NWFDMedic

It's good that the EMS crew knew what to do, I don't think many EMS providers that aren't firefighters as well would have thought to make the effort to mitigate the hazard. This might be something I'll talk to new employees about when I'm doing field orientation.

Well, I think you made a good choice to immobilize because of the unknown incidence of trauma (ie. how did he get there?). Otherwise, airway, breathing (O2 via NRB), circulation. Considering the patient is initially combative, your treatment could be limited. I see no indication for Glucagon. If you can stick someone with an IM injection, there's no reason you can't obtain glucometry to potentially rule out hypoglycemia, especially in the presence of a potential head injury. My course of action would have been as follows after the c-spine and oxygen: First, I'd call for help. Get enough people to hold him down to safely immobilize him and get an IV started. If the help is unavailable, skip the IV and some IM ativan would probably be my choice. Even in the event of hypoglycemia or a head injury from a fall, it won't have a detrimental effect. Then get your IV started, check blood sugar, have the PD check his person for possible drugs or paraphanelia (?sp), and have an officer find out who on the construction site might know him and a little bit more. From there, if his vital signs seem to be indicative of an opiod OD, I'd give some Narcan and obviously if it's indicative of hypoglycemia, I'd give Dextrose. It sounds like a simple seizure, but with unknown trauma, you'd obviously be immobilizing. I'd keep a close eye on respiratory status, mental status, and of course vital signs to look for signs of a closed head injury. If I thought any of those were compromised or about to be, I'd be ready with a BVM, Lidocaine, Atropine, Etomidate and Succhinycholine because I'd rather get the patient intubated while I can and before he's seizing again or dead. I'm from the Hudson Valley Region and I'm honestly impressed that you got orders for 10 mg of Versed IM right off the bat.

And I'm sure your kids will make good firefighters one day. I agree with you too, there's nothing wrong with a little soap.

Congratulations and good luck in a great profession. Will they let you fly school bus yellow planes???

It is indeed a Wheeled Roach. You can see the logo above the ford logo on the front quarterpanels.

And on the cover of today's Times-Herald Record, the top 10 overtime earning cops in the county. I haven't seen them publish the OT pay of the county's DPW workers.

It's a shame that a few bad apples can ruin the bushel. Career firefighters are, for the most part, respectable and honorable men and women. Their unions are there to fight for everything they can get, that's what unions do. Unfortunately, the media doesn't help either, for career or volunteer departments. How often do you see in the news "Firefighter arrested after drinking binge"? Well you don't hear about the "Wal-Mart greeter arrested in drinking binge". If that even made the news, it would be a "local man". And if you think the fire service has cornered the market on disability, you ought to go into any local sanitation or highway department one day.

When I joined my first fire department in 1990, I did it not because I wanted to, but because I had some sense of obligation to my family. My grandfather was a member (and in fact President) of my local volunteer department, my father was a member (VP), and both of my uncles were members. A past chief sold the family all of it's insurance, members of the department sold us our produce, fixed our cars, owned the local deli that I visited every morning, ran the Boy Scout troop, managed our Little League teams, and countless other things. Today, just 18 short years later, kids do all of their shopping at Wal-Mart, there are very few locally owned corner stores, most of the time we get our convenient store supplies at the Qwikie-Mart, we buy our insurance online, we go to Pit Stop for our oil changes, the local Boy Scout troop is gone, and the Little League is managed by people who are more concerned with their travel teams than an outlet to let EVERYONE who wants to play have fun and learn something about teamwork. Excuse the run-on sentence, but the community is gone from the community; heck even our kids are bussed away from their local schools in the interest of some sort of racial equality (???). In the Hudson Valley, we all know about commuting parents and bedroom communities, people who work 10 hour days and spend 3-4 on a train, etc. etc. So, what do we get in the fire department these days? No offense to the kids (younger members) who are out there doing the job, but for the most part, our younger members are the outcasts. They have very few friends and are looking for some type of identity. Some turn out to be great firefighters, but for the most part the new generation of young firefighter turns out to be more of a headache than a help. I'll take my 40 and over crew any day and twice on Sunday because I know they'll be willing to work with me as an officer, not against me. The young kids only want to do what's in it for them and they rebel when you actually ask something of them. Again, there are some great members in the 16-24 crowd, but they are the exception now and not the rule. I have no problem with kids wanting to party, get drunk or laid ... we all did it, but when it's time to be a firefighter, it's time to be a firefighter.

They are not all that bad Rob. In fact, I just got back from one (surprise). They have procedures that they have to follow that we don't understand in a lot of cases. I just go with the flow; anything that happens before I make patient contact isn't on my watch.

The state prisons generally bring their prisoners to and from non-urgent procedures in those beautiful blue vans. However, if a patient is non-ambulatory and cannot sit in a wheelchair, they have to go by ambulance. My company currently has the contract with Fishkill Correctional and we take patients fairly regularly to Mount Vernon for routine procedures. In fact, I was just there Wednesday night (and I hate Mt. Vernon with a passion). You have brought up an interesting point though. Would it be appropriate for NYSDOCS to provide our staff with any type of training regarding issues with the transports? Is there any type of training available for civilian personnel that have to deal with the prisoners on a regular basis? Personally, if something goes wrong, I would lean toward saving my rear and my partner's rear and let the corrections staff deal with the rest. I know there are some issues regarding driving with the corrections staff and with a "chase" vehicle (ie. no quick lane changes, signal and then let the chase vehicle move first, etc.) but those are things I picked up along the way.

Was this a one time incident or a regular occurrence? I have been transporting prisoners from state and federal facilities for 12 years and have never seen anything other than a handgun brought into a medical facility, with two exceptions. One patient was a (very) high profile prisoner from Otisville Federal Correctional Institute and the other was a patient who the state considered a high risk of activity because he was being transported to St. Luke's Hospital (Newburgh) and had been involved in an incident in Newburgh and still had friends (and likely enemies) in Newburgh. The latter patient we actually transported code-3 to the hospital at the request of the facility.

Well, I'm not going to argue your points because they all have merit. As far as my accident was concerned, I was hit in the driver's door by a vehicle that decided not to stop at a red light (and I was young and stupid and thought that the green light was my ok to go). The impact actually sent my upper half across the center of the car and basically into the passenger's seat. The driver's seat was crushed into the steering wheel and broken in at least 3 places. I know it's the exception rather than the rule, but on that day I was lucky not to be belted in. I don't know if this thread will make me change my mind in my personal vehicle (I'm a stubborn getting-older son of a gun), but the post regarding the safety of the other occupants of the back of an engine left an impression on me.

I think we all need to remain objective here. I'm sure that everyone here could tell stories about this agency doing this and that agency doing that, but if we look in the mirror, every agency and probably every paramedic has had that call that just didn't go the way you would have wanted. Each and every interaction I've had with Empire State has been less than pleasant, but it at least sounds like they are making an effort to turn things around. If patients start getting the care they deserve with this change then we all come out winners in the end because our profession looks more professional.

Excellent post and quite frankly something I had never thought about.

The difference in that situation is that the Chief was the proximate cause of the problem. If there's a seat belt in the truck and you are told that you should wear it (which we all are told in OSHA class) and you choose not to, YOU are the proximate cause of whatever happens to you. I'm sure there will be an attempt at civil litigation, but unless they can prove that the Chief willfully promoted not wearing seat belts, then the litigation will be DOA. Sorry, I'm just sick of people putting hammers over people's heads with fear of litigation. Call me stupid, but I don't wear my seat belt in my car either. I was in an accident when I was 20 years old that would have killed me if I was wearing my seat belt. If I end up ejected and dead, that's my own dumb fault. If I end up getting a ticket, I'll be mad, but again, it's my own dumb fault. Seat belt laws and helmet laws drive me nuts because they are a victimless crime (unless you consider the financial burden). You can't hurt someone else by not wearing your seat belt or helmet. The only place I wear it is in the ambulance at work because I'm required to by company policy (coincidentally not by state law).

Well, when you consider it's less than 10% of 25%, you're talking less than 2.5% of the total LODD that occur responding or returning on an apparatus. Less than 2.5% is a lot less than 25%. I'm not a fan of scare tactics and that's what your entire post was.

I know what your point was, I was just razzing you a bit. Our dispatch does something novel with direct calls from skilled facilities (and a few unskilled ones). They ask the facility whether they want the crew to respond lights and sirens. Generally, the nursing staff will say no unless it's a true emergency, where the EMD information may warrant a different response. If I'm going to ABC nursing home for difficulty breathing, EMD is always going to place that in a code-3 response. However, the nurse might know that he has pneumonia and has been a bit short of breath for 3 days, which would not require the same response. As far as response in a reasonable amount of time, I'd think the same rule would follow. If I'm paid service X and I know the closest unit I have to respond to a facility is 25-30 minutes away, why not advise them of that? If they say that they really think the patient needs to go sooner, then offer to get a closer resource for them and turn the call over. If the delayed response is the exception rather than the rule, your facilities will understand and you won't lose your contracts, so long as you don't lie to them, send inappropriate level units, etc. etc.

Like I said in my last post, I will neither support nor speak against the use of seat belts in the back of the apparatus, I'm simply stating facts. I don't like when people like the previous poster create facts or scare tactics to make you think wearing a safety belt is that critical. If I get killed in the back of the truck because I'm not wearing a safety belt, however, my parents wouldn't sue the fire district because I was the idiot not wearing the belt. At work, we have a policy, so I have to do what they say. The whole SCBA thing is a convenient excuse people like to use for not wearing safety belts. As a larger person (nicely put), in today's apparatus, I have a hard time trying to don an SCBA in the front seat, not to mention my district is the size of a postage stamp and I have to call out to two bases and talk to whoever else is trying to give me information (that I usually don't care about ... sorry chief). I usually put my pack around one shoulder, it comes with me when I get off the truck and it takes about 5 seconds to don outside. Coincidentally, that 5 seconds also gives me time to relax, finish up my size up that I started as I approached the scene, and then go to work without the huge adrenalin rush of jumping off the truck. As far as those yellow straps are concerned, I hope you have more luck with them in Wiccopee than I do. If there's one thing that I hate about checking packs on our new rescue, it's those brackets.

It took you 45 minutes to travel the 16 miles between Kingston and Poughkeepsie? I did Newburgh to Kingston at a nice leisurely code 1 pace in 30 minutes the other day, and that was on 9W, not the T-Way.

OK, I'm not going to argue the issue of seatbelts in the back of a rig persay, but here's a bit of information regarding the statistics that are being quoted. While it is true that 25% of FF deaths occur during responding to and from alarms, less than 10% of that 25% actually occur while responding or returning in an apparatus. The majority of those deaths occur in personal vehicles. While no death is a good thing (obviously), the numbers are not nearly as alarming as one might like to portray. Second, the concept that drivers of apparatus would be subject to litigation is absolutely absurd. In New York State, there is no law for back seat passengers requiring them to wear safety belts of any kind. If there is no department policy regarding safety belts and the drivers' responsibility to make sure they are worn, then there is no grounds for litigation against the driver. Stop trying to scare people. Finally, while chiefs or districts may be subject to litigation, the possibility of the litigation actually sticking is somewhere between slim and none. In fact, a chief or district would be more likely to be subject to litigation if there was a written policy that was not followed and something happened.

I saw one of the new HVP busses yesterday in Wendy's in Fishkill. Nice looking new Ford type II. The lettering looked like it was done by a 12 year old, but otherwise, very nice looking bus. I hope we'll go back to the Fords soon; I can't stand the Chevys.

Well, good luck to them. Joel is indeed good people; I worked under him at Sloper and he was one of the nicer administrators I have worked under in my career. I know quite a few of the Putnam medics who have gone through quite a few uniform changes just to cover the same area. They do a good job and I always hope for the best for them.

OK. So the answer is that just because someone else did it, it's acceptable. I can't wait until the first time I'm dispatched mutual aid to Hudson Valley Paramedics for a paramedic.

That's a pretty impressive skip. I don't know what's been going on in the air lately, but it seems that an agency called St. James has been showing up on my FD frequency almost 80 miles away. I looked into the FCC license and they have a 35 watt paging frequency license for our frequency. Must be something in the air.

I wonder if anyone can answer the question I asked in the other thread... how can you call a company "Hudson Valley Paramedics" when your ambulances don't have paramedics on them in many cases?