Skooter92

Sometimes the way that the force of the impact is transferred to the occupants causes non-obvious but fairly serious injuries. Side impacts to vehicles that cause rotation of the affected vehicle around an axis can cause similar effects to the internal organs and suspensory structures of the body which can cause shearing and tearing-type trauma. Remember, look at MOI as well as where the occupant was not only at the time of impact but also the path their body took after impact.

If the CON for Mobile Care's Orange County operations doesn't need to be actually transferred (since HVP already has an Orange CON), then there doesn't need to be an administrative hearing for the simple transfer of assets and contracts. I don't understand why they would buy another CON. And since the service itself isn't being sold, there is no transfer of ownership, which also means no hearing necessary. Almost like Empress selling off it's Mount Vernon "division" with the contract and the physical assets to someone else. No Article 78 needed.

Embarrassing, yes, but it could have been worse. At least they could still perform supression duties. I remember years ago, working as a dispatcher for a commercial service in lower Westchester that had a contract with King Street NH on the Greenwich/P'chester line. Call came in for a chest pain and per management, we sent the nearest available bus: from Montifiore in the Bronx. After they arrived, we got a phone call from the medic asking if we had anyone else in the area. Of course, we didn't (why else would we send them all the way from Monti?). He then informed me that they had left their stretcher, with the o2 bottle and monitor strapped to it, back at Monti. You can guess at the rest of the story.

OK... 1) I'm jewish...and I wasn't offended, because I've learned not to be reactionary. Simply put, if you aren't looking for a reason to fight, why bother? 2) The Hasidim have the same issues of crime, both violent and otherwise, as the greater society around them. They aren't any better or worse than the rest of us, just dressed differently. I speak from experience on this one, trust me. 3) Hasidic or not, someone accused of a crime must undergo the same experience as any other person in the same circumstances. A valid medical reason for some exception to the booking procedure is one thing, but the greater good allows for some diminishment of certain personal freedoms in certain circumstances. In order to enjoy the freedoms and priviledges of society, one must accept that at certain times certain things that have been granted may be revoked or limited. That is a fact, as we have seen after 9/11, for example. We gave this woman access to certain benefits, she stands accused of abusing this priviledge, now she must endure some curtailments and limitations in order to go through the process to either clear her name or be found responsible for what she has been charged with. 4) Jewish thought and custom allows for the conformance with secular law and the possibility that doing so may cause one to break one of "the rules". She isn't going to be penalized for removing her wig, no one was hurt, and her relationship with God has not been jeopardized. Who has been harmed?

Had our monthly CME tonight at Stamford Hospital, and per our clinical coordinator we are starting cooling next week. I'll get a copy of our clinical guideline and post it if anyone is interested.

If the patient is "very large", i.e., heavier than 220lbs/100kg, than why the heck were they pushing only 30mg of Etomidate anyways? Seems the problem was with someone's math, not the drug used. Etomidate does not have any known decreased effect in the obese. There are some folks who seem to feel that "just push 30 for the big ones" is the way to go . We carry 80mg total in our catastrophic airway kit. That's plenty for most patients. I've actually had great success with giving Etomidate and then not even needing the paralytic as a chaser.

Actually, per Paul, the device to maintain core cooling is fairly inexpensive and mainly requires an ICU. The clinicians involved need to be educated and on board, but the cost is not huge.

Dr. Paul Hinchey (any of you old Empress people-remember him?) did a presentation before the Westchester conference up in Stamford on core cooling. Very impressive, and definitely worth a shot as the cost involved is minimal and the potential return if the protocol is intiated pre-hospitally and extended into the receiving facility is huge. For a county-wide trial, it would take every hospital (not just the ED) in Westchester to fully sign on-highly improbable. In Stamford, it's a matter of just doing it-all the stakeholders are on board. Seems to me if it's cheap and easy....but in Westchester, it's all about turf and ego.

The target temperature is 92 degrees farenheit, or so I've been told. How many bags of frozen veggies would it take to chill, say, a 100 kg patient to that desired temp? Peas vs. corn vs. broccoli? Brand name vs. store brand? I ask ONLY for clinical reasons.

Stamford EMS will be trialing this fairly soon. We are doing it in steps, the first being adopting the E-Z IO drill, which is on all rigs right now, the second step then is to work out the logistics of providing cooled saline to victims of SCA with ROSC. What will probably happen (per reliable source) is if a medic unit has a "fresh" arrest with high probability of ROSC or god forbid an actual save, the supervisor will roll to the scene and provide cooled saline from a fridge on the 901 truck. Makes more sense in our system than putting a beer fridge on each unit, although every rig has an installed Temperature Control Unit (TCU) for the drug bag.

Any thought given to how this all affected the chicken?

This is an excellent argument for cross-training or at least familiarization and working out roles, to allow other public safety personnel to do more than stand there. It has worked in Stamford and multiple other places I have worked for years. Plus, sometimes it seems like they drive a little safer than my partner

In Stamford CT, if we need an extra set of hands, FD hops on board. They are all EMT's, and some are even medics (some are ex-SEMS or other area agency ones). Cardiac arrest? I tube, my partner sticks, the FFs then compress and bag, we do meds or whatever, and another FF drives. Time saved, no one crosses any lines, and patient care gets done ASAP. Traumas? Me and my partner hop in the back with an FF as another set of hands PRN, and an FF drives. Most codes, we go routine into the ED. Rarely do we go a$$ pounding into Stamford ER because it generally isn't needed, even on traumas. We are starting to train with SFRD on basic skills/knowledge, and IMHO (21 years on the job), it works very well. Plus they make good meals.

Stay strong, and know that you have quite a few people pulling for you. Get well soon.

I recently took the DAMS (Difficult Airway Management Seminar) class in Stamford, and got the chance to play with dozens of toys. Besides the gum bougie (a.k.a. the "bubble gum boogie"), the Viewmax® Laryngoscope Blade was the most impressive simple add-on to plain old laryngoscopy. The built-in scope gives great visualization. Hold on....(cut n' paste in process)....."Patented lens system refracts the image approximately 20° from horizontal, allowing visualization of even the most anterior larynx. Exclusive lens system also provides visual confirmation of endotracheal intubation by allowing a clear view of the vocal cords even as the tube passes through." Couldn't have typed it better myself. It really does give a terrific view, and especially with bull necks and droopy anatomy, makes things a bit easier. WARNING-for fiber optic handles only, and costs about $175 each. Worth carrying. LOOK HERE Pretty darn cool.

I'd check the cat's pockets as he leaves the room. Wonder how he got all those really cool kitty toys.....?

In Columbia County, the VACs got together and decided that weekdays, each VAC would staff a BLS bus in rotation that would serve as a "Tac" unit. If Westchester did something similar by zone or other geographic particular, it might be useful in decreasing volunteer stress and response time. Note, I am NOT stating HOW/BY WHOM it should be staffed-work that out amongst yerselves.

OSHA only states that you must wear protective apparel/gear appropriate for the task.. That leaves a lot of room for interpretation, as Empress used to consider our long sleeve shirts as PPE.

Even cheaper (and easier to use), is PMView. Download the trial version and look on the menu bar for all the effects and filters. Inexpensive, and a great pic catalogue app.

GM- Thigh cuff or ankle pressures, or for that matter, forearm pressures, will be close enough to anything you might take on the upper arm so as to make no difference. The popliteal artery is a good second choice for auscultation for a BP.

Take a number of standard linen sheets to your friendly hospital's central supply, where they process supplies to be pouch sterilized. Have them pouch and sterilize a bunch for your service (if anyone uses that many of them, barring working in a burn center for BBQ chickens) as they will be the best darn ones you ever had (no acute disintegration) plus they are dated for sterility, plus it is free. Why we buy paper one$ that fall apart before they get used or rip when damp.....no idea. The old cloth ones that were commercially prepared used to work best....cost a bit more...then came the stupid paper disposables. Sort of like the little food service aprons that come in OB kits. Totally useless.

I used to carry an ASP back in the day...and I cringe now just thinking about it. I probably would have either reflexively struck at a "no-strike" area on someone, and ended up in jail; or accidentally dinged my partner with the damn thing. Silly me. The last time I needed a way to get out of a situation, I told the EDP my p**** was bigger than his; he was laughing so hard as a result that my partner and I strolled out without incident. Later, after I actually showed it to him, they ended up giving him Haldol and Benadryl, to stop him from crying, but that's another story.

I remember the old "Assassinated" Ambulance as well. How about: Keefe & Keefe Weir Metro USA Ambulance Big Apple Scully Walton Brings ya back a bit.

What you have is the control head for a Kenwood 30 series mobile-you're missing the actual "deck", or transmitter/receiver. By itself, it makes a really cool conversation piece. Or wire a set of headphones to it, and show off your "new MP3 player". Bonus doorstop too.

I've been asked to do a presentation for a local high school on making choices regarding drugs, alcohol, driving impaired....the usual scare 'em straight kinda thing. I'm asking anyone who has digital pics of PIAAs, fatality accidents, or the general consequences of the above who'd be willing to let me use them for this presentation to email them to me. If they are royalty free, that would be ideal; I will credit all submissions to their owners, and I will not redistribute the presentation unless you give me permission in writing to do so. You can email me at: mongomedic@optonline.net or PM through the board. Thanks!!!