ny10570

:cough: value jet :cough: I'll stick with Jet Blue

If you're responding in with an engine, it works. Maybe you should be leaving the tool with the engine while you transport. If you are going to spend the money and space on CAFS then I'm assuming you're not responding with FD. Who's going to treat the patient while you're fighting the fire and cutting the car? In depts where the ambulance is the second piece the engine runs with, is the engine company able to operate if there are victims on the lawn that need EMS?

120mph isn't enough to say reckless endangerment without info on road conditions, traffic, etc. I know the top speed of my last three cars and I haven't been to a track yet and these aren't cars that should be doing their top speed on the open road.

There's no quick fix for EMS. Municipal certainly isn't it, but it beats the hell out of commercial. NYC has Municipal, Hospital, and Commercial and without a doubt commercial is the last choice. Now I'll get my soapbox out... I wasn't in EMS 12 years ago when the merger, takeover, invasion, whatever you want to call it occurred. I'm here now and two main gripes from everyone who was here HHC. It either revolves around EMS being a second class citizen or the increase in supervision and regulation that fire has forced on EMS. I have yet to find anyone who can show me how the job has been made worse since the merger. We didn't get a tenth of what was promised, but we've never had a newer or better maintained fleet of vehicles (EMS use to have to change their own tires), we've never had better facilities, we're taking back units that were given away (HHC gave away many more slots over the years than Guliani did), better equipment, LODI, 3/4's pension, 25 year pension with a 20 year pension languishing at the state, uniform status, more command and control over units, and LODI (This is probably the biggest benny). EMS was offered unlimited sick but the senior guys who stood to lose a lot of sick time shot it down. Back in the HHC days the job tried to get them to respond out of stations but the rank and file fought it because they saw it as an increase in supervision. In the old days EMS in NYC was like working in the wild west. They ran non stop and chased the jobs they wanted. Man under, shooting, MCI great response times. Talk to any cop or firefighter and they have horror story after horror story about 20 and 30 minute wait times for a bus. Fire started their first aid units (the origin of the CFR program) because people were pulling call boxes when they needed an ambulance. PD regularly transported the sick and injured to the hospital because a bus just took too long. Yeah, a lot of it was under staffing and a huge call volume, but HHC wasn't expanding. Their philosophy was do what you can for who you can. The fire dept is numbers driven. They've established a standard of care that didn't exist under HHC. There's a lot more supervision but its to get everyone the help they think they need. Sadly the days of going down to the point for a few lines and a BJ are gone (yes, that crap happened frequently). Yeah, our pay isn't close to what PD or Fire make, but we do better than EMS in the surrounding communities and if you include our benefits it gets even better.

At this point there isn't much evidence to back up immobilizing everyone. Even NYS protocols allow you some leeway if you have faith in your clinical judgment. The big study on spinal immobilization was NEXUS (The National Emergency X-Radiography Utilization Study) begun in the late 90's. It was a retrospective study to determine just how well physical exam could determine who does and does not have a significant spinal injury. I don't have the numbers in front or me or my access to medline, but if I remember correctly of nearly 50,000 patients 1.6% suffered clinically significant c-spine injury. Injuries to the thoracic vertibre were more than twice as common as cervical injury. All it takes is 5 criteria t catch 99.9% of all spinal injuries in the study. Midline tenderness, neurological abnormality, altered level of consciousness, intoxication, or distracting injury. Yes to any of these questions gets immobilized and irradiated. Immobilization isn't a benign treatment. In the elderly skin breakdown can begin in as little as 20 minutes on a long board and 40 minutes in a healthy adult. Spending an hour on a board is a very real option in a busy ER that relies on radiographic c-spine clearing. CT scans are large doses of radiation (10 times that of a c-spine x-ray). My other point in the beginning wasn't so much as why we immobilize, but how we do it when we immobilize. The collar, even when properly applied does not protect the c-spine. When combined with the long board or KED you now have "effective" immobilization. As more research goes into immobilization there is an increasing amount of literature that indicates people would be better off left alone. The biggest issue is trunk movement. If the body is allowed to move independent of the head we create the potential for displacing an unstable cervical injury. This is why holding the head and having the patient slide over to the board or duck their head out of the car is doing more harm than good. The KED is far from perfect, but I have yet to see a rapid extrication that was even close to protecting c-spine.

It is a calcium channel blocker commonly used in the pre-hospital setting to treat rapid afib, atrial flutter and SVT. These are all dangerous arrhythmias that originate in atria of the heart.

FDNY lost Cardizem when our supplier stopped making a lyophilized version. Since we lack refrigeration and don't have an active stock to rotate out of like the hospital based units the liquid version has been found to not be cost effective. Just curious as to what you guys use up here.

If you show up with a combi tube in place on an uncomplicated arrest you really need a good excuse as to why you could not intubate your patient. If you can't get it done now then how are you going to get it done when the conditions suck and the pt isn't lying out on the floor in front of you. Yes I understand there times when it just isn't going to happen but they need to be few and far between.

This is going to go worse than Colin Powell's Yellow Cake speech before the UN. I can't wait.

The cop was a douche and so was the kid. There was no reason for the cop to start in on them like that and no excuse for the kid to respond the way he did. Sadly, in the end the cop loses.

More bad press for 911 CRO's http://abclocal.go.com/wabc/story?section=...&id=5957267

Jacobi hospital box truck with hydraulic lift gate...its been done before. When not approaching marine mammal size a sked is a great choice. If the pt is too big then the sked goes on the floor of the bus and a K-12 makes quick work of the stretcher hook at the ambulance door.

75k is a very fair price. It comes as is and where is. They aren't driving it home.

Oneeye, Running through a potentially occupied structure is completely different from approaching a burning vehicle. Any time there is an immediate threat to life you cannot blame an officer for trying, in fact they should be commended. The issue here is there was clearly no threat to life. It wasn't an accident where there would be vehicle deformity and potential entrapment. If there's too much fire to tell if anyone is in there than you can't do anything for them anyway. The chances of being struck by any projectiles from a car fire are slim, but they are a significant projectiles traveling at high speed. Definitely penetrating trauma. As far as hot is to hot, who the hell knows. Even if I knew the temperature there's no way to tell what its at and how long its been exposed.

Most of these problems are a result of Fire and PD being an integral part of the community since its inception. If fire started 30 years ago they'd be on street corners too. I defy you to find a city agency that would cough up the cash for a facility located in some of the hoods that Fire and PD occupy now. Back when everything was on foot and then horse drawn you needed a protected facility and you needed to be close. Hell, in many 'old' cities Firehouses are still located on hill tops and in most communities fire and pd are located at the old center of town even after the populace has shifted. Until municipalities begin taking responsibility for EMS it will continue to be shopped out to the lowest bidder who will make their money on the backs of the employee.

You nailed it as usual. Much of the research pointing towards the removal of ETI from the field is based on studies out of slower areas and based on airway injury. Often times medics don't have an option past ETI (until recently if ETI failed we only had needle cricothirotomy in NYC). That leads to some rather "agressive" intubation and some potentially significant complications. We are our own worst enemies in that we aren't that great at intubation. There are still a lot of right main stem and esophageal intubations. We all know the right way to do it, I'm not going to start preaching, but if you aren't sure don't do it. Another issue that Stat mentioned is easily addressed without a formal system in place. Don't leave your patients head until you have confirmed the tube is still in place and report it to the attending or who ever it is you're turning the pt over to. Combi tube is not a definitive airway. If an ET tube is the key to airway management then combi tube is a hammer. The pressures created by the cuffs cause far more damage than the cuff of an ET tube. The dual lumen design makes the device larger and potentially more damaging to a swollen airway. It is not indicated in laryngeal spasm, edema, or airway trauma. It cannot be used in children. All that asside, any area without reliable ALS needs a device like the combi tube. When done correctly with an uncomplicated airway ETI causes no significant damage especially if cuff pressure is measured.

Damn, you beat me to it

Bnechis, you're spot on that we are killing ourselves many other ways much more efficiently but we have seatbelts in all fire apparatus, we have SCBA to protect us from the environments in which we operate, and we know how to protect our health. The real issue is how we choose to not protect ourselves. But that shouldn't excuse the job from providing the appropriate equipment.

This may not be the 'right' forum for this thread, but I wanted this somewhere that gets a lot of traffic. Its very well done and provides some very good insight. If you are going to fightfires these are important to read. http://www.pwcgov.org/default.aspx?topic=040026000110004566 Thanks JM. Links usually help. Thanks ALS. Eventually I'll get this post right.

FDNY*EMS. Always hiring. 27,000 a year ($14/hr), full benefits, pension, lodi, 3 wks paid vacation, shift diff, meal money and more OT than they know what to do with. Questions, I'm happy to answer them.

Moose, thats a pretty common place for standpipe packs. Works real well for depts that use them frequently. 1 3/4 off the side is a great trash line for rubbish fires and the like.

A quality rope and caribiner is cheap enough where there is no excuse for every firefighter to have one. That shouldn't even be an issue. The truth is a system like the FDNY Petzel system (you don't have to use this one, but its the one I'm most familiar with) is far easier, more reliable, and offers greater versatility of application. It is however expensive and there are many depts out there that realistically cannot afford it. These depts do not exist in Westchester. Anyone who's not buying used fire apperatus or accepting donated equipment for frontline service needs to find the room in their budget to properly protect the members. Escape devices are no more essential than SCBA or PPE. Bailing out the first floor, yeah you don't need anything, but come check out the house I live in. Second floor is about 30' to the ground on side B 15' on side C, and 20' on D. Thats a traumatic fall no matter how you slice it. Go out head first you may not survive and will be spending some time in the ICU. Feet first and you get a hardware store installed. There are three other houses on that block that are nearly identical. What about your 3 story Tudor or victorian style houses. Then there are the McMansions. Any houses in your district that drop off the side of a hill? In Pleasantville is residential suburban community I can thinnk of multiple examples of each of these types and many more that are unsafe to drop from and a few that aren't even possible to ladder. Just about every town has a nice little commercial stretch in the middle of town. Most run at least 3 stories. Then there are a few of those odd balls taht are significantly taller than you average structure. Where do you think things are most likely to get you jammed up. Your bread and butter 2 story residential or the 6 story commercial that was pre planned years ago and has sinced changed owners and occupants a few times. If you're still undecided about how necessary a bailout device is, I welcome any of you over. I'll cook and if you can can make it back inside after a trip out a 2nd floor window dinner is on me.

The sad truth is this is happening everywhere in every job title, from firefighter to loading dock worker to corporate lackey. Some blame it on the 'me' generation that has recently gained attention in the media. Some research points to a steady change in attitude thanks to our parents. Either way a lot of money is spent on trying to figure this out. If you can do it you'll be rich. What just about everyone agree's with is that we're a reflection of our parents desires for themselves. After the Great Depression people were so greatful to have work that the employer came first. This wasn't fair and parents passed this message on to their children. With time unions came into vogue and helped balance out the power. This fostered a culture of I have a job to do and I am going to be compensated for it. Next Generation steps up and having your place in society isn't good enough. We are to step up above our meager means and succed in life. This means the job has to work for me or I'm leaving. Here's the best part, its only going to get worse. Unemployment is low and goverment assistance is high so...DILIGAF? IGM! There is no motivation to go the extra mile outside of peer pressure. Political correctness and white guilt has so hampered managements ability to punish the bottom of the barrel that the whole barrel is being poisoned. As long as the senior men/women keep up the pressure there's still a chance for enough people to do the right thing and save their job. I hope.

The FDNY system is as close to idiot proof as you'll get. Incapacitated FF is just as safe as one with full control as they will hang below the window until they can be lowered by a ladder or someone can operate their device. Its expensive, but its well worth the cost if it saves one life. No matter what you get just make sure you train hard and train often.

There is a very simple solution to your problem, but its easier said than done. Just stop. Fast food will always be easier and the cravings are going to be a problem. Thats why the stuff is so popular. You're body becomes addicted to the sugar and fat rush of the junk. These guys on this board have tons of great tips and info on what to eat and how to set yourself up but it is going to come down to what you want to do. Hands down the most cost effective and healthiest way to eat is to prepare your own food. Cook from scratch and you can control exactly what you put into your body. Garbage in = garbage out. Get yourself into a rhythm and schedule and it becomes very managable. It will never be the easiest way, but it will be the best way. Just keep yourself motivated and get your co-workers and family involved. For those tiems you slip up they can help keep you in line. Remember this is a fight for your life and it looks like you have a lot to live for.