NWFDMedic

Thanks for the info right from the source. I'm sure most of the street level providers there (fire and EMS) are out for the best for your patients. We all have some political issues in the systems in which we work. Best of luck getting them straightened out.

1990 Troop 125 Coldenham, NY

The particular "Myers case" seems to be a bit vague. If this gentleman was actually short of breath and the primary crew thought it was appropriate to do vitals, O2, EKG, maybe 12 lead, IV and maybe some appropriate 1st level medications, I can more than see that taking 10 minutes. If it was 10 minutes they waited AFTER the initial treatment was done, then there is an issue. I have been on scene before while performing initial stabilizing care (or first round care) and asked by family why we aren't "just going" and I generally do not like sitting on scenes. The policy referenced in Richland County definitely needs to be amended. These firefighters have at least CFR level training and should be able to assist a medic in the back of the ambulance. I believe my agency's policy is to have the additional support in the back of the ambulance and the employee driving unless there are extremely extenuating circumstances. In those circumstances, the outside agency personnel used to drive the ambulance must be a qualified driver for whatever agency they responded with.

Good luck to Goshen with the new engine. Quite frankly, I have no idea why they replaced the old one though.

Hey Doug. I saw this on the wall at one of our stations last night. I absolutely hate the Mutts, but I plan on heading down to Shea for this. Do you know if any of the Orange County agencies are putting a group together to go down to the game? It's short notice, but maybe we could put something together. Dan

Well, I see your point, but they are still a revenue producing entity. Anyone who has buried a relative can tell you that. There's no reason why they can't charge a few more dollars to help offset the tax burden (note that your casket isn't tax exempt). Besides, it's not like cemeteries don't use resources (roads, police resources, brush fires, and I've been to a few EMS runs in cemeteries too ... not for the residents).

Unfortunately, the problem for the Fairview Fire District is similar to the problems faced by several districts throughout the state. There really needs to be some revamping of the tax code for tax exempt properties. First, places of worship and cemeteries should not be tax exempt. The Catholic church (just citing one) is one of the richest entities in the world. Although the wealth may not be passed down to the individual churches, places of worship should be responsible for bearing the tax burden for the public services that they enjoy, including the fire service. Second, municipal properties that are available to a certain group should be responsible for the taxes in the municipality in which they reside. For example, DCC is an entity of the county available to county residents (and others of course), the county should be responsible for providing their share of the tax burden to the fire district or the Town of Poughkeepsie (for increased traffic on town roads, etc.). The same would go for county offices or state offices located in a particular municipality. Third, private colleges should not be tax exempt period. They charge nearly half a thousand dollars per credit hour and their resources are not available for public use. The old argument for the tax exemption of private colleges was that they bring in money to the community. In Marist's particular case, I would imagine the majority of the "benefit" reaped by local business because the college is there goes to business in the City of Poughkeepsie or down in Arlington and New Hamburg. There is also a nationwide trend with private colleges to be a self-sufficient entity for their students which is posing a big problem in a lot of the "college towns" upstate. Of course, none of this is going to be solved overnight and their probably isn't even a huge push to get this changed. I wish I had some answers but I don't. My fire district has similar problems with a large percentage of the district being residential and cemetery with the commercial base lying in the district next door.

Any addition to EMS for your community is a good thing. Having worked as a medic in Putnam County in the past, I can say there are some great people there in the volunteer departments but most departments are feeling the same effects of just about every volunteer agency in the region. There have been a lot of particulars about this trial posted here and it seems there are quite a few things that are still up in the air. From what I've gathered though, the most accurate representation of the truth is that ESA will be adding an EMT to staff the former Medic 4 fly-ambulance as a BLS unit and Medic 4 will get its own flycar. This adds a great deal of flexibility into the system while not wasting the limited ALS resources. As far as the utilization of the unit is concerned, I would make a suggestion. Rather than dispatch the unit simultaneously with the medic, I would set up some sort of tiered response. Maybe something like this: Priority 1 calls dispatch volunteer agency, ESA Medic, and ESA BLS unit; Priority 2 calls dispatch volunteer agency and ESA Medic; Priority 3 calls dispatch volunteer agency and ESA BLS; and Priority 4 calls dispatch volunteer agency only. Now, with the dispatch procedure I have outlined there would be some ground rules. First, if the first responder (either EMT or Medic depending on priority) gets to the scene and determines that the patient is an emergent transport, they can make an immediate request to respond the ESA BLS rig if the volunteer agency has not responded. Second, if the volunteer agency goes to third dispatch (say 8 minutes for argument's sake) without response, the ESA BLS rig would be automatically dispatched. Third, if the volunteer agency previously turned over calls in the same time period (say a call comes in at 0930 when they turned one over at 0900), PC911 would have the discretion to immediately dispatch the ESA BLS unit. Fourth, the ESA BLS unit would return to service upon response of the volunteer agency (within the third dispatch window) unless the Medic determines the patient needs the most emergent of transports (scoop and run). The procedure may seem a bit long-winded, but it's actually relatively easy. Each priority would have an appropriate responder responding immediately (with the exception of priority 4, which by definition should not be affected by a delay). The ALS resources are kept in town as much as possible. The paid BLS crew would be returned as often as possible to handle the second call that the volunteer agency may not cover. The BLS unit can be requested as needed and should be able to arrive in Medic 4 area by the time the medic has an initial assessment and treatment done even if they weren't initially dispatched. The system would eliminate undue delays while still allowing the volunteer agency to maintain coverage and transport of their patients (and their skills) if they respond in a timely manner. Finally, taxpayers wouldn't be able to scream about paying taxes for the volunteer ambulance that was sent away causing them to get a bill. Responsible EMS agencies (paid and volunteer) could make this system work, with the appropriate checks in place to make sure nobody is abusing the privilege of being able to "scoop and run" on the paid ambulance. There are surely better ways to get the job done, but if you're being offered a new resource, procedures should be in place for it's use that will make everyone (including the taxpayer) as happy as possible.

I hate that "speed not prudent" violation. I actually got stopped for some odd reason on a clear day in light traffic on the NYS Thruway doing 72 in a 65 on my way up to an EMS event of some sort. The trooper wrote me for "speed not prudent" and somehow it stuck. I was nice to the trooper, all "yes sir" or "no sir", never complained, etc. I have that odd feeling that it had something to do with the fact that I was captain of my EMS agency at the time and had red lights on my personal vehicle and I found a trooper with a grudge. I guess I really shouldn't complain because I was violating the speed limit but I knew full well that the NYS Thruway was built with such sight lines, grade changes, and turns, that they somehow scientifically figured out that it should be able to be navigated by the average driver at a speed of 75 mph with the cars of those days. Oh well, those points are long gone from my record.

First, I have to apologize for this fire. When I first started working in Wappingers Falls for MLSS, I saw this house in my travels getting familiar with the roads and said "that place could be a death trap of a fire." Well, in any event, great stop guys, limiting the body of fire to the addition. That was also some pretty darn good placement of the truck given the room you have to work with there. I too listened to the fire on the radio and I only wondered one thing... What is with one of the mutual aid departments refusing to send mutual aid? Isn't that in violation of the county mutual aid agreement? I know it would be in Orange County.

Well Goose, I surely hope you are wrong. I didn't find out about the accident until 4:30 am this morning (oddly enough after bringing a cardiac arrest to Putnam Hospital). I know the MOS more seriously injured and reached out to her and her mother privately and didn't think it was necessary to post on emtbravo to express my compassion. Quite frankly I'm not sure many up here in Orange County knew about the accident; it didn't make The Record and none of the crews that relieved me had heard about it. Both MOS and their families will be in my prayers before I go to bed this morning and I'm sure all MOS regardless of the uniform will be working with heavy hearts today. P.S. To the person who has the pictures on the Internet, I think it might be best that some of the more graphic pictures be taken down at least for the time being. I had no problem looking at the pictures and I'm really not one to cry, but seeing the blood of a friend and fellow MOS in a picture on the internet while she is very much not out of the woods and clinging to life brought tears to my eye. I know people want to see what happened and at some point it may be educational, but not today.

We have a gate in one of the areas we serve that is supposed to do this as well and it leads to an entire community, so walking isn't an option. We've found that the siren option doesn't work more often than not. My ambulance service has programmed into their CAD system special instructions that can be automatically sent based on the address of the emergency, so they can send us the code via text message on dispatch. It is not the most secure method, but it allows the owners of the complex or facility to change the emergency code with one simple phone call. To be perfectly honest though, a lot of our employees keep a list of important numbers/codes for facilities on their person, maybe in a more secure place like a wallet.

That article simply shows that people don't know what they are talking about. He's increasing the fees probably to go along with current Medicare reimbursements. If DC charged less, they'd be basically giving money to the government for no reason. Those who are crying hardship to residents should probably realize that they aren't recovering from the people who can't pay to begin with, why not get the money that is out there to get.

As a fire officer, I would expect my responding EMS agency to do rehab at any fire more than your basic room and contents fire. If your EMS agency is sitting in the rig sipping coffee and you're allowing it to happen at anything more than your basic incident, you are setting yourself up for a world of trouble.

Actually, soft billing is illegal and if you are getting money from Medicare or Medicaid, you can get in trouble for it. Most of the third party billing companies are very careful about the way they do and practice methods similar to "soft billing". Basically they are skating around the law. As I understand it, the current Medicare standards have a few different levels. First is BLS, then BLS with EKG, then ALS 1 and ALS 2 (dependent on the number of procedures or medications given). Those rates are flat rates and most agencies use those rates as a guideline for establishing their billing procedures. There are also 2 allowances that I am aware of: one for oxygen use (a flat fee) and one for mileage (if not specifically documented, I believe Medicare uses the ZIP of origin to the ZIP of destination).

I've seen just about every brand of the electric stretchers with on the BLS ambulances we meet and assist. The stretchers are cumbersome for the crew, uncomfortable for the patient and difficult to operate except in optimal conditions. I would like to see them in our bariatric transport buses, but otherwise let me keep my 35A. The only argument I can't see is the "going up and down stairs" thing. That's what the stair chair is for. If you don't have an advanced style stair chair at this point, go to your management and start to complain. You would be amazed at the decrease in back related injuries with an advanced style stair chair. They are well worth the money for any service... and if your service is really in that dire straits, talk to your local legislators and get them to find you some grant money. We even had a commercial service around here that got grant money to get new stair chairs.

In Orange County, unless the fire district you happen to be in responds to medical calls, it will be you and your ambulance. I've been roadside many times with patients while traffic whizzed by at 80 mph. I would imagine if the incident is reported to be in the lane of traffic, county would send the fire department.

Well I wouldn't be the first one to say abandoning the service is a viable option to even consider, however, a restructuring of the system might be appropriate. I would also think that there has to be some more utilization of resources outside the county. In 2001 when I worked for Sloper, the county would have no problem sending a third medic to an accident in Patterson from Medic 2's station or maybe just on the road to relocate while medic ambulances sat in Beekman and Pawling. While it's not appropriate to be using other resources to constantly bail you out, I think it would be worthwhile for the county to enter into discussions with agencies to the north, south, and east to find out what availability they might have for mutual aid and to develop better procedures to use the aid when appropriate. I'm pretty sure this is happening a bit more now; I would hope the days of staging the 4th medic at the TSP and 301 to cover the county are gone.

Why does it seem like every 6 months or so for the past 10 years something comes up about the Putnam ALS contract? The population demographics, the lack of east-west through routes, and only one hospital in the service area make it a very difficult system to cover. Having worked in Putnam back in the Sloper days, I can imagine that a good percentage of the calls cannot realistically be covered in 9:59 with the 4 medic stations. There are places in Medic 2 and 4's coverage areas that can't be safely reached within 9:59 even if the medic is sitting in the station in the flycar and doesn't need to locate the call on a map. I'm not too familiar with Medic 3, but I'd imagine it's the same story. Add in a single call in the county and you're stretching your resources even further. I don't know too much about the service that ESA provides to Putnam County, but keeping the existing antiquated system would be setting up any commercial service for failure. The first issue that needs to be addressed by the politicians is the problem with the system, not the provider. The county needs to have a professional evaluation of the system and have a list of suggestions from an independent auditor. The auditor will tell them what is needed to provide certain levels of service in certain amounts of time and will provide new coverage ideas that may be beneficial to the communities in the county. Then the politicians have to make a political decision with the right information in hand instead of trying to make the current system work and then blaming the private service when it fails.

Obviously everyone agrees that this patient at least required an ALS assessment. The possibilities with this patient go from AMI to psychiatric, but there's no reason the patient shouldn't get O2, EKG, IV, and a blood sugar. Pain in the chest and/or abdominal cavity is often non-descript and not well located because of the way the brain receives and processes the information. A couple of things that I haven't seen mentioned are cholecystitis (which of course usually has some other s/sx and RUQ pn.), hepatitis or pancreatitis. As far as history is concerned, we'd also want to find out if she is or was a smoker and birth control has been previously mentioned. You aren't going to rule out any of these conditions in the field, but you darn sure should prepare yourself to deal with any of them and give this patient a full assessment and rapid (not balls to the wall) transport. I'm not a big fan of the "diagnostic" NTG since the vasodilation of NTG can cause pain relief of non-cardiac chest pain, not to mention the fact that it may give the patient a distracting secondary condition (the killer headache). If the 12 ld. is clear and other cardiac S/Sx do not exist, I'm not going to give NTG. ASA on the other hand, I might give, because it's really not likely to increase the degree of any bleeding that may be going on.

If you guys have food, I might just consider working a day shift in Fishkill tomorrow.

You're absolutely right. When you tuck yourselves in the corner and fall asleep, people do notice. However, when you wallk around the event, socialize, and put your name out there, they notice too. This fault of lack of recognition you are referencing might not be with the public, but with the third party service and its employees. Now, proper salaries, pension plans, etc. is a whole different story. I've been waiting for quite some time for the ball to drop and for wages to get better in the Hudson Valley, but I'm still waiting. Municipal service does not guarantee you'll get that though... most municipal service EMS doesn't get paid as much as PD or FD despite requiring more training.

While I'm a proponent of municipal EMS in a lot of places, there are some places where it just isn't cost effective. Municipal EMS may indeed be the long-term solution, but the short and intermediate term solution should be to look for a service to provide what you want at a decent cost. Municipalities are starting to realize that sharing EMS resources can be beneficial, cost effective, and appropriate if done properly. If what you're out there looking for is respect, it doesn't come with the difference between a municipal or third party service. I know for a fact that the communities that I work in have a great deal of respect for our service... I hear it constantly form town officials and fire district officials who often make a special effort to come to our stations and tell the crews how appreciative they are of our service. However, that didn't come overnight. It took a great deal of time and effort for us to show them the job could be done and it could be done right.

Undoubtedly correct. I'm not saying to go out and stop immobilizing people, we MUST follow the NYS BLS Protocol as much as it irks me to immobilize someone who barely has any paint scratched on their car. :angry: I would hope there arent providers or agencies out there making up their own rules.

Well, that's an interesting viewpoint and you do have some valid points. I'm not a member of a VAC anymore, but I do work with them every day. Many of your EMTs and drivers would not be capable of working as a 2 person crew. Maybe one of the crew members is a bit "older" and can't lift anymore. If someone is willing to ride the ambulance and do other things like maintain the apparatus and station, contribute to the business end of the VAC, and/or raise funds, then they are definitely worth the expense. If they are causing problems, then they may not be someone you want to keep around, but that goes for EMT, driver, whatever. Another note on the questions asked... the VAC I belonged to most recently had a restriction on corps. equipment being worn by non-EMTs while not on duty. From a liability standpoint, we didn't want Joe Attendant roaming around Wal-Mart and get looked to in the event of an emergency as a medical authority of some kind. As far as badges are concerned, they are best kept in your wallet or on your dress uniform. P.S.: If a volunteer agency starts discriminating too much and the wrong person catches wind of it, you could have a nightmare on your hands. You don't want someone in the community saying to the paper "I wanted to help, but the wouldn't let me."