ny10570

I believe the trucker who jumped was at a lower portion of the span. Leave the bridge alone. I enjoy the view without a 12' fence that will not save lives. It will just stop people from using that bridge.

Used phones before, but they never had ice. Wound up using recent calls.

My point was people need to stop accepting crap situations and fight for what they need to do their job and go home. There are mechanisms for getting this done. No crap, you can't just go to the chief and get an additional man on every rig just because you realized you want one. There isn't an easy solution but saying that it isn't there so we can't get it is guaranteed not to help. If the commercial ambulances don't want to go, what does their contract with the town say? If it says they're required to respond to any public emergency or potential life threat then f-em. They're bound by their contract. If they don't have enough units to cover the area then thats a problem they'll have to figure out. Maybe they'll find a way out of it or maybe the town will realize the gamle they're taking. Either way they're making a decision and thats when you'll have you chance to be heard. Its not about determining them to be fit for duty and able to return to the fire. Its about catch an impending medical disaster. If you're that affraid of big bad DOH then don't provide any treatment. Just asses and send them on their way. If they come to you because they feel sick or think they're injured then thats a different story. Checking everyone regardless of complaint does not open you up any increased liability. If I knew that answer I wouldn't be posting here. The point I was making is that you have to push for the changes you want. They don't just drop out of the sky and land on you. There's a big difference between saying we don't have something yet and saying that its an impossibility. What finally changed to get the regionalization study commissioned? Things change and they can change for the better, it just requires people to be there ready to effect that change.

If you've got a lot of taxpayer or a long strip mall thats still uninvolved you have a chance at an effective trench cut. But you need to give yourself enough space that you'll get the cut done before the fire can get to you. It really only comes into play if you're writting off the involved stores and most likely the next uninvolved store. Like others have pointed out, it takes a lot of time and probably a saw change or two to get it done.

I don't get why people make excuses for their dept not having enough resources. Its your butt that on the line. Make them either increase staffing or call in mutual aid. If there are not enough resources then put pressure on your leadership to get those resources there. Make it their problem and let them deal with it. Now if you don't believe that rehab has anything to offer you or you think having EMS standing by just in case something happens to you is a waste, then so be it. But don't excuse management 's responsibility to protect you because there aren't enough resources. This is not directed at anyone individual. Just a reference to a general attitude.

Rehab really is an over looked necessity at any emergency scene, but anything worth doing is worth doing right. To do rehab the right way you need a crew that is dedicated to it. If you're going to actively track the condition of the ff's you need to be there the whole time and not getting pulled away in the middle because someone needs help. So you need a second crew there to handle that. Hell, you could even get away without EMT's running your rehab. Get an automated BP cuff, thermometer, CO monitor, clip board, and pen and you have enough to get started. As usual I should have been more clear the first time. Gingersnaps, not trying to bust chops, but what happens if you're inside on the knob and someone goes down outside? Vacguy, if the IC and fast (By fast i mean the fast staging area) are that close then they need to re-evaluate what they're doing. As with anything, you and your crews personal safety are paramount. In the end it doesn't matter where anyone on here sets up or stands by. So long the people you are there to help know where you are and you can get to them in a timely manner you are where you need to be. Just don't be wasting time that doesn't need to be wasted. Chris, every fas team I have seen or worked with operates with a rip and run mentality. For two reasons, the primary concern is removal from the dangerous environment and usually by the time you're found it becomes life over limb. One of the benefits of integrating EMS and the Fire service is more and more firefighters are becoming trained and experienced in EMS. So in the future if you get the trapped ff who is still breathing hopefully we can bring treatment to the ff.

mfkap, there is very little actual compression of the heart. As you increase the pressure inside the chest cavity pressure back into the venous system is stopped by the valves in the vasculature. Over time pressure builds up in the arteries and pushes the blood through the capillaries. It is when the pressure finally builds up in the venous system that CPR reach peak effectiveness. Circulation through the coronary arteries into the heart works opposite of the rest of the system. During recoil the pressure in the arterial system pushes back up against the aortic valve forcing it closed. At this time it pushes into the coronary arteries. At the same time the recoil pulls blood out of the venous side or the coronary circulation. Ventilation without supplemental O2 is effective because the body's oxygen demands are much lower in arrest. That and right before arrest the blood was most likely fully oxygenated.

People keep on putting forward the abdominal thrusts, but they only work on healthy individuals. Too much gut or skin and bones and the numbers don't work. Then of course there is the abdominal trauma that Goose mentioned.

That article really does a poor job of explaining the research. In cases where the arrest was witnessed and Defib was used they had a 12.5% survival to discharge rate. AHA lists the arrest to discharge rate at 6.8%. Seems pretty good to me.

The science behind this study is sound. Without supplemental O2 there is little difference between compressions only CPR and 30:2 CPR. Mouth to mouth or mask or whatever gives almost as much O2 to the patient as a BVM without supplemental O2. This is because just before ventilating the rescuer takes in a deep breath and expells the breath quickly. There is little time for respiration to occur. So the air they are receiving is close to 20% O2. When you push on the chest air is forced out of the lungs. This volume of air is actually greater than the anatomical dead space present in the lungs and airway. Over 100 compressions in cadaver and animal tests there is a significant enough exchange of air to provide meaningful ventilation. Another factor is that it takes between about 15 compressions to generate enough pressure to get blood circulating. So even now with 30:2 half the time we are doing CPR we're just catching up to where we left off. This you can see for yourself. Next time you're working an arrest monitor the CPR pulse. It gets noticeably stronger after the first few compressions. There may be more changes to come. There is some research that suggests supplemental O2 may be harmful in an arrest or at the very least retarding our efforts. Saturating the limited circulation with oxygen may be no different than hyperventilating your patient. This leads to cerebral vascular constriction. For the vast majority of cardiac arrests, it is a problem with the heart and not with the lungs or any other organ. Years ago it was shown that administering glucose just because its an arrest did nothing to help patients, because hypoglycemia wasn't the problem. There was still glucose in the body, it just wasn't getting to the brain. The same should be true for oxygen. Its there, its just not getting where it needs to be. The body's metabolism is all but shut down, so it doesn't even need as much oxygen as before the arrest. Just enough to keep the brain alive.

If you're the only crew available forget about rehab. Be there for when crap hits the fan. Get out and stand by near the fast team and check in with the command post. Have your stretcher ready, long board, collars, etc. The two things that kill ff's on scene are sudden cardiac arrest and trauma. Make sure the bus has a clear shot to the road and you have a path to the ambulance. If you have the equipment and staffing to dedicate a separate crew for rehab and monitoring, thats excellent. But thats best arranged with the depts you will be serving.

For Westchester there is a central dispacth (60 Control). But some fire depts, EMS agencies and I think all police agencies are self dispatched. The majority of 911 calls go to the local PD from land lines and to the state police from cell phones. If you call 911 if you're in the wrong place you're screwed. Recently I got a call back from the State Police after calling 911 to report an MVA in Chappaqua. State Police were calling to see if I was in New Castle as there was not a a matching address for Chappaqua, only New Castle. Chappaqua is a Hamlet of New Castle and while Chappaqua is good enough for a mailing address and post office, apparently it doesn't work for 911. I have also been bounced back and forth between police departments each one saying its not in their district. At this point I just call county directly.

many depts make exceptions for people who work in their district. Even if you can't respond from work if it happens to be one of those neighboring districts it may work out.

http://www.snotr.com/video/568

Similar problem for EMS in the 5 boroughs. Over the years more than a couple of units have been sitting available when without warning the beach begins to shrink and a unit suddenly finds themselves amphibious.

My only problem with this law is that it makes your employer pay you while you are responding. If you are not at work then your boss should not have to pay you. You should be allowed to leave to respond, but if they're going to keep you on the clock consider it a bonus. The law as its posted applies to everyone. The only exemption is for people employed in the service of the public with where their absence would result in staffing below a set minimum.

Thanks to time based performance standards response time is one of the biggest issues in both volunteer and career fire departments. On the career side of EMS response times are also a major issue resulting in being stuck on street corners, moved around at the whim of SSM, and stuck racing after sick jobs just in case they're real emergencies. I never hear anything from volunteer EMS agencies about response times, only the number of calls covered compared to those dumped out on mutual aid. How are you guys doing with response times? Anyone have numbers to put up?

ckroll, as usual, excellent points, but we face the problem that I was getting at when I started this thread. No one is tracking their own performance. Apparently the prevailing attitude is "we got a bus on the road, so what". Three days after starting this only Moose, and mvfd 1813 have stepped up with numbers. Are these the only agencies that keep track or the the only ones who are not afraid of their numbers.

A municipal based agency most certainly can bill in NYS. Only fire districts are unable to bill.

At 500 a trip you guys would have to pop off 14 transports a week every week. Plus your pay, equipment, gas, maintenance, vehicle replacement, and they've got to fund the 911 side of the business. I'd go with a number closer to trauma's figures.

Moose, you gave me a reasonable estimate of how long it could take to get an ambulance. Sorry, I wasn't accusing anyone of using fake numbers when I said "real numbers", I am just looking for concrete numbers based on documented performances. What was the average response time from dispatch to on scene? The issue with obtaining response times wasn't one of not knowing where to look, but more of no one was tracking them. If they are not recorded in a system then there is no system to look them up in. Since there is no EMS response standard that I've been able to find, I'll go with what NFPA suggests Fire Dept based EMS service. A crew of first responders or better in 4 minutes 90% of the time and ALS in 8 minutes 90% of the time. They also suggest a minimum of 2 paramedics and 2 emts. Since I don't think any medics in Westchester work with a medic partner how many agencies can get the medic and three members on scene in 8 minutes 90% of the time?

I thought there were three ALS levels. I also thought the first 2 drugs were free, but I then again I don't do billing. I just do the damage.

Most agencies follow the medicaid reimbursement schedule for their billing. I don't know the exact numbers, but its a flat figure depending on the level of care (ALS or BLS), and increases based upon the number of medications administered and the miles transported.

We are so far from the social and economic conditions of the 70's and early 80's. We're only now approaching the economic losses after the tech collapse in 2001/2002. I wouldn't get too hyped up waiting for urban blight to set in.

A couple of excellent points, but how come no one other than Mahopac has solid numbers to put up? MZVFD, when does your clock start and stop? The numbers games people play really kills me. If anyone has some flexibility with how they come up with their numbers how about dispatch to the ambulance on scene. This is the best measure on that agencies performance. A lone medic, police officer, or EMT on scene should not stop the clock because if its an arrest, until they get some help they might as well be a citizen with a defib. If it is a Cardiac emergency unless they're a medic or are going to transport without the ambulance they're really not doing the patient much good. Some have brought up that the bus often is not a priority as long as treatment has begun. True, so then is the bus told to slow it down? If you're an agency that consistently has a fly car on scene first, why not roll the ambulance cold until being informed that it is a true emergency? Not breaking balls, just throwing out ideas. The other issue here, is there enough help on scene without the bus to begin treatment of the critical patient or is the lone responder going to be stuck trying to play catch up? In the spirit of full disclosure, this came about because of a discussion with a VAC officer about how great they were doing this year. They had only had to look to mutual aid once so far this year, but he had no idea and no way to look up how many calls took more than 10 minutes to get a crew on the road. GAW, a great way to fix that is to switch to 60 and utilize EMD. A tiered response will save you so many of those headaches.