NWFDMedic

As a bigger guy, I can tell you that driving some of the newer apparatus with turnout gear on is just dreadful. It's usually not my first option to drive, so often I'm already in my gear when I find out that I'm going to have to go behind the wheel and it's very cramped. In my classes, I was taught that drivers should be wearing gear to protect them from potential hazards associated with operating a pump panel and in most cases, that included a helmet, jacket, and some type of leg covering (at the time a long coat and hip boots were acceptable). Basically, our instructors thought that we should be protected in the event that something falls, breaks, ruptures, etc. in our operational area.

From the Poughkeepsie Journal: http://www.poughkeepsiejournal.com/article...1/81208003/1006 Early morning fire initially reported as a house fire on Route 82 near the TSP (EF Station 1 area). A quick reponse from the EFFD resulted in a good stop of a potential working fire. EFFD activated a second alarm which included a standby unit from NKFD but it was quickly scaled down as the fire was knocked down quickly. Great response and a good deal of manpower (good thing because there was a lot of supply line on to be racked). Good job by the men and women of EFFD.

I knew I'd forget someone. I even talked to the Village's guys on their way out. Busy morning for 42-12, they also went to the Wappingers Falls fire a few hours later. As long as we're not leaving anyone out, Mobile Life responded with unit 285 (and yours truly) for one patient with smoke inhalation. And yes, it was c-c-c-cold out there to the point that your cheeks were numb after a short stay outside.

You are correct Doug. If the rig was labeled as "paramedic unit" or "paramedic" otherwise, but the company name doesn't really apply. Our old lettering scheme at Mobile Life had "Paramedic Unit" on the sides and when we had a BLS unit we would put magnets over the words. I'm not quite sure of the laws, but truth in advertising would at least be nice. HVP might as well change to Hudson Valley Paramedicless. Then again, I remember seeing a BLS FD unit that has something like "Medic Unit" on the side of it.

If your grandmother is in a nursing home for rehab and you feel that she may be affected by some of the situations you mentioned, she can request that a specific service is contacted if she needs EMS. My grandmother was in a nursing facility and they were contracted to a certain service and there was specific instruction in her chart that the EMS provider of her choice was to be contacted. They initially gave my father and I a hard time but when we educated them about patients' rights, they did comply with her wishes. I just hope that providers that are being put in these difficult situations realize that their cards (and personal liability) may be on the line if something goes wrong. If the agency is acting so irresponsibly by dispatching you to a P-1 emergency from far away to assess and decide if ALS is "really" needed, do you really think they are going to stand behind you when the lawsuit comes?

I don't think anyone said there aren't bad EMT's or Medics out there but I think we all know that the story we get from the press or the family quite often does not match what happens. Heck, I'm sure we all hear stories about "what happened on this call" and find out later that it was far from the truth. I also agree that the best thing to do is transport the patient but no matter how much effort you put into it, you aren't going to win 100% of the time. I've sat on scene with patients for an hour, called families on the phone, called medical control, had the police come into assist, called local friends and had them come to the scene, sometimes it just doesn't work. If I believe a person is having a medical emergency, I will do everything in my power to convince them to go short of kidnapping them. I've even had a medical control physician instruct the PD to take a patient into protective custody because the MI he was having was making him hypoxic and therefore not of sound mental status. I'm not sure how well that floats legally, but that was the doctor's decision. Documentation is the key in any refusal situation or for that matter any transport situation. I have been called to court for a case where I did transport the patient and the patient had a bad outcome in the hospital. I documented everything I did for the patient well and why I had a high index of suspicion for the patient's eventual lethal diagnosis (it turned out my paramedic impression was right on the money). That patient's family eventually sued everyone involved in the patient's care (hospital, doctor's group, individual nurses and doctors) and I received a subpoena as well. Fortunately, my documentation saved me from being listed as a defendant and I was instead a non-party witness. The plaintiff's attorney actually said that I was the only one during the course of the patient's care who did what was right to look out for the patient. (I'm not saying that was true, but it was definitely nice not to be a party in a lawsuit.)

I have never shown up at the scene of a rescue call with my department and had the patient wonder why the fire department was there. The public knows that rescue is our job. Now, from an EMS standpoint, I still don't understand why many large cities roll fire trucks to EMS calls or why EMS workers would want to be combined with a fire department. EMS is, and should be, a distinct third service. I can understand the purpose in rural/suburban areas but in a large city, I just don't see it. Could you imagine if NYC wanted to combine the FD and PD?

The kid was born on November 18... now I see why he's trouble, that's my birthday. Anyway, I often wondered what the "right" thing to do would be in these situations. The husband does not have the right to violate the law simply because his wife is in labor. Once the trooper was alerted that he was doing this because his wife was pregnant, wouldn't that lead you to believe that the husband may do other things on the way to the hospital, like maybe run a red light and kill a pedestrian. I would imagine the Mass. SP would have a lawsuit then if they just let this guy go. I would think the proper answer here would be... "If your wife is in that much danger of a true emergency, let me get you an ambulance." If not, give the husband some time to cool down and let him go about his business, hopefully in a less hurried manner. I'm not sure the summons was completely necessary but as the officers here say, they've heard about every excuse in the book.

IBM EC in Poughkeepsie are contractors. IBM EC in East Fishkill are still regular IBM employees.

This is why even with 10 years as a paramedic that RMA's scare me. We are all sitting here hundreds of miles away and commenting on a news story. This might be the same information that eventually a court may hear. In EMT and paramedic classes, we spend very little time on documentation in general, much less documentation of refusals despite the fact that they are one of our highest risks for lawsuits. This crew may very well have done everything right, but when the family wakes up in the morning and dad, son, and coach is dead on the ground, the family will have to look for an outlet of their grief. I know this is the time of year where a lot of us get students on our ambulances both perspective EMT's and paramedics. Take a few minutes with your students to discuss your documentation, even if the call might seem to be one that is relatively benign in nature. Remind them that even the best documentation, the best assessment, and the best witnesses may not eliminate problems but they will have protection behind them. For RMA's in particular, go overboard with your assessment, performing every last procedure in your scope that may be of benefit. If you think you've explained to the patient enough times what the problem might be (worst case) and you're sure that they understand, tell them one more time about that worst case problem and tell them that we don't have the resources in the field to rule it out completely. When the patient and family look at you with the look of "ok, I heard you already, now let me sign and get the heck out of here", then you've told them enough. In this case, if the patient is convinced he has reflux, don't disagree with him and become confrontational, instead tell him "Well that may very well be the case, but your symptoms may also be consistent with serious heart problems or a heart attack." For the most part, if the family hears that, they will convince the patient to go and the job is done. For the BLS providers, don't be afraid to keep the ALS provider coming if the patient has/had an ALS complaint and is now looking at refusing. I'm sure some paramedics will grumble about it, but feel free to tell them to do their job and get over it; a little extra paperwork won't hurt (too much) but an abnormal EKG finding, for example, may save a life. Remember to get reliable witnesses. The 85 year old wife of the 85 year old man who is refusing may not be so reliable. The other family may be in a better state to remember what you are saying and if you have doubts about their state, get a member of another service (police) to witness. If you've said the right things, a reliable witness signature will be your a good backup. Finally, remember to document everything you did. Pertinent negatives are important. Patient statements are important. If the patient tells you why they are refusing, that may also be important. Document your explanation of the patient's potential problems, the patient's apparent understanding of your explanation. Document the fact that you have told them that they can still ask for help at any time despite refusing now. We all know that if we don't write it, it didn't happen but a lot of people forget that even if we write it, it may be our responsibility to give information to show it happened. That's where documenting patients' responses come in handy. Even if you do everything right, your patient may not make out so well. I had a case a couple years ago where the patient wanted nothing to do with the hospital. He was c/a/o x 3, had completely normal vitals, a normal EKG and 12 lead, a normal finger stick, he passed the Cincinnati stroke assessment without defecit, and had no complaints. I told him, his wife, his family, etc. that even though he seemed fine, he may have suffered a serious medical condition (general in this thread for the purpose of HIPAA); he was still set on refusing. When he died a week later of a serious medical condition, my call was investigated by the medical examiner's office and it was my documentation, the extra assessment on scene, and the confirmation of my assessment by a family member who was a nurse on scene, that prevented it from becoming possible litigation.

I believe in innocent until proven guilty and quite frankly how many career public safety responders are suspended with pay pending the outcome of their case. However, in this case, it comes down to being a man and looking out for the best of your men. Even if he is 100% not guilty of the charges, he should realize the embarrassment this is causing his department and more importantly his brother firemen. Two of the positions are without opposition, so the positions would likely be waiting for him when he was cleared of the charges. Bryan is just looking to make a mockery of the system and thinking of himself. Having known him since middle school, quite frankly I'm not surprised.

We definitely shouldn't be pulling over anyone in the ambulance (Greenburgh notwithstanding). When I see a potential DUI, I will call the jurisdictional dispatch and follow at a safe distance if possible. The last story though, where a life was potentially in immediate danger would be different. I think in that case, we would have to do what we think is the right thing as human beings. There's no way I'm going to let a woman get assaulted on my watch (at work or otherwise) and not do what I can to prevent it.

From the Times-Herald Record (12/01/08): http://www.recordonline.com/apps/pbcs.dll/...2010329/-1/NEWS --- It will be nice to have another resource for helicopter landings to use. This is also pretty close to KJ, who likes to utilize medevacs quite regularly.

The correct answer, of course, is that PD and Animal Control are responsible for the animal. If a police officer sees an injured dog walking in the roadway in absence of an accident, it would be their responsibility to take custody of the animal until Animal Control arrives. Well, if you let this animal alone after the accident, guess what, he's the injured dog walking in the roadway. Now, here's an answer that may be more specific for you in Orange County. I know that back in the day, Rick Metzger had donated an old ambulance to Flannery Animal Hospital to be a "pet ambulance". I know they still provide 24 hour emergency service at the hospital, however I don't know if they have the staff to come and get the animal during non-business hours or if they even have kept up the pet ambulance service. Rick was a huge animal lover and always did a lot to support the hospital. If it were my scene in New Windsor, I'd call Flannery and see what their suggestion might be. Then again, I don't think I'd get a police officer who wouldn't agree to help out. If I were your fire chief, I'd be on the phone with the police officer's supervisor on Monday morning.

The Town of Lloyd unanimously voted last week to renew its contract with Mobile Life Support Services for EMS service to the town. Congratulations to our Highland staff for doing such a commendable job this year. http://timescommunitypapers.com/default.as...ers&he=.com

Actually, here's an even better resource... directly from the Canadian government. http://www.tc.gc.ca/canutec/en/guide/ERGO/Training_ppt.htm

Chief. I made one up a few years ago to train my department because I couldn't find anything online. If I can dig it out of my old computer, I'll send you a copy that you can use, update, delete, whatever.

I'm sure the M/A agreements aren't based entirely on a bill either. I know that Arlington and LaGrange like to work together and that's awesome when it makes sense and because of their proximity, it often does make sense. I'm sure the patient that got Rich as their medic was very happy to see him. And when the facts came out, although the transport vehicle may not have been there as quickly as we would all like, the system was stressed and LaGrange still had care to the patient in 5 minutes... to me, that's a system that is working. By the way, I can't speak for LaGrange, but I know Arlington has a pretty responsible setup for mutual aid agreements in their district. They not only utilize LaGrange, but they also utilize Alamo and Mobile Life based on the location of the call and the relative proximity of the units that would be available to assist them. I have gone from our (Mobile Life's) Poughkeepsie station mutual aid into the Croft Corners area because we were the closest ALS unit. At the same time, I've heard Alamo go mutual aid into the HQ area because their S. White St. station is closer. So, I think saying that there is some paid v. volunteer or union v. non-union thing here is completely inappropriate. Rich... next time you decide to invite a Mobile Life unit to come back you up at AFD HQ, it better be me. I actually drove all around Arlington last night during some downtime showing my partner where the various stations were and what areas they covered.

I'm sure it's not going to be a popular viewpoint but whomever is found to be at fault should pay with their job or at the very least suspension and chauffeur training (for the driver) and a demotion for the officer.

First of all, good luck with your rehab. You are correct in reading that at least the HVREMAC has no protocol for interfacility transfers. I think a lot of that has to do with the fact that there would be an enormous number of procedures and medications that would need to be added to the protocols and for 911 only medics, it would be a lot of extra requirements for nothing. When I do an interfacility transfer with a drug that I'm not familiar, I'm not shy about asking for a drug reference for the drug and any further information I need. I'd rather take 10 minutes longer getting out of the hospital than put my patient at risk. The problem with doing an interfacility job without MAC credential in the region of either origination or destination is what happens when that transfer becomes an emergency. Our signed transfer form allows us to enact any of the HVREMAC protocols if needed, along with any specific instructions ordered by the transferring doctor. When this transport goes bad, you need to work under a doctor somewhere, and I think that would mean you should have MAC credential in either the original or destination region.

That would be more of an operational issue for HVP. If they wanted to segregate their system, they could have medics that are MACced in one region or the other. However, since most services operate with the understanding that your reporting station is only where you park your car, I would think they would want all their medics having both certifications so they can manage their system without limitations that Unit 1 can't do Westchester calls and Unit 2 can't do Putnam calls.

Just seems like an awful big expenditure for a transport vehicle. Why put a $3000 light package into a van that is going to be used to bring coffee to fires or students to classes? I can't talk much because my district has a vehicle that is basically a transport, but it is outfitted for use by fire police if needed. Also, it was a used chief's vehicle, not a new expenditure.

Is there something in the back of this vehicle that makes it a fire apparatus? It looks to me like it's just a van. With the lighting package, it looks like it could be set up as a really nice fire police van.

Thanks for the real information emd.

Doc, the simulcast may actually help you believe it or not. I live in New Windsor and my portable only opens for a Mobile Life dispatch (if I actually have it on at home); the rest is just squelch. I'm rather certain they dispatch Mobile Life off of Illinois Mountain. However, that same portable will pick up dispatches off Clove Mountain (say Union Vale) like I'm standing in the DC911 center. Sometimes the closest tower as the crow flies may not be the best transmitting tower to your house.