations.
Fast-forward to 2012, he was hired full-time by Berthoud Fire Protection District.
In 2014, Macdonald, who joined the military in 2010 to teach water and combat survival, was activated on military orders and completed two years of active duty as a military contractor. He went back to work at BFPD in February 2016.
What he didn't know, however, is that his life would drastically change merely one month later.
Back on scene
After leaving the hospital, Chief Michael Bruner called Macdonald back to the now-fatal scene as the lead fire investigator. Because of the nature of the call, the scene was very chaotic.
In order to keep everything moving, Macdonald broke up the scene into different divisions.
"I had the deputies doing interviews, one engine stayed on scene after the overhaul," he said. "I just wanted to investigate the scene to the best of my ability. I was now invested in the call; I didn't want her death to be for not."
Fire Captain Nico Romero, who helped pull the victim out of the fire – along with a rookie who was on his first fire call, had some fire investigative training and was able to preserve the scene for Macdonald.
"We cleared out the clutter and only essential personnel were allowed on scene now."
At that time, the sheriff's department had a 3D camera that they wanted to use to get complete images of the scene.
"Once that was done, we were able to get to work. But I didn't want to go inside right away. I wanted to work from the outside-in."
Macdonald started walking around the house, along with the Bureau of Alcohol, Tobacco, Firearms and Explosives; Longmont Fire Department's arson dog; Larimer County Sheriff's Department; Loveland Fire Department; and the Colorado Bureau of Investigation.
"The ATF agent was my second-in-command," Macdonald said. "We worked really well together as far as dissecting the scene and looking for the cause and origin."
Once the air conditions inside the home were within an ideal range, crews went inside.
"We started making our way back to where the origin of the fire was and started to develop different hypotheses on where the fire had started. At that time, the leaders of each division regrouped and we put our information together."
Macdonald, who didn't want to get tunnel-vision, was unsure about narrowing the cause of the fire down just yet.
"I wanted to have different hypotheses; I didn't want to focus on one specific thing just yet. I was really trying to refocus the team back to what we had – what was tangible – instead of what ifs and maybes."
He went back outside the house, and that's where they found wires that were going to different places.
"They didn't seem right; they didn't seem like they were wired right. So, again, we went back to the area of origin, which was in between a hallway that opened up into a closet area and then a back bathroom. It was right in between there where our heavy fire damage was – we kept finding things that would take us off track. I kept going off track. I should've been focused on leading that investigative team. I was too focused on our cause."
They were later able to narrow it down back to the electrical room. Macdonald, the ATF agent and Mike Manzo, an arson dog handler from Longmont Fire Department, were walking back through the house to the area of origin when he fell through the floor.
"I knew right away that there was something wrong with my leg. It had caught wires on the way down and bent in such a weird way and my back was killing me."
Macdonald, who fell four feet, was pulled out of the hole by Manzo, but was unable to move.
"I laid there for a while. We had to call another engine and ambulance out to come get me. It took about 15 minutes to get me extricated out of the hole, onto a backboard and into an ambulance."
When he arrived at the hospital, doctors told him that he might have torn something in his knee.
"My leg was so swollen. I ended up tearing my ACL and PCL."
Once those injuries were repaired, Macdonald noticed that he started to develop a raised bump on his leg.
"I could feel one of the screws that they put in my knee; I could feel it on my tibia bone. The bump was right above that. It kept getting bigger and bigger and my leg was swelling up."
The start of many hospital stays
Macdonald was at his fiancés family's house for Thanksgiving in 2016 when he passed out in the bathroom. She threw Macdonald in her truck and rushed him to the hospital, where doctors did a CAT scan on his leg and determined that he had a staph infection throughout his entire leg. The staph infection later turned into MRSA and he was put in isolation in the hospital. Doctors had previously misdiagnosed Macdonald's condition three times.
"They flew me down to the University of Colorado Hospital in Denver and they cut my leg open and cleaned it out. I was put on IV antibiotics through a PICC line in my arm and had to go into a rehab center."
Macdonald was in the hospital from November through February. He went home with a PICC line and had to find a doctor that would work on his leg. Dr. Jeremy Kinder, with Colorado Limb Consultants, took on his case.
"Dr. Kinder wanted to clean out all the metal in my leg, which I had from getting worked on in the military. I hurt my leg in the military coming out of a helicopter – the same leg I was now dealing with again; it's the cursed leg."
Macdonald was once again put on a high dose of antibiotics through his PICC line and was sent to a rehab center to learn how to walk again. After four weeks in the rehab center, Macdonald went home but he was still on IV antibiotics every eight hours.
"The next step was for Dr. Kinder to go in and take out three inches of bone and put in an antibiotic spacer to prep me for a mechanical knee replacement."
Again, Macdonald was put on IV antibiotics and sent to a rehab center.
"If you add up all my hospital time since this happened, it has totaled a year and two months. I've spent a lot of time either in the hospital or a rehab center."
He had to wait three more months until Dr. Kinder was able to put in the mechanical knee replacement. However, about a month and a half into rehab after the procedure, Macdonald developed another staph infection on his leg. He went to the ER, doctors cultured him and they found MRSA.
"It was back in my leg and the MRSA started to attack the mechanical knee replacement. I had also developed an allergic reaction to the cement that they put in my leg." At that time, he also started to develop a bone infection.
"In Oct. 2018, I was in the rehab center and Dr. Kinder wanted to operate sooner rather than later. I wanted to have Thanksgiving with my family; I missed the last two because I was in the hospital."
Doctors decided to operate on December 5, and that's when Macdonald had his leg amputated.
Post amputation: 'Confused and in so much pain'
A team of doctors came together to discuss Macdonald's case on whether or not they should open up his knee, clean it out and try again. At that time, it was Macdonald's 18th surgery on his knee throughout his life.
"I couldn't go through another surgery. The antibiotics were really starting to affect my kidneys. I was just done."
Once the amputation was complete, Macdonald remembers waking up in his hospital bed – screaming for his leg.
"I was confused and just in so much pain. I was scared. It took a long time to process. It was hard for me to process and mourn the loss of my leg."
He spent about a week and a half in the surgery floor of the hospital and was later moved to Spalding Rehabilitation Hospital.
"Now I'm in a hotel, waiting for workman's comp to renovate my home. There's close to $100,000 worth of renovations that they have to do."
Renovations to his home include taking out the carpet in order to put in hardwood flooring, building ramps, renovating two bathrooms, and widening doors and entryways to the kitchen and hallways.
"It's going to be a while. I'm still waiting for them [workman's comp] to get contractors."
An inspiration to other firefighters and amputees
Nonetheless, nothing is slowing Macdonald down from returning to the fire service. In fact, another firefighter – Lt. Brandon Anderson – an above-the-knee amputee with the Fishers (Ind.) Fire Department – encouraged Macdonald to continue fighting his way back as a fully qualified firefighter.
"I want to go back as a firefighter. I'd like to be the first firefighter in Colorado to have an above-the-knee amputation."
Lt. Anderson, who had his right leg amputated after a motorcycle crash in August 2016, passed all the physical requirements and agility tests to return to his previous position in the department just 10 months after the crash.
Since his amputation, Macdonald has become very close with Lt. Anderson.
"He's been a great mentor. He has talked to me about the different challenges as far as what his department put him through to get back on the line as a firefighter. In fact, my legs are getting built just like his."
CBI Agent Chris Schaefer, an above-the-knee amputee, has also been in Macdonald's corner since his injury.
"He reached out through one of the CBI agents that I work with on the fire side. He didn't know me, but he just knew a firefighter was injured. He called me up and came down to the hospital. He was there for me, helping with the mental part of losing my leg."
And, once Macdonald left the hospital, Schaefer continued to help with his recovery and working to get the right prosthetic.
Right now, Macdonald is unsure what his position will be on the department. "I love the community that I serve. I would love to go back to my department, but I don't know how it's going to play out."
One thing is for sure – Macdonald is an inspiration to firefighters both near and far.
"There are days when I don't want to get out of bed; when my leg is so painful ... days when I don't know if I can do this. And what gives me the strength to get up and get motivated is all these people that I don't want to let down; all these people who are praying for me and seeing me as an inspiration and that I encourage them. It's weird for me. How am I inspiring them? I'm just a guy that's trying to get through an injury."
And ever since his injury, Macdonald has used his voice to remind firefighters to never take firefighter safety for granted.
"There are times as firefighters that we get tunnel vision; we get focused on one thing. We can't do that. Our job is too dangerous. We have to have situational awareness at all times."
That's what happened to Macdonald that day, he explained.
"I got focused on one thing – which was going back to that electrical panel and I wasn't aware of my surroundings and I fell through the floor. That can happen so easily in firefighting."
Macdonald says that he reminds firefighters every chance he gets to always go back to the basics, including Capt. Jason Goodale's crew from Loveland Fire and Rescue Authority. Capt. Goodale wanted to check on Macdonald's condition, and he used that opportunity to teach his crew about what happened that day and how one injury can put your career at risk.
"The basics are what are going to save your life. Not all those certificates you get; it's the basics that you learn at the fire academy."
And on the days when his pain level reaches an eight out of 10, Macdonald leans on those around him – including his fiancé and 10-year-old daughter.
"I read the letters that I've gotten, I call people, I lean on my fiancé, who's been there with me through it all. When I was having nightmares from losing the woman in the fire that I tried to save, she was the one calming me through the night. She is there for me; she encourages me and has been strong for me."
Macdonald makes it a priority to talk about his experience so other firefighters can learn from it.
"I talk to them about situational awareness. It doesn't take much for another firefighter to be in the same situation that I'm in. For me, it all happened so quickly. In the blink of an eye, our career as firefighters can end from an injury."