ny10570

How much difference is there between different manufacturers? They're all Aluminum frame, wrapped in sheet metal, with a wood floor. I'm willing to bet they all stand up reasonably well to rollovers, but an impact like that is going to destroy that box no matter what you make it out of. Make the ambulance box out of stainless and you will overweight most chassis with the way some of these monster boxes are configured. As it is many agencies run around with these monsters on go cart wheels to keep the load height low enough. Next size up chassis means air suspensions or a switch to commercial chassis. The increased weight also makes the ambulance more prone to rollover as much of the structural members are across the roof.

f-bambi, hit the deer save your life and potentially those around you. A moose on the other hand is different. Seth, in a word No. For ambulances to be built substantially stronger without adding significant weight the cost would absolutely skyrocket. High strength metal alloys and composite materials are extremely expensive. In this case or in the Rockland accident its not so much the ambulance as it is the object the ambulance struck that is the biggest factor. Trees win every time whether it be a fire apparatus, commercial truck, suv, or car people never fare well in these incidents. In the Rockland accident the ambulance hit the equivalent of a steel blade. It will cut through no matter what vehicle hits it unless you want to start building ambulances out of solid steel.

I doubt he did it to himself. A fall would have probably left other injuries, so I'd agree with the prosecution that Perez was probably assaulted. I just disagree with their version of who. I fully believe he was injured long before officer Bubaris came into contact with him and judging form experiences with other similar pts had he been taken to the ER he would have been put into a corner or left out in the waiting room until he turned south so may still have died. Abdominal pain is not exactly an usual complaint in a chronic alcoholic and as a frequent flier the ER, staff's index of suspicion would understandably be decreased.

Littman Master Classic II. My hearing blows and it has some of the best acoustics I've heard. The tunable bell is also a nice little convenience. Ebay.

Without actually reading the research myself the only numbers I remember are an increase in neurologically intact discharges from 40% to 55% in one study and another study in Australia reportedly doubling the percentage of post arrests surviving with "good" neurological function intact. Now it turns out there will not be an effort to get all hospitals involved as some cannot meet the demands. A few hospitals in each borough that will be made into Resuscitation Centers and anyone with ROSC will be transported to one of these facilities where the cooling process will continue and other interventions begun. The cold saline being infused isn't suppose to cool the pt into hypothermia. It is only suppose to begin the cooling process and facilitate the receiving facility's cooling efforts. Actually cooling the patient too far in the field results in shivering, bradycardia, and other problems that you either can't or just don't want to deal with in EMS. if anyone is interested on getting some more edumacation on this, PM me I have a couple articles here that I have to get through that I can pass along.

From experience cops tend to be more concerned with BSI than anyone else and since in the next photo what appears to be the same officer is wearing gloves, so I'm willing to assume he was practicing BSI the whole time. That much steel when it falls is going to do a pretty good job of stabilizing itself. I'm willing to bet the roof of that excavator was pretty well deformed to the shape of the steel beam. Good call on the TL. Trying to take someone off that mess by hand would have been a trip.

To say that his family did not care about him is as ignorant as rushing to convict the officer before he was tried. Maybe they had reached out to him many times and tried repeatedly to get him cleaned up. At some point no matter how much you care about someone you just have to cut them lose if for no other reason than to save yourself. Had the officer been responsible for his death I don't believe anyone would say that the family was trying to profit from his death. I'm really curious to see where those injuries came from. There is someone out there who thumped Perez pretty good and caused those injuries.

It's hard to know how you'll react until you see it. I know medics who faint at the sight of a needle during a physical but have no problem sticking pts all day long and I know 20 year EMT's who will vomit if they see someone vomit yet they've worked NYC through some of its roughest years. A lot of it has to do with being focused on the problem at hand and not being bothered by something that normally makes you heave (for me its saliva or phlegm). You won't know until you try it, so see if you can get a ride along with your local vac and if you make it to an EMT program when you go rotations see about going somewhere busy. At least increase your chances of testing your limits.

effd, I understand your trepidation but if you follow the exclusion criteria you catch more than 95% of all spinal fractures and 100% of all unstable spinal fractures. Also remember that this protocol is for exclusion, not for inclusion. So when in doubt they're getting immobilized. The New Hampshire Protocols posted by stat are a great example (pg 98 on the pdf). The only concern is that any time you decrease the need for a skill there is a concern that people lose the skill. People who do not qualify for spinal clearing are at a significant risk for having a significant spinal injury and immobilization needs to be done properly every time. Also intoxication is different from alcohol consumption.

The prosecution put together a garbage case. From the evidence that made it to the media that case was completely circumstantial. However if the feds bring a civil rights case forward I see them getting a conviction.

All the protocols I've seen for cardiac arrest cooling involve post arrests. Since BLS rarely get BLS only saves and the few they do get do extremely well just based on practicality I don't see much reason for this to become a BLS procedure. However I'm familiar with a story about a guy arresting in a supermarket where the BLS crew packed the guy in frozen vegetables after ROSC. I'm going to assume that if hypothermia became a standard treatment in your area and as a BLS you packed a post arrest in frozen peas you would be commended rather than punished.

Use the force JJB, use the force.

step in and inform the cop about whats going on. I've found that officers are generally very willing to defer to our judgment when dealing with medical patients. Assuming the officers were within their training it implies that the pt couldn't be safely physically restrained. If he can fight that hard then he isn't so badly hurt where I would be concerned with any risks a taser might present.

Throughout Westchester outside of a few extraordinary circumstances you really aren't going to need statflight. Unless the helicopter can be on the ground at the scene before the pt is extricated the ambulance is almost always going to win the race. Special circumstances are where flying becomes an asset in this area. With your scenario with 5 or 6 critical pts all who NEED a medic and a Trauma or other specialty referral center, statflight would be an excellent resource to help take some pressure off of WMC by running a pt out to a further facility. Croton's motorcycle accident is another example, a pt with probable spinal trauma that would either take too or long or be to rough to drive to WMC so they elected to go for the helicopter. Remember protocols are a guideline. While MOI may qualify a pt for ALS assesment, think about what a medic is going to do for this patient. The protocol is just trying to cover for people who can't think on their own. They figure that odds are a pt meeting such and such criteria might need ALS and the EMT's reading this may not be able to figure this out so well just tell them to call for ALS. I've been on several accidents where to has taken more than 20 minutes to extricate or the vehicle has rolled where the patient was fine and truely needed no treatment or were who's injuries were so minor that ALS was clearly not needed. You as a competent EMT should be able to asses your patient and justify why you do or do not need ALS for your patient. Same goes for medical calls, if the pt is responding to BLS interventions then you do not need ALS. Judgment judgment judgment, I can't stress it enough. The car with a scuffed bumper and no complaints is pretty much a no brainer "EMS not needed". When you start getting into more significant MOI its once again falls on your judgment. The RMA is a statement that you as the health care provider believe that the person should go to the hospital and is potentially placing themselves at risk for further injury or death as result of their refusal. It is important to understand what it takes make a case involving patient care. First they have to prove that you had a duty to act, second that the care provided was below the standard of care, third that the patient suffered harm, and lastly that your actions caused or made worse that harm. The RMA is just to document that you fulfilled your duty to act at the recognized standard of care. If in your judgment the patient stands to suffer no harm from refusing treatment then you have no duty to act and can send them on their way. It is also important to understand that unless the person has a complaint or there is something to indicate to you that they may not be aware of the extent of their illness or injury they are not your patient no matter how old they are or what their mental status may be.

I think Oswego is spot on. Commissioner needs to be at these events, but he certainly doesn't need to fly.

Finally someone has pointed the potential dangers these present. They're great in concept but a nightmare as far as safety and the environment are concerned. A guy from HazMat1 was telling me a cute story about a woman who after hearing about CFL's and how great they were went to WalMart and loaded up on them. First stop was the babys room where she promptly crushed all of them. After a call to 311 an hour later her apt is sealed off the carpet is gone from the room and she needs an environmental cleaner to come in to remove the remaining mercury from her apartment. Great product.

emtb23, everything you have here is exactly what makes EMS so tough and so much fun. There are extremely few hard and fast answers. Just a lot of guidelines to get you headed in the right direction. This where clinical discretion comes into play and it allows you to break just about any rule or guideline (so long as you don't try and operate above your training) if you are doing it to better care for your patient and you can justify why you did it. 1. You do not need ALS for a mechanism based trauma transport. There are three reasons to take ASL with you; underlying medical condition that is actively causing harm to the patient, an unmanageable airway, or hypovolemic shock. Since these are mechanism of injury based trauma calls unless they are complaining of something medical roll on out, their airway should be intact, and they shouldn't be bleeding too severely. 2. You have two critical pts on scene packaged and ready to go and two RMA's standing around get your giddyup on. No medical director on earth will hang you for leaving two non patients so you can treat people with life threatening injuries. If the pts are not critical, the call becomes tougher. Do you wait till they start to circle the drain and get your RMA's or do you take off. So long as you asses your RMA's, properly inform them of their decision and have them sign, who says you can't fill out the paperwork after the job. I've been called to jobs just to get RMA's and as much as it sucks if the crew had a good reason to spilt its completely understood. 3. Its extremely unlikely you'll be able to get lifenet anywhere faster than the local VAC or ALS flycars. While they can be an excellent resource at MCI's they aren't going to be any use that early in an incident.

Some more info on the mess in NYC... http://wcbstv.com/seenon/ambulance.emts.nyc.2.746133.html

Yep, and its going to happen again and again. They're short EMT's and have had to cut back on units assigned to beaches that helped prevent unnecessary transports and saved time with the necessary ones. This weekend they were down quite a few ambulances per tour and had a couple of substantial fires, a parade, and 20 block long party sucking units out of the system while handling well over 4000 jobs each day compared to a sumer average of around 3600.

I know nothign about this incident firsthand, but to help short cut a lot of the speculation it is extremely unlikely the crew was lost in Manhattan. From New Dorp on SI to Bellevue is about 25 minutes. 55 and Lex is another 20 blocks and this was after 3pm when all the schools are out and workers are starting to hit the street. A 50 minute drive to the job is not unreasonable. A very reasonable scenario is that the unit was sitting "89" at their regular assigned location. When a borough runs out of units and units are redeployed the units to be redeployed are done so by RCC. RCC reassigns the unit to the new borough and designates a new cross street location. If the unit did not change their signal from "89" they would now show up in the system at their newly assigned cross street location even though they are still sitting in SI. So the Manhattan dispatcher sees this unit show up sends the job out and is too busy to hear the unit explain that they are severely extended since BLS are technically not allowed to be extended (thats a whole other story). They would be told to "do their best" and so away they go. As for PD sitting there for nearly an hour with this woman, the PD dispatcher would be able to see that a unit had been assigned. To get an ETA they send a message over to EMS who if they have the time to do it will ask the unit for an ETA. ETA's are not a priority and for a non-life threatening call type would probably be ignored on such a busy afternoon. Now for two quick related anecdotes. I was redeployed to Harlem from Throggs Neck in the Bronx and seconds later assigned to an injury at 145 and Amsterdam in Harlem. Different traffic conditions and I have a bit of a led foot. Made it in 14 minutes so no story for the papers. The other was another extremely busy day and a glitch in the system put a job in Riverdale right next to me all the way down in Soundview at White Plains and Randall Av. Dispatcher was too busy to hear me and the ALS try and explain we were at the wrong end of the borough for this chest pain call. Luckily a heads up unit and Lt were listening and took the job in themselves. smwells, to answer your questions... system only shows your actual status when "available outside battalion" (98) or "available inside battalion" (97). When you're at you assigned location (89) no matter where you actually are the system puts you at your cross street. PD asking for updates probably only got "a unit has been assigned" at least thats what we get when we're waiting for PD. Another unit getting free wouldn't have changed anything unless someone specifically looked into that job. Once a unit is assigned a job the job sort of goes away. The only time that changes is when a higher priority job pops up in which case the unit would be pulled off the lower priority assignment. There is check to keep track of units in that every 10 minutes from when you're assigned to when you arrive on scene a light flashes and the dispatcher is suppose to get a verbal update on your status, either on scene or still responding. Why this didn't catch this mess I don't know.

This is not MetroWreck koolaid. The plan is for a small refrigerator large enough for 2 1,000cc saline bags (apparently its all ready been picked out). Get a pulse back on an arrest and they buy themselves a large bore IV and a liter of ice cold saline on the way to the ER. The plan is to begin the cooling process that will be continued at the ER. Its all still a way off, its part of a larger plan to improve the arrest survivability numbers in the city. The dept is going to designate cardiac arrest hospitals and to qualify they have to provide certain services and meet certain standards. I don't remember all of the qualifications required but there was nothing outrageous with the idea being that every 911 receiving facility could comply with minimal effort. They were all centered around establishing a standard of care citywide so that any interventions begun in the field would be continued at the receiving facility.

Nick, anyone who works in Emergency Services can attribute their career to stupid people trying to kill themselves in new and creative ways. I like Chris's idea, pay for a permit and then jump to your hears content. You can't stop it so you might as well regulate it.

All right, so the Guardian Angels claim they train their people. Here's a NY Times article from 1992 about the fraud that Sliwa was. http://query.nytimes.com/gst/fullpage.html...752C1A964958260 Another one out of Florida. http://www.browardpalmbeach.com/2007-08-02/news/wingin-it/1 I'm not saying they don't have good intentions. Curtis Sliwa is a self promoting jackass and the Guardian Angels are an over hyped group of clowns who don't do what they claim.

How about the guy on the garden state filling barrel with Diesel in an old bus. The idiots are plentiful and Darwin is always lurking.

http://video.google.com/videosearch?q=b2+c...mp;sitesearch=#