NWFDMedic

This is an interesting topic; anything that would promote agencies working together is a good thing. In Ulster County, there are 4 departments that are part of a cooperative mutual aid for BLS during the day. If one agency can get a driver and another an EMT, they can get together and make a crew. I imagine that this would require some cross-training of EMT's to the operation in the back of the other service's ambulances, but that is a small obstacle. Anyone here from Wallkill, Modena, Shawangunk Valley or Gardiner that can tell us how this works and how effective it has been?

Well, I would hope for the sake of your department that the ambulance was properly labeled as out of service and depending on your protocol taken out of service with your dispatch agency. It was probably pretty poor planning on the part of the crew involved to have the next due ambulance out on driver training without a crew; you effectively left your jurisdiction without coverage. I would not take an engine out in my volunteer department for driver training without a full crew if it was expected that said engine was going to be first due for an incident. If I was in this situation in an OOS vehicle, I would probably use the apparatus to make the scene safe and call for the proper resources. If an EMT responded to the station, I would hope they could take a utility, meet up with a chief officer with a district vehicle OR (novel concept) break your standard operating guidelines and get the EMT to the scene in his/her POV. SOG's are made to assist you in the performance of every day duties, they should not override good judgment.

This is actually a misnomer. There are states that require EMT's to act in the event of coming upon an emergency. New York state is not one of them. I have paramedic plates and nobody could do anything to me if I didn't stop to help an ill or injured person. However, is there really an EMT, firefighter, or LEO here that wouldn't offer assistance to a person in need? It may not be safe for me to stop or if I do, I may not have any equipment to do anything safely, but I would at least call 911 and I think most public safety providers would do the same. There ARE some towns out there that require EMT's in their jurisdiction to stop and offer whatever aid they can. I would suppose that would be something you would have to agree to as a member of that agency. Finally, the issue of the EMT at the station. If I were the officer, I'd probably want to insert some foot in rear end if qualified and able personnel sat in front of the television while a call went out. We have some guys at our house that may not prefer to go, but in the absence of other personnel, they will respond. While it may be a departmental issue, I don't believe there is any liability on the provider unless the patient presents to the fire station (or locally established policy requires you to respond). If someone comes to your station sick and you don't offer aid, I would suspect you'd better get a good lawyer.

Apparently Mike M. has better information than I do. My initial knowledge of their FD was that they did not go interior, but I guess that is no longer the case. I know that KJ EMS has provisions for service on the Sabbath (ie. paid drivers). To answer your question about population, that's the biggest mystery of all. The last population quote I saw was over 20,000 (making it the largest village in Orange County) but they have estimated the population will be near 30,000 by 2010. I know there has been a ton of political clashing between the communities surrounding KJ and the residents of KJ but I'm sure a lot of that is due to a surrounding population that does not have an understanding of the community and their customs. KJ is not the "victim" though, because the residents of the village often do not respect the customs of the surrounding communities either. It also doesn't help that KJ generally votes as a bloc and generally for democrats in a county that is largely Republican. From an emergency services standpoint, I can't tell you much about fire at all. I can tell you that 10 years ago, we had a lot more issue with KJ EMS, especially when we were providing them paramedic intercept service reguarly. Today they have a self-sufficient ALS service and we rarely meet them unless they are responding to a call outside of their community for members of their community (apparently their CON allows them to do this as they are a division of Hatzolah). There is the occasional discrepancy on scenes, usually regarding patient destinations but my experience has been if you take two minutes to talk to the KJ EMS representative and coordinate with them, they are more than helpful and appropriate care can be provided while respecting their wishes. A lot of the issues were also cleared up now that KJ communicates with county when responding, so it's not a surprise when they show up or if we show up and they are there.

It is indeed an interesting situation and I'm surprised this hasn't made the local paper yet. KJ doesn't have interior firefighters but they have refused to contract for the services. I'm wondering if this would place the village in violation of some sort of law since incorporated villages in New York are accountable for the provision of fire service. I would also wonder what effect this has on the county mutual aid system. Could (or would) Monroe (or other) fire departments refuse mutual aid into KJ?

I think you did some math wrong. A square mile is bigger than a square kilometer. 180 sq. km = 69.5 sq. mi. Still a huge area to cover with one house.

I can't agree more. I can just imagine if my family wasn't a little more understanding of situations and called 911 for either of my ailing paternal grandparents. My grandfather wanted to die at home; he had given up the fight after his third stroke and we were able to respect his wishes. My grandmother was in a nursing home with terminal lung cancer, had refused to sustain her own life, and had made all of her final wishes known, yet my father and I still nearly had a fistfight with the nursing home staff because apparently a patient that dies in the facility looks bad for their records.

Nice looking vehicle although I've also heard a lot of negative feedback about the Trailblazer as a service vehicle. I'm pretty annoyed that it's not school bus yellow though. What kind of EMS call volume does Union Vale do? I know they have a paid crew during the day; it just seems like quite the expenditure for a department that I don't hear doing a ton of EMS calls.

I would say if someone came onto my property with a video camera, digital cameras, and a halligan bar, they would most like get a much less warm reception than these kids got.

I thought Pawling had three stations. Station 1 is the one in the Village. I'm pretty sure the other two stations are out near Whaley Lake and up on the east end of town somewhere.

This is an interesting topic that has strayed a bit from the original question. As far as chief's cars are concerned, I'm not really certain when the idea came up that we needed chief's cars in the volunteer service. I guess that one would be a good idea, but I don't see why the assistants in small departments can't be properly outfitted in their POV's and get reimbursed mileage for responding to scenes. There is no reason why a duty roster cannot be set up for the assistant chiefs and/or line officers and a single vehicle could be available in the absence of the chief. As far as the liability is concerned, the district should be assuming the liability for the chief responding in their POV to a scene (including the use of red lights and sirens or any damage that may be incurred). The argument about a chief's POV getting damaged because they blocked off a scene is moot, because the district is liable for any damage incurred to any memeber's vehicle during the proper performance of their duties. As a junior officer, if there is an instance that I need to respond to the scene and use my car as a block to maintain safety of the scene until apparatus arrives, I wouldn't hesitate to do it and the district would be liable for damage if it was determined that I was properly performing my duties. Heck, if I came upon an accident outside my district in my POV, I would position my vehicle for to maintain the safety of those injured... life before property, although in that case, my wallet might feel it. Another thing that I am fully in support of is the management of scenes by junior officers. When I first ascended to captain, nothing bothered me more than the fact that I am next in line to be assistant chief and the chief officers would insist on taking command of an incident I could easily handle. I had no problem handling incidents when the two chiefs were at work. If I have things under control, why not let me get the experience and the chief can sit in the air conditioning. Finally, in regards to the radio traffic, I'm guessing you guys are referring to communication with a county communications center. On a department level, each of our six officers is supposed to call responding, but only the highest ranking officer calls to county. Usually I won't call county unless they make more than one call for "any New Windsor officer" without a chief answering or known to be responding on our channel. My first contact with county is usually leaving the station as the apparatus, not as my car number. If I get on scene with the apparatus and no chief/higher officer is on scene, I'll call "Engine 447 on scene, Car 6 will be command". In the grand scheme of things, that doesn't even matter. County should be able to call for command and I should be smart enough to answer if I am wearing that hat.

Thanks for the info Scott. As you know, the 2 or 3% does very very little to help the increased operational costs, but every little bit helps. I'm sure all commercial agencies are feeling the pressure right now and I know providers are struggling to make ends meet too.

Well, one thing I've learned in EMS is not to trust studies. Look at what they did with Lidocaine. They told us it didn't work, when we've all seen it work, and then all of a sudden it came back because another study was done and it was shown in some cases it's actually better than other "more expensive" drugs. I've had some success with Morphine, but I'm willing to listen to the studies regarding chest pain, but not react too quickly about it, as it's still the standard of care. As far as CPAP is concerned... what an awesome tool to have prehospitally. I've used it a couple of times since we got it here at MLSS and the patient turnarounds are outstanding. I didn't carry enough oxygen, nitro, lasix and morphine to do the trick that this simple little mask does. It stinks because my intubations are going down, but it's definitely improving patient outcomes, and that's what it's all about.

I don't know if we have a policy on the matter, but I think it's a matter of common sense. If you get hauled into court, they could estimate patient contact time by walking from the place you park your bus to the actual patient. If there is any kind of delay, such as need for forcible entry/extrication, need for the scene to be secured by PD, or any sort of misdirection, I will notify dispatch of the problem. Dispatchers are supposed to enter this information in the "trip notes" for a call, but I couldn't tell you if it always happens.

I really don't know why we are having this conversation in 2008. Maybe when you were up here in 2002 you may have seen some issues, but I can tell you as a medic at the time that a good number of ground crews were relieved to see the SP helicopter rather than StatFlight. The Mobile Life medics that currently man LG-17 have a great deal of experience, including critical care nursing certification, CCEMT-P, national standard flight training, and years of flight and ground experience. Mobile Life doesn't just throw anyone from the back of an ambulance onto a ship; there is a selection process and extensive flight training. Although I don't always agree with 100% of the selections (who always agrees with their boss), the medics on the helicopter are some of our best and do an excellent job. Their treatment also stands up to the rigors of our internal QI program as well as the region's aviation committee which I believe is still led by Dr. Larsen. The LifeNet medics and nurses also go through national standard training and have a lot more experience with interfacility transfers. They do a great job on scene and I will not hesitate to compliment their work. They came to one of my scenes about two years ago and totally took control of a patient I had difficulty managing beyond effective BLS. The LifeNet crews I've had recently are great not only with their patient care, but also in their interactions with on-scene personnel. I don't see many helicopters these days because most of my calls are within a short drive of a trauma center, but I wouldn't have any issue calling for them if needed. I can remember a time when the StatFlight and Lifeguard/MLSS crews were at odds and fighting but it just doesn't happen today. I think the region should be happy that we have two more than competent services available for the air medical transport needs of the Hudson Valley.

Good call chief about the politics. You can talk politics all day if you want, but during the emergency is no time for politics. Equipment to the scene should be closest available to arrive, but station backfills can come from wherever. I was working in the area and listened to most of it, glad that I wasn't the command fire officer, and it sounds like you guys did a great job.

I always love the old QI thing about 2 sets of vital signs. I've seen paperwork come across with 5 minutes of patient contact time and 2 sets of vitals. Come on, give me a #$%$# break. But a lot of EMT's/Medics are told they will have some type of QI monster come after them if there aren't 2 sets. However, with that said, I'm sure pretty much everyone has done that once or twice in their careers. As far as touching a female patient more than he had to, I sure as heck hope he answers that question no or has a darn good reason why yes was his answer. I don't know about the rest of you guys, but I'm scared to death of getting arrested or sued. I won't even do a 12 lead on a female patient unless I'm the only one qualified to do it (since I work with 3 female partners out of 4, I have them well trained).

I bought what was hopefully my last pack on Monday and finished it this morning. I rarely go through a whole pack on my 3 off days and seem to smoke at work because it was something to do. When I go to the races with my dad, I go 5 days without smoking and it doesn't seem to bother me (and I'm drinking then, which usually increases my smoking). We'll see how the first smoke-free night goes at work tonight. No patches, no nicotine gum, no nothin'. Just plain old chewing gum.

If they have the money and they have everything else, more power to them. When I was a volunteer EMT-I, our personnel had some of the corps' older AED's in their vehicles. They were not purchased for that purpose, but simply kept in service rather than being retired. However, I would like to see this community be a bit more responsible and leave the grant money our there for communities that really need it.

Hey Bart. I think you probably guestimated the recovery a bit on the low side with the population demographics of the town, but who's counting. I would also imagine that $80/hour cost could probably be bumped up a bit given the increased cost of fuel and equipment/products secondary to the increased cost of fuel. But the bottom line is quite correct; I can't see the contract being break even, much less being at least somewhat profitable.

Maybe I'm sounding a bit heartless, but the person will still be dead if they get to the burial site a few minutes later.

If there was ever a situation for an SCBA, that would be one.

Well, this sure comes as a surprise to me. I thought that Alamo had spent the last year saying that they were going to be responsible in bidding instead of following the path of Sloper by underbidding contracts and losing money. Having a good idea of the call volume and billable recovery of the PV community, they can't possibly be making money or breaking even with that contract.

Ok. While I respect your opinion, chest protectors for infielders? This is a sport we're talking about. Just as in other sports you could just as easily take an elbow to the head (basketball) or a cleat to the chest (soccer) causing permanent injury. If you go back to the days when aluminum and other composite bats became popular for youth baseball, there were a significant number of injuries because the bats were being made lighter and with better characteristics to cause the ball to fly off the bat. Today, most youth leagues, including Little League Baseball, Inc., have rules regarding non-wood bats including a Bat Performance Factor (BPF) which is a quantitative measure of a bat's transfer of energy to a ball compared with a wood bat. They have also limited the difference in weight and length to keep from artifically increasing a child's bat speed. In younger leagues, they actually use softer baseballs. The news said there have been 3 "seriously" injured kids among the millions upon millions of kids that play Little League Baseball. As much of a tragedy as each case is; it's a game. LLB and other youth groups have taken proactive steps to limit injury. This kid was FOURTEEN years old at the time of the incident. If he hadn't developed basic baseball skills by then, he would not have been that close to the ball.

Exactly, there are a good number of meals you can make in bulk for next to nothing. The way I see it ... those out there serving our country are eating MRE's in the field in many locations, if the prisoners are getting slop with calories, I could care less.