NWFDMedic

I'm pretty sure he was specifically referring to the Dutchess Junction area. I'm pretty sure the Beacon flycar was allowed to go there because of the extremely low call volume and because it made sense. Also, City of Beacon does a lot of mutual aid down there, so I would imagine that they like working with the medic they know. The City contracts for the medic unit, not BVAC. That medic unit, as far as I know, would be part of the mutual aid plan and I've heard it requested via specific request into the Glenham Fire District. Also, assuming that Dutchess' mutual aid plan is written similar to Orange's, you can deny mutual aid if the request would leave your district without adequate coverage. I'm sure there are plenty here who know Dutchess mutual aid better than I do.

That's why I generally don't mention any particular service. Nobody is perfect and no matter what the system, there will always be the event of one more call than unit. But, I've got to defend our company just a bit. We don't have a station in New Hamburg, so it would be VERY rare for us to send a unit from NH to East Fishkill. Wappingers yes, but more often than not, those calls are in the Hillside Lake area or the Brown Road area where the closest unit is actually the Wappingers unit. Has it happened where the units have come from further? Of course. Nobody is perfect, systems get busy, and sometimes the waste product has hit the rotating device. I hope this thread doesn't turn into an argument between agencies. The lives of residents of a City and Town depend on the decisions made by their lawmakers. If we as providers can't keep the content at least close to the subject at hand, there would never be any productive discussion. You never know, someone here might actually have a good idea and the people that live in the city or town that read EMTBravo might bring it to the people in charge.

That's true and as a chief that would be something for you to address with your town or your provider. Some services think it's ok to tell there crews to lie about where they are responding from or creatively not giving information (like calling out as a medic when you don't have a medic). There is no service out there that will be perfect in every situation but at least I can say that I've never been told to lie to the county dispatch center.

Amen to that chief. We all have our own competive banter in the station but when it comes down to patient care we should all be working together. When the call drops, it's not my sandbox or my competitor's sandbox, it's the patient's sandbox and we should be doing everything we can for them. Fortunately, the vast majority of experiences I've had with street level providers in the Town of Fishkill has been exactly that, a spirit of cooperation for the good of the patients. Leave the competition off the scene.

I guess there are a whole bunch of options out there and we'll just have to wait and see. I don't necessarily think this means the end of BVAC; I would imagine they could enter into an agreement to pay an ALS provider from their billing receipts and still meet the terms of the contract. There would definitely be some changes in store for BVAC though because they could not responsibly provide service for the far end of the Town of Fishkill (Rob's house) from their headquarters on Fishkill Avenue. They would also have to ensure response to a higher percentage of their calls (I find the 90% number quoted in the article very hard to believe) and better response times. All of this would lead to increased costs which would probably have to lead to increased bills and possibly a change in their practice of billing recovery. Whatever the result, and of course I have a biased interest as I work for one of the providers that would at least theoretically be interested in providing service, I hope the City and Town make a decision that provides the best patient care to all of their residents. They hopefully will not look only at a dollar figure, but the services promised and the track record of the agency (volunteer or private service) submitting the proposal. There have been agencies in the past that have undercut others to get contracts only to provide a substandard service and eventually back out altogether.

Honestly, we want to bring skills to BLS when EMT's can only tell you that Nitroglycerin (a medication they are allowed to administer) gives you a headache. Ask any paramedic who had to write out drug cards if this would suffice for an explanation for a drug.

This article is what it is, opinion. If your house was going to burn to the ground before the City of Poughkeepsie 2nd alarm assignments show up (generally combo departments with staff on duty themselves), it was going to burn to the ground to begin with. To those reading the article that don't know how the system works, I'm sure they think that the City firefighters are sitting there short of help for a significant period before mutual aid arrives. That's hogwash. Any good first arriving chief or officer who shows up to the "fully involved" fire is going to immediately strike a second alarm and get the equipment on it's way. In some cases, I would imagine Arlington might even be CLOSER to some precints of the City than some of the remote city stations. I just don't think adding volunteers to a City system this large makes any sense, especially in the face of layoffs. The IAFF would have the City in court, and rightly so.

Your foot worked just fine Tommy.

Here would be my plan of attack for these situations (this is not my company policy, so assume that I'm operating in my own world): 1. As soon as you find out that you cannot gain entry through conventional means, request PD. Even if you have a Knox Box, the PD should be there as another "witness" that the residence was not altered in any way. 2. Attempt to confirm presence of a patient and establish dialogue either through dispatch or through the door. Check with neighbors, etc. 3. If the patient seems to be stable (ie. they can tell you they've fallen and cant get up), wait for either keyholder or a less invasive method of entry. 4. If you can confirm a patient and have either a confirmation (ie patient panting "I ... can't ... breathe. Help") that they are unstable or a reasonable suspicion of an unstable patient, take the door and ask questions later. Limit manpower to those needed to perform patient care. 5. Make sure the PD secures the residence. 6. Cover your behind, fully documenting the reason why you took the door, why there was no other option, and any abnormal conditions found in the residence. I actually had this very situation happen to me last year. The patient communicated with her son and the life alert company complaining of repiratory distress. The keys in the (fake) Knox Box didn't fit the patient's door. The son arrived on the scene with us and concurred with taking the door (the FD did it, not me). As it turns out, I had a patient circling the proverbial drain after entry. We were able to stabilize the patient enroute to the hospital. The complex called and asked why the FD took the door, but after explaining the situation to my supervisor, it was taken care of and the proper keys were put into the box.

I think there are a few differences to look at here. For instance, I am a member of New Windsor FD. For the majority of our district in an "active fire" situation, we have some response from the City of Newburgh FD because they are manned in quarters, quick to respond, etc. etc. However, if we're pulling a standby assignment, we generally won't use the City because we know the stresses it can put on their coverage area. Besides, if we get a second incident, they are still there, right around the corner to assist the standby department we have brought in from further away. Sometimes the county control centers use some discretion when it becomes a "all hands and more incident". In Orange and Dutchess, I've heard units moved to a station to cover an area that may not be just that district. Even in a more extended fire situation, bringing manpower to the scene from further departments may not be a bad idea if you have gone to an exterior or save exposure method of attack. My department's feeling for an incident that is still immediately dangerous to life and property (or basically where we're operating inside or fighting to prevent further fire loss) is that we'd rather have the closest units respond, regardless of the uniform or color of the trucks. When that situation no longer exists, using your head to use all resources available to cover the entire affected area seems to make sense to me.

Well, half a month later... agreed. All that wheezes is not asthma. I have gone into a nursing facility with an RN on duty that gave me a great story about a patient in CHF on the way to the room and then told me she had the patient on a treatment. The first thing I asked the patient when I reached her and pulled the treatment out of her mouth ... "Was the treatment making your breathing better or worse?" She answered "Worse". Now, if an RN can do that, I don't think we can even expect an EMT with a 120 hour course not to make the same mistake. It doesn't speak to the EMT's abilitiy; it speaks to the level of training.

Here's a quick and probably incomplete list of requirements for our officers (a 150 or so call per year department): Lieutenant and Captain 1. Current interior certification (physical, OSHA) 2. Member of department for 5 years (or 3 years with previous department service) 3. Certified driver and pump operator on all apparatus for at least 6 months 4. Firefighter 1 or equivalent 5. Hazardous Materials First Responder Operations (significant due to our rail traffic and fuel farms) 6. Incident Command 7. ICS 100 and 200; NIMS 700 and 800 (not specifically written into rules at this point in time) Chief and Assistant Chief 1. All qualifications above 2. Three years as line officer including 1 as Captain 3. Hazardous Materials Technician My question regarding our rules specifically involves driving. Not everyone is comfortable driving an apparatus and I think this might preclude some perfectly good members from becoming officers. I am a proponent of allowing a member to be familiar with operating the truck/pump (maybe a pump ops or ladder ops class and certification on specific equipment) should they have to in an emergency, but their lack of comfort actually driving the vehicle shouldn't stop them from being an officer.

Multiple fire police being dispatched to Greenville (Orange County) to assist in closing interstate 84 due to weather conditions and mutual accidents.

I got to see one of the new Tahoe's first-hand upstate this weekend. :angry:

Personally, I think the state needs to go back to teaching EMT's, rather than trying to make the EMT class a class that everyone can pass. When I took my original EMT class up in St. Lawrence County, there was very little ALS to speak of, and when you did get ALS it was from another volunteer agency that could be up to 60 minutes away. They taught their EMT's assessment skills so when they requested ALS, it was needed and they also knew how to manage and continually assess patients over a long period. Today we teach a lot of things in EMT class. Students are taught to ask a ton of questions but get little or no education regarding what the answers to those questions mean. The answer is always oxygen and ALS. While that is often the correct answer, many times if you don't have good assessment skills, you will miss the correct question or disregard the correct answer. I know, I've done it as a paramedic. I am firmly against the use of Albuterol in the field without medical control, mainly because I've seen too many EMT's, medics, nurses, and even doctors give patients nebulizers and at the very least put them in harm's way. If you pull up on a 45 year old male patient with a significant asthma history, you hear wheezes, but then notice his B/P is 210/100, I don't think you'd be quite so willing to stick a treatment in his mouth without an IV line. I had a 50 year old female patient literally begging me for a treatment when she was in CHF because that's what always fixed her before. There are too many precautions with Albuterol and although they may not throw the patient right into failure, they can certainly make the situation worse.

How old was the Alamo rig? I didn't see it on the page. Either way, it might be in better shape than some of the stuff they have on the road.

I was hoping for a few things that I haven't seen so far, but they may be coming when the new ER is complete. The ambulance bay is horrible. Between the ramp on the east side, the ridiculously narrow docks, the pole on the west side, parking is atrocious. I went into the ER last night and BVAC was parked in the middle spot (straight and between the lines) and the only place I had room to park was in the east side spot putting the vehicle partially on the ramp. Also, the new concrete slab takes out the exhaust pipes on new Chevy vans in the west dock (fortunately I saw another crew do this before I did). Restocking is even more difficult than before. You need to inconvenience a nurse to unlock just about everything, often several times. I'd love to see some of these facilities get an EMS Pyxis like Albany Med has. That way you know the EMS crew is taking 1 for 1, the correct patient or agency is getting billed, and you don't have to run around looking for someone with a key. EMS should have an area to do paperwork that isn't the nurse's lounge or the desk in the ED. I hope this might be coming when the area is complete. The last thing I want to do is be in somoene's way or taking up the space for those trying to eat dinner. The temporary door will not open if you are anywhere near it, which causes problems with the yard sale of equipment outside if there is an ambulance parked in the west dock. I would also imagine a bariatric stretcher would be quite a tight fit making the turn. This should also be rectified when the renovations are complete. Security is now stationed in the back of the ER with a limited view of patients coming in and they are very difficult for EMS crews to access. Knowing the type of patients that come into the department, security should be accessible at the ambulance entrance because it's not always easy for one member of a two person crew to break away to get assistance. Twice on Tuesday night I witnessed crews coming in with combative patients and three security officers didn't even know they were there because they were at their post and could not see. (Yes, I did help the crews even though they were from another agency ) Overall though, it's a work in progress and it's definitely a 1000% upgrade over what they had.

Unless you're able to get your rig off the road, your emergency lights should most definitely be on. Even when off the road, I'll leave my emergency lights on if there are other responders following me to the scene (aka EMS indicators). If you work in a city environment, there are many times where the only place to put the apparatus near the scene is smack dab in the middle of the street. The lights are important to warn drivers that the road is blocked before they get on that block and they can turn off before they get jammed up. I don't quite understand what the problem is with locking your apparatus and taking keys for ambulances and police cars. For ambulance, make a set of keys for every member of the duty crew. If someone wants to break a window to get in your bus and take it, they are going to find a way to take the apparatus no matter what system you have. The only annoying thing I have found with the new Chevy's is that the driver's door automatically unlocks if the key is in the ignition if you hit the automatic locks. So, if you hit the lock button on the back door to make sure the vehicle is secure, the driver's door unlocks, even if you locked it manually.

Winona Lake (Town of Newburgh) Orange Hose (Walden) Enterprise Steamer (Walden) The old Enterprise Steamer (Walden) before the Ghostbuster slime paintjob Greenville NY (Orange County)

I can't resist... would that be called a Muttphen?

I'm pretty sure we all get this in facilities that are not familiar with us. I remember working for Mobile Life as a young EMT asking myself what the problem was with the Vassar staff when we brought the occasional patient there. Now that they are familiar with me and most know me by name and vice-versa, Vassar is one of my favorite facilities to bring patients to. I have never had those kind of issues in St. Luke's, as a volunteer or with Mobile Life or Sloper (RIP) back in the day. Again, I'm sure some of that comes with familiarity. I brought a patient there tonight and was greeted right away and given a bed (for a patient who could have waited).

Well, I have literally brought thousands of patients into St. Luke's Newburgh with 4 different agencies and I can say I've NEVER waited 30 minutes to get a bed and give report. There may be a bit of a wait sometimes and I'm sure they seem slower than say Vassar, but they are also working with a lot less staff in a very busy emergency department. While I've found the occasional staff member that I rubs me the wrong way, I've never had a problem with getting the needed help in an emergent situation. By the same token, they are very appreciative of EMS crews that work with them instead of against them. If I have a patient that can wait and I have nothing better to do than go back to the station and write on EMTBravo, I'll help them discharge a patient, make a bed, etc. etc. and I'll tell them that I can wait if it will help them out. To the original poster, I don't think anyone would go on a message board and say the ED in hospital A stinks. Most of us have to work with them on a daily basis and since we are far from anonymous on EMTBravo, it may even put our job in jeopardy. Every facility I've ever visited has had some staff that were more into working with EMS crews and some that see EMS as a nuisance. Every facility has staff having good and bad days. I'm sure the same can be said for the EMS crews bringing patients in too; I know I've had my VERY bad days.

And to think I was annoyed the other night when someone came and asked if I could move the ambulance at a fire standby. At least she came over to ask and didn't move my bus drunk. Then again, I wouldn't leave my bus unlocked in the middle of a parking lot.

It's a tough requirement sometimes. My FD has had two days this year to get your physical at the firehouse, the second being this coming Monday evening. Unfortunately, I had to work the first date and I'm working again Monday evening. The letter I got said that I would be removed from the active list if I didn't get the physical, so if I can't get a bit of coverage on Monday, I guess I know what's going to happen.

It certainly is a touchy situation and I've had it happen. Any flight medics here, let it be known that I have a DNM order in place, similar to my DNR. Seriously though, I had a patient that we called for a medevac for, we were well over a half hour from a trauma center, and she needed to be in a trauma center. The extent of her injuries was such that the flight medic told me that her ability to make an informed decision was compromised secondary to probable hypoxia, etc. That patient was taken pretty much against her will to the trauma center and (by the way) almost immediately to surgery. If you want to consider someone who meets trauma criteria who may be c/a/ox3, I would say a motorcycle accident patient with some road rash and bilateral femur fractures from an up and over collision. Now granted, we don't know if there are more injuries, but if those ended up being the extent of his injuries, he could very well be alert and oriented. He is also someone who will not be treated in a local hospital, most wont even treat simple femur fractures these days. While he may be stable for ground transport to a local trauma center, I wouldn't want to be the one debating an hour transport from upper Sullivan County versus a medevac.