ny10570

HazTac are BLS with a Henry designation (18H) or ALS with a Zebra designation (14Z). Rescue/Crush units are ALS with a Retard I mean Rescue designation (03R). I have no idea how many HazTac units there are, but there are 5 Rescue medic units (1 for each borough). The Rescue and HazTac all run 3 tours and operate as any other line unit until there is an incident requiring their response. They can be special called to any incident and are suppose to all ways be assigned on certain calls. I don't know the specific assignments that are assigned to HazTac, but I do know inhalation or suspected HazMat spill are suppose to have a HazTac and the the closest appropriate unit. Building collapse and entrapped firefighter automatically get a Rescue medic. Maybe a dispatcher or buff can help more here. The HazTac are designed to be able to bring patient care into the hot zone of a hazardous environment and through decontamination. The Rescue units are there to bring patient care to an entrapped patient in a variety of dangerous environments. They are able to operate along side fire's rescue units just about anywhere they are able to. They are also trained in crush medicine and I believe have a set of protocols specific to their training coming out soon. Both the HazTac and Rescue units are there to bring treatment to the patients instead of waiting for the patients to come to us.

http://www.firefighterspot.com/2008/02/fdn...tment-fire.html

OLM was bought out by Monty last year under an agreement to protect OLM from bankruptcy. 15V was not taken from OLM, rather Monty gave it up. While voluntary units have been around since the beginning, several years ago under VonEssen and Rudy EMS contracts were handed out to hospitals instead of funding NYC EMS and later FDNY EMS so they could handle the growing system. As a result of these contracts the Fire Dept cannot kick an agency out of the system without cause (they tried). So, when GPS became required, the voluntaries coughed up the cash. Same thing for the PPE. If they don't staff their units or maintain a certain level of quality they can also be removed from the system. None of this applied to 15V, they were an excellent unit. They were screwed by Monty. Fact is, there isn't much money in EMS and even less in ALS so Monty turns to Transcare who is according to some is the reason why the Fire Dept is trying to get voluntaries out of the system. I also heard that Monty will be looking to hand over the OLM BLS to Transcare but these same birdies are saying that it would be equivalent to OLM dropping the units and Monty trying to pick them up. Probably not gonna happen. 15V will probably not run out of the new station up on 233rd when ever they finally get around to building it. It will most likely go to Sta 15 and 27W will go to the new station assuming there is not some big shuffle. Either way 15V didn't go because the FD needed an ALS for the new station. Station 26 has been there in the North Bronx since the very beginning. I wish you guys at OLM all the best luck during this transition and I really hope to see those ugly a** buses cruising the Bronx for years to come. All ways been good people, good at their job, willing to help out even when its an EDP splashing around in blood .

I would like to see him receive LODD benefits, its no different from a posthumous promotion. However if I get hurt on my lunch break, I know I'm on my own, so I'm assuming death would carry the same lack of benefits.

At this point the booster is probably full and you can feed the ladder.

So the officer of the rig supervises his crew and you need a chief for every 5 mutual aid companies. Still no reason for three chiefs to roll up with an engine and a ladder or whatever may be called.

Biggest correlation between success and failure with any treatment has nothing to do with call volume. Its service size. In a service were the Med Director knows his medics and can train all of them personally the success rate climbs tremendously.

Is anyone still making the Mark 1 kits? I know FDNY switched to a different kit after their stock expired. Its changed out protocols a bit as we have less control now what we administer.

Smiley, luckily its a very simple issue. Either you'll have time to find out where they are and where to go pick 'em up or by the time you realize you need 'em its too late and you're S.O.L.

FFD, just about any possibly cardiac chest pain get nitro. feraldan, how did the pt do on the look test? One of the most reliable tests I've seen, especially in the absence of any significant clinical findings is "How does the patient look?" Did she look ok or did she leave that impression that something wasn't right. This is an excellent case to follow up on, because if the medic did miss something they need to be held appropriately accountable.

This isn't about getting dress uniforms or even a strict duty uniform for volunteers. Unless you're required to be in quarters while on call, its ridiculous to expect a volunteer to spend their day walking around in BDUs, boots, and a uniform shirt all day just in case they get a call. You can however make sure they're wearing something that fits that identifies their agency. The bus doesn't have to be immaculate, but if the roads are sloppy wash it off once in a while. You don't need 40 year vets to start pressuring people to do the right thing. Ask around, I'm sure some of the older members of a dept or company at times are as much a problem as anyone else. You just need someone to step up and say this is how its done and this is how you will do it if you want to continue with us. None of this crap is he solution to every problems. This is about bringing your bottom 1/3 up to the next level. As someone else pointed out, you could go out and hand pick the best people to operate in your system, but you'll still have your weak links. The game is to improve or eliminate them so you can move on to the next weak spot, and eventually you wind up with what you're looking for.

No apparent cardiac hx, but she's a diabetic with high cholesterol. The chat with telemetry is going to be very one sided and short because I'm asking for morphine for a hemodynamicaly stable adult with chest pain.

Vacguy, you're right, they are different. My point is in both cases you have individuals who have chosen to give up their own time to train and serve their community yet fire seems to get a higher quality of membership. In this case its not the training that creates this environment, its the leadership and senior members of that agency. Sorry Bnechris, I wasn't clear. I'm not implying, I am emphatically stating that UPS requires regular cleaning of their vehicles and the vast majority of EMS do not. They may encourage it, maybe even request it but either don't provide the facilities or the motivation to get it done. I know there are individuals out there who clean their buses (I was a regular at the Gun Hill Rd Bus Depot so I could wash my bus), and there may even be an agency that does require this, but it is certainly in the minority.

Anything in the 12 lead? SpO2? Pulsatile mass? If all are unremarkable she gets nitro, ASA, morphine, at least a 16g IV and a nice relaxed trip to the ER.

JJB, lets compare apples to apples. Volunteer fire, while not the gold standard of physical specimens appear much better than your average VAC. In both cases training is done on your own time in a non academy environment, yet why does one look different from the other? Commercial EMS, compared to just about any other corporate enterprise has stricter standards of appearance. Hell even UPS requires vehicles to be washed on a regular basis. Its the people in charge and the senior members who are responsible for setting the standard. This once again comes down to the rank and file stepping up and demanding more from their co-workers and employers.

Many things in that article don't sound right. I'm curious to see what really happened.

Thanks shipwright. Thats a great example of the old EMS that I hear about.

Turning EMS into a civil service position tomorrow would be great, but who is going to give up their and control and who is going to cough up the cash for this? Lets be real. This is going to take an effort from the bottom up. The only way I see this happening in the short term is through a union. I am far from neing one of those rah rah union guys, but EMS needs a common thread and a strong union could be it. Bnechis, you're right just hiring a few part timers isn't the solution. What's important is that it establishes a precedent where agencies don't have to sell out to privates to fill their staffing needs. Mt. Pleasant is in a unique position where they really could lead the way. Two of the three agencies all ready are paying for part time EMTs, they share the same ALS service, and they could easily be organized under one municipality.

Several people have brought up drunk driving accidents and drunk runs on college campuses. Personally, I've handled a lot more over 21 drunk driving accidents than under 21 accidents. The drunk runs at colleges are probably because the majority of the population is under 21. There is also a much lower threshold for EMS activation on campus than there is off campus. In college, if I found you intoxicated and under 21 I was suppose to call PD and have you taken to the hospital. As a general rule enforcement began if you were found not on your way to your room and intoxicated. Personally unless you were really in bad shape and unable to take care of yourself you were sent on your way. Off campus, as long as you manage to make your way inside your home you are good to go. Come spend a weekend night with me down in the meat packing district. 07C tour 1 is the busiest bus in the city Friday - Sunday. 75% of that is the drunk shuffle to St. Vinnys where the majority of the patients are of legal drinking age. Illegal drug abuse seems to follow the same trends. I have yet to catch an under 18 OD, but once they hit their mid 20's they start to reach their threshold. The whole point to this ramble is that maybe the increase in underage drunks and DWI is more about perception than it is about hard facts. We all know that drivers under 25 are more likely to crash. Maybe someone with access to these figures can apply the accident rate for your average under 21 driver to the accident rates for your under 21 drunk. I'm willing to bet they're the same if not better.

How. How are volleys suppose to screen their members better? Without a history there isn't a thing that can be done. Don't forget, paid firefighters have been nailed with arson charges as well.

Its the same root issue. First off EMS is a relatively new service. Fire and PD have been around as long as the community they protect. Fire is extremely devastating. A little bit of fire does a lot of damage, nothing like watching your neighbors home go up in flames to remind you how much you need fire protection. Fire is also a great headline grabber. It can take time to kill resulting in great video of people being rescued. Fire can also kill innocents very quickly making for compelling tragedy. One the most pervasive fears in the average person is crime. A few headlines about home invasions, robbery, or murder and people begin clamoring for more police protection. Just about any headline you see on the nightly news PD will be involved in. They're at the accidents, they handle the crime, the standoff, the major weatehr event, the missing child, they're friggin everywhere. PD is the one service that everyone will call upon at one point or another. EMS on the other is seen as unnecessary. People think they can get themselves or their loved one to the hospital. Its not like if you get robbed you just need to run down to the community gun depot pick one up and go catch the guy. House catches on fire, if you're garden hose doesn't cut it you have no recourse other than to call the FD. We're are never going to catch much real press coverage because half our job is getting off scene quickly. The incidents that are specifically EMS only affect one person. So now taking all of that in account the general image is going to be that EMS is less important. With an economy that isn't so hot any more budget tightening has begun and its only going to get worse. Fire and PD are facing budget cuts in every big city across the country. With this new economic pressure how much traction is the new kid on the block going to get when they start asking for money. If you want to fix the system, its going to take the efforts of the grunts on the ground. If your vac is failing start hiring people. Don't contract out to a paid service. Then as volleys drop there is a slow transition to paid that if the day comes that the volleys can't do the job any more there will be a system in place to create a municipal service. Be professional. Do the job right and take pride in your apperance. Your uniform, no matter what it is should always be clean, in good shape, and FIT RIGHT. Wash you bus once in while even if you just hose off the salt and sand in the winter it makes a big difference. Having a station is not the solution to our problems. Our unhealthy habits will follow us to the couch in front of the TV just as easily as they do to the bus. If you want to pick a fight, fight for pensions, better salaries, LODI benefits, and better training. Find a union and get one in there. Once we stop letting the management kick us around we'll all be better off. EMSBUFF, its not the 12 hour tours that are unhealthy. You're killing yourself. You're carrying around 70% more of you than there was 2 years ago, there's no way it doesn't show. Stop kidding yourself and fix this before you do some real damage. Most jobs don't let you work out while on the clock, so don't use that as an excuse. If you want to make some changes in the job we're going to need you to be around to make them.

First off, I am fully aware of how rare significant spinal trauma is in your typical MVA. That being said, it does happen. So why is it we are so relaxed about properly applying the collar and immobilizing. Everyone just gets a small collar and then they're asked to slide onto the board. If they're stable get out the KED and do it the right way. Car is banged up and you can't get at the patient without them moving, let fire get to work. I have yet to meet the ff who bitches about cutting a car. If nothing else when you do finally get the legit injury you'll be proficient and comfortable with your equipment. Most Westchester agencies wouldn't dream of walking a patient to the bus yet as soon as its an accident they have no qualms about compromising c-spine just because they think its bull. Don't take this as me advocating collars and boards for everyone and every accident. If the mechanism is insufficient and the physical exam is clear they should up and moving. I'm a huge fan of field clearing c-spine. What this is all getting at is, if you're going to do it, do it right. Thanks for reading, I'll put the soapbox away now.

I tried the whole ask the doctor trick but it seems it comes down to opinions and rectums. Everyone has one and everyone else's stinks. I can't even get doctors to agree clearing without x-ray in the ER. Hopefully next week I can take a trip down to SIBL next weekend. One article I found was a research analysis done more than 10 years ago. I'm going to see what comes up now. As of right now I've got the ear of ER attendings from Jacobi, St. Vincents, and a few of the EMS fellows. If anyone has some specific questions I'll be happy o pass 'em along.

I agree with wheel that we need to lead by example. Absolutely there are times when you may have to be on the phone, just keep it to a minimum.

Excellent posts Ckroll. Someone just sent me chasing after an article out of Pediatrics published in Aug of 2001. They found the 5 criteria for c-spine clearance applied as well if not better to children older than 2 years of age(The authors felt there was not enough data, only 88 children less than 2 years of age of which none had spinal injury). While they also found distracting injuries to be more of an issue with children, resulting in fewer c-spine clearance candidates they estimate a 20% reduction in pediatric cervical spine imaging. Proof that the KED works... Cline JR, Scheidel E, et al: A comparison of methods of cervical immobilization used in patient extrication and transport. J Trauma 25:649-653,1985. A radiographic comparison of pre-hospital cervical immobilization methods. Ann Emerg Med 16:1127-1131,1987