NWFDMedic

Well, from the information there, it sounds like the Taser did kill the guy, although I'm sure an autopsy report will tell the real story. I'm all for the use of "less than lethal" options, but just like anything else, the use of force must be restricted to the situations where it is necessary. If the Taser kills a criminal who put himself in the position of needing to be tasered by the police, the real fault lies with the criminal. I'd rather put a low risk on the life of a suspected criminal who is resisting forcibly than risk injury to a police officer who is doing his/her job.

Great job by all involved. I've seen some civilians relating that this was "overkill" but all you have to do is read the newspapers to realize how important it is to take every precaution in these situations. It may have inconvenienced a few folks, but everyone left the scene safe and that's more important than having to take a detour or leave your house for a few hours.

That's exactly what I was thinking. The interstate highway system is built to standards where the average driver can safely navigate at 75 mph with vehicles of the Eisenhower era. That being said, we are not all the average driver.

Firefighters flock to get a nice ...umm, cat.

And Pennsylvania as well. It's not all about money (note all). The SEMAC takes certain legal responsibility for the provision of ambulance service in New York State. They have every right to make sure the standards they write are followed. Certification is one of the methods used to do that. Otherwise, anyone could just put AMBULANCE on the side of a vehicle and go out to pick up patients. Personally, with some of the junk I've seen running out there, they need to really take more consideration into what a safe ambulance is.

I'm sure you could try to save some of the more expensive and portable stuff if you can but I'd be more worried about the dangerous stuff. If there were any oxygen or other compressed gas cylinders on the rig, they could become a significant danger.

My major concerns with giving first responders Narcan would be airway protection and other drugs on board. We all know the vomiting that is almost sure to occur after Narcan, even if pushed at 0.4 mg intervals. Also, I had a reported heroin overdose a few weeks ago that actually had quite a few other things on board. The heroin was causing some respiratory depression but actually masking the effects of the other recreational pharmaceuticals. Once I fixed the heroin part, I had to manage the patient pretty aggressively due to the other stuff on board. With the tools available to a BLS provider, I think bagging that patient would have been the most effective means of patient care whereas if they had used IN Narcan, they would have had a world of other issues.

This is simply how the health care system works. I don't see any surprises here. MCO's negotiate with providers based on their ability to bring groups, just like you can get a group rate if you buy a certain number of tickets to a Yankee game. Medicare and Medicaid only pay what they determine is reasonable and they leverage their patient base and other federal and state funding. Many doctors have stopped accepting Medicare and Medicaid because their reimbursement rates cause them to operate at a loss. Unfortunately, providers have to make up the gap somewhere and it comes from payments from the uninsured, no-fault, and non-participating MCOs.

Should paramedics be required to go to nursing CME's? I think both sides are very different in the type of care they provide. We work under the doctor's license. Having a doctor at CME's is enough for me.

There are no less than 4 conferences every year where you can get your year's worth of CME in one day.

We had the smaller S10 Blazer as a flycar at Sloper. The problem with that vehicle was that the aftermarket stuff that was put in to hold the ALS gear took away from the driver's compartment of the vehicle. We had to move the truck when larger medics were working because they couldn't fit behind the wheel.

You might want to pick another incident as an example of one that upstaters managed well.

Why the inflammatory response to people who are just asking questions? From what I've heard, FDNY did a great job managing the incident. However, to insinuate that us "upstaters" would be blowing chow if we came upon a similar incident is just ridiculous. I can remember as far back as 1989 when a bunch of volunteers assisted by a small (at the time) commercial EMS service, managed a school collapse and had all the patients to definitive care within 60 minutes. FDNY is very well trained, but they don't hold the patent on capable responders.

It sure seems like the FDNY did a great job here. I just have one general question. This accident occurred within yards of the Westchester border yet it seems no Westchester resources were used. FDNY obviously has the resources to handle this incident, but wouldn't it make more sense to pull a closer Westchester unit than a far away FDNY unit just to keep the incident all FDNY? Obviously, the specialty resources are going to come from the City, but if there's an ALS ambulance 2 minutes away in Pelham, why wait for one that's 15 minutes away on the other side of the Bronx?

Gotcha. The drug shortages are causing havoc down here too.

I'm amazed that they have removed D50 and added D10. Administering 250cc of fluid to a diabetic seems to be something that could take a long time. The justification was to reduce errors. Is my assumption correct that this is to reduce Dextrose pushed through a non-patient IV line? If so, is the issue really the D50 or the provider not properly insuring a patent IV site prior to medication administration?

I've never heard of the "auto-narrative". That sounds a bit sketchy to me. We've been using the ePCR for about 18 months now and I absolutely love them. National studies say that your average report writing time will increase slightly even after the learning curve is achieved, but it results in a much more complete report. I agree with those who posted above though, a short narrative is needed for all calls to explain the things that don't get entered on the menu or sometimes just to paint a picture that will help you remember the case in the future if the case should end up in court.

I beg to differ with this statement. Our TEMS program has been very well received right here in the Hudson Valley. Then again, our program is not one where the medics simply have a "patch thrown on their uniform" and they are required to undergo a good bit of training. (I'm not 100% sure of their standards as I'm not a member of the team.)

Great post. In our area, the only reason why a "second medic" is usually called is for a second set of hands for a 2-person crew. There have been many times that I have called for a backup unit and utilized the second crew's EMT as it is a good training opportunity for the EMT. If a medic is calling for a second medic in a single patient situation on a regular basis for reasons other than the need for hands, I would question their level of competence. There are rare cases where a second medic is warranted, and a few by protocol (i.e. in the Hudson Valley region, a patient requiring RSI needs a credentialed paramedic). As far as the EMT-I program is concerned, I took it in 1997 before I decided to go to medic school. I didn't get a lot out of the increased skills available. What I did get, and maybe it was a function of how my class was taught, was a feel for WHY we do a lot of what we do on the BLS level. The EMT program basically teaches you to ask a bunch of questions to gather information and if you "find this" then "do that". My EMT-I program taught a lot more about systems and how to do a more advanced patient assessment which could lead to a better field diagnosis. For a while, I volunteered with an EMT-I agency and I actually found the skills part of the EMT-I function to do more harm than good. Providers that weren't getting regular experience doing ETTs and IVs were wasting a good amount of time on the scene trying to perform those skills instead of getting the patient to the EMT-P unit or the hospital. I've also had the pleasure of volunteering in St. Lawrence County and you are correct, it is a different world. Their program relies on EMT-CC providers, mostly from the larger volunteer agencies, to provide mutual aid to the outlying agencies. There are places in the county where the closest CC unit is almost 40 miles away and given the general condition of St. Lawrence County roads in the winter, that could mean your closest ALS resource is well over an hour away. The EMT-I could prove to be an invaluable resource in these situations. They also teach the EMT-B class differently up there. Due to the limited ALS resources, their EMT-B class teaches their EMTs to exercise much more clinical judgment than we do down here. The volunteer EMTs were very mindful of the fact that they were waking up a volunteer from an agency an hour away and taking away their scant resources if they called for EMT-CC mutual aid. The patients that we ALS for "precaution" are generally brought in BLS up there and I must say, the BLS providers up there are really good. This may be different now, as my experience up there was almost 20 years ago.

I find it very hard to believe that you have any concept of what goes on in the real world. The only thing you've done on this forum is sound off for career firefighters and ridicule volunteers. What you don't seem to understand is a single thing about how the law really works. When people have told you within this thread, all you have done is continue with your anti-volunteer rhetoric. The Board of Fire Commissioners holds the responsibility for setting the standard within their district. If they wanted background checks, psych evals (which are not required of any career FD that I know of), and a full length fire academy, they COULD set that as their standard. Most volunteer or combo departments have commissioners that understand the sense of fiscal responsibility and realize that they can provide a certain level of fire protection at the least burdensome cost to the taxpayer. The Board of Fire Commissioners has the final say on all membership applications and all officers of the department. They have the final say on all training and continuing education requirements. The taxpayers sign on to the standards required by the Board of Fire Commissioners by electing them. As such, the taxpayers should bear the burden of indemnification of the firefighters and officers that are acting within the standards that are completely in control of the municipality. The commissioners are responsible for providing a level of fire protection that a reasonable district of the same size would offer and they hold the sole responsibility to make changes if that standard is not being met. In the event of gross negligence, indemnification does not apply. All of the cases you mention are gross negligence and the firefighter(s) would be on their own.

To clarify Nate's post, it is not that one NYSP helicopter is solely rescue and the other medevac. The ships have to be rigged for the mission that it is intended. Our newest flight medics were actually doing hoist training just last week.

Volunteer firefighters are under the control of the local government (in my case, the Board of Fire Commissioners). If a firefighter meets the requirements set forth by the Board of Fire Commissioners, he should be protected just as a career firefighter would be. If your municipality's volunteers are not "under the control" of the Board or governing agency, it is the fault of the municipality.

The franchise agreements that towns have with the cable companies are ridiculous. In some instances, the competitor (like Verizon FiOS) has to be able provide services to the entire town before they can apply to be allowed into the market. The cable company, however, had years to develop their infrastructure. I can toss a stone (or could when I was in prime baseball shape) from my house to a county highway, yet I still can't get FiOS at my house.

Is there such a thing as a legal closed shop in NYS? When I worked a job with a union shop, I was offered the opportunity to join the union but was told that, by law, I was allowed to decline. However, because the union was still the bargaining unit and they were bargaining on my behalf, I was still responsible for paying dues (or more appropriately stated a fee) to the union if I were to choose to not become a member. Obviously, this would have been stupid as I would have been paying and not getting the other benefits of the union.

Don't worry. If one of those "civilians" ended up with a scratch, I'm sure they'll claim police brutality.