NWFDMedic

It appears that the Orange County 911 Center has made another step forward in their communication protocols. We received word this week that effective October 1, any traffic addressed to the Orange County 911 Center on police, fire or EMS frequencies will be using the call sign "Orange 911". Gone are the days of "36 Control", "WAU-718" and "Central". Although the memo read October 1, from the radio traffic I'm hearing, they've already started the process. Orange County now joins Ulster, Dutchess, and Putnam with a similar dispatch identifier.

What I don't get about this whole thing is why is the firehouse "closed". I would assume that there is some old extra hose sitting around the firehouse. Why could they just not bring that and if they got an alarm, disconnect and go? These guys must drill all the time and I would assume that if they got an alarm during their drill they would pack up and respond. What's the difference?

What else would my fire chief do with all that space in his console if he didn't need 4 mobile radios just to communicate with our primary mutual aid departments?

They probably wanted out-of-title pay for that 1/2 hour.

My department has used FailSafe as well. Can't beat them for the price and I'm sure the assurance that a professional has done the testing is worth it too. They also do a great job of re-racking the hose.

Route 9 is actually a federal highway.

Every once in a while, I will take a picture of an accident to bring to the hospital. That's generally only if there is a particular mechanism that I want the doctor and trauma surgeons to see.

That is an incorrect statement. The state police helicopter operates on rotation with the LifeNet helicopters as to which is first due for the service area.

I'm sorry to hear that some brothers and sisters will be losing jobs but I honestly never saw the need for a third medevac in the Hudson Valley with the vast number of flight resources available surrounding us.

Funny you should mention that actually. It's definitely difficult for commercial or municipal services to get information about patient outcome. The nice feeling we get is when the patient gets to the ER alive or alive and improved. Sometimes the ER doc might tell us how the patient progressed until they went to the floor, but rarely do we hear how the patient made out in the long run and whether our care helped or hindered the outcome. That's always been one of the questions about intubation in general. We had an in-service yesterday for our new electronic PCR's that we will soon be implementing. A couple of the data fields that they have involve patient outcome, even to the point of discharge. While we obviously cannot get this information in most instances, I wonder if this is a precursor to better national data reporting.

I don't know the answer to why only 2 agencies in Westchester. The protocol for RSI was opened to any agency in the Hudson Valley Region where I work and only 2 agencies that I know of have chosen to be in the program. I guess you would have to ask each particular agency whether the QA/QI appropriateness of medevac decisions. I know how my agency's program works and all flight calls are reviewed and the appropriateness of the decision is considered. Finally, there is a difference between calling someone unqualified to discuss an issue and calling someone unqualified to discuss a case. I consider myself to have a pretty good knowledge base about EMS but I couldn't tell you a thing about a specific call in Somers nor would I be the one answering questions about it on this forum if I was involved. All the knowledge in the world without the proper information can lead to bad assumptions and decisions. Part of my job is to proactively question cases such as this at my agency (even before they get official QA/QI review) and I would never come to judgment without first asking even my newest medic what his/her reasoning was at the scene.

My take on this is that there was a request for a resource that the patient needed for the best possible patient care. It just happens to be that that resource came out of the sky. The medic on-scene noted that the patient had a possible head injury, was combative, and was likely not going to be able to have a secure airway by the means available to him. There is a resource available that can assist in securing that airway, so why not call them? I am lucky enough to work for an agency that has several adjuncts above and beyond the protocols such as RSI and CPAP. I have been called mutual aid to other ALS services to assist with an RSI or a CPAP application because we had the resource, it was available, and it assisted in the best patient outcome. I know if it were my family member, I'd want to know that the paramedic on scene did whatever was in his best judgment to perform the best life-sustaining measures for the patient. If the paramedic felt that getting an RSI medic to the scene via air was better overall for patient outcome than trying to run to the closest facility with a BLS airway or to make the 20 minute ride to the Medical Center with the same, then good for him for requesting it. The agency's QA/QI program is responsible for the retrospective review based on the medic's paperwork and potentially a personal interview. The EMTBravo QA/QI committee often seems to work on generalization and assumption more than fact.

Good luck to the officers involved and my prayers go out to the families and brother/sister officers of their departments. Although the perps got the proper sentence, it would have been fitting to see them suffer until the last officer is better, then shot.

Regional Medevac handles which ships are assigned to a call. They have maps of the areas, weather maps, etc. and they can determine which ships are most appropriate. Given certain wind conditions, I would venture to guess that a ship on the ground at the Medical Center might actually have a longer flight time. Atlantic Air 1 is a medevac located somewhere around Parsippany, NJ. According to their flight map, they can be between exits 2 and 3 on I-84 in 12-15 minutes of flight time (which I think is a bit of a stretch, but still it's not too awful far). Northstar is located in Somerset, NJ and is approximately 55 miles by air to the call, which could be accomplished in maybe 20 minutes of flight time. The other thing to consider is the fact that the LifeNet helicopters may not be where we expect them to be. They maintain system status just like any commercial ambulance service would. It's not at all unheard of that if both Albany area ships are out of service that they will float a Hudson Valley area ship up to cover. As far as taking all 4 patients to WMC, the patients all were in the same vehicle according to the Record, but that would only be a secondary consideration. I'm fairly certain the air crews coordinate with WMC to see if they can handle the volume.

Nice shots Bill. Of course, my white cloud sent me on the call just prior to this one in Rombout. Three units at a serious MVA and I'm clearing Vassar to come down and cover Wappingers.

There's not much of anything in Watertown except snow and Fort Drum. 87 to 90 to 81 is probably the safest way to go. I dated a girl from Watertown when I was in college and I found it just a little bit quicker to get off I-90 in Utica and take NY 8 and NY 12 up through Lowville. It also took away the monotony of driving on the highway and there were a few more options for food. That entire area is really struggling with the economy, so for me to guess what's still open having not driven that way in 14 years would probably be misleading to you.

The 2007 was the first Chevy model we got as well, also from AEV. I'm not a big fan of the 2007's in the back because the suspension is horrible. They are more comfortable in the front but something with the rear suspension makes the smallest bump feel like a huge pothole. Our 2008 and 2009 models are a much better ride in the back, so at least it seems Chevy was responsive and worked to alleviate that problem. They have been a reliable running truck but we'll see what happens as our 2007's are starting to get up in age. The Fords had more room in the back but they had more issues under the hood as well. The new required net in the back has made the 2009's seem even smaller but well planned placement of gear helps to make it workable. I'd still prefer to be in a Ford but they are going to be pretty much extinct from our fleet soon, so this dinosaur has had to accept change.

The NCAA has different rules for different divisions. My guess is that UNH is a division 2 or 3 football program so comparing them to FSU isn't exactly accurate. For the most part, eligibility begins when you begin your life as a college student or you play that sport at a similar competitive level. For example, if you play basketball for 2 years at an NJCAA or NAIA school, you lose those 2 years of NCAA eligibility. There are many NCAA division 1 hockey players that play 2 or 3 years of prep/junior hockey before enrolling in school and keep their 4 years of eligibility, even though they are sometimes as old as 22 when they get to college. Their only limitation is playing in major junior which the NCAA considers as a "professional" league and you lose all eligibility after playing in major juniors (some players have filed for exceptions if their time in MJ was short and the NCAA will typically take away 1 year + the number of games played in MJ).

Nice to see Milan 48-52 or the former New Windsor Rescue 448 all shined up and looking nice.

I believe NHFD's chief posts on here and can give you the real right answer, but from working with them, I believe the rescue equipment from Station 2 is now located on 53-13. They also have 53-52 from Station 1 which is their heavy rescue and 53-67 also from Station 1 which responds to EMS calls throughout the district.

I have never been in the position to be 10 minutes from a level 1 trauma center and had a call that would potentially require a medevac. In my short time at Sloper, I never did any calls out in Medic 4 that was a hop, skip, and a jump from Danbury that may have met the trauma criteria (call me a white cloud). I have, however, been that guy in regards to a level 2 trauma center and my decision was questioned by the Monday morning QB's (not by my agency's QI committee because they actually read my report). I was a 10-12 minute drive from a level 2 trauma center and I came upon a car wrapped around a telephone pole basically into the driver's compartment. For 30-45 minutes, the only visible contact I had with the patient was one hand and audible contact revealed a conscious but confused patient. There was blood everywhere around the scene and I knew from the start that this was going to be a difficult extrication. To make a short story long, the helicopter was on the ground and at my side when we got access to the patient, only to find out that the patient had some significant injuries but was not significant enough to warrant transport past the level 2 to the level 1 trauma center. I made the decision to bring the helicopter based on limited information and a long extrication in the best interest of the patient, should they need a level 1 trauma center. People could question that around the table at the station all they want, but I still feel it was the correct decision. My decision to call for a medevac in most situations is a combination of the availability of the patient (ie. need for extrication), the condition of the patient (if I am limited in access, I will presume worse rather than better), and distance to a trauma center. I must say though, as my experience has grown, I'm more comfortable transporting the patient by ground than calling for a medevac that can be better used somewhere else. It also helps that I have RSI available to me if needed.

There are so many different variables to this question, from the volunteer, to the career EMT, to the (for lack of a better term) kid EMT working through college, to the EMT with aspirations to become a medic. There are also a number of different response systems here in the Hudson Valley. I've seen good and bad EMT's in every one of these areas. As a medic for a commercial service, I work with four very competent EMT partners (yes, I got lucky with this schedule). For the most part, I allow them to go into pretty much every situation where we operate independently first and let them do the assessment/interview. With a good partner, I can get the answers to the questions I need and do the things I need to do while he/she is asking questions and doing basics. Some of this didn't come easy because not all medics expect so much from their partners. There have been plenty of times where I've stopped at the front door and pushed my partner in first. When I end up dealing with BLS agencies on meets, I find the entire spectrum from great to not so good at all. I like to let the volunteers do what they are getting out of bed to do for free because I respect that. Some want to do everything, some want to do nothing, and some are afraid they will do something wrong. I try to work with the ones that want to learn and take whatever I can get from those that have no interest in learning. Everything they can do independently is one less thing I have to do, which is both good for the patient and good for me.

Interesting story Seth. Wouldn't her car insurance pay for it though? Either way, I think it brings to light an interesting topic. Personally, I think if the firefighters were acting to the initial acts of preserving life and property, then this is something the City and its firefighters shouldn't have to be responsible for because they are responding to a threat to the public's safety. If they were doing it after the fire was brought under control during routine overhaul, then I'd say they were negligent and liable.

I agree with you about the increased training. When the topic was initially discussed here, I don't think anyone was against requiring CDL training for apparatus operators, just the way the law came to light. If they gave districts say a 5 year period to get all operators to get CDLs and made the training available, then I don't think it would have been as big of an issue. Then again, that's EMTBravo, where most of the posters are pro-training.

Hey, just a little reminder because I know the new procedure is a bit confusing... only half of your physician contact CME's now have to be from a HVREMSCO doctor. I see you're from Westchester, so half your hours can count from stuff down there. From the process: C. Complete 8 hours of Physician Contact CME per year for a total of 24 hours of Physician Contact CME throughout the three year certification period. 1) A minimum of 12 hours of the Physician Contact CME must be earned with a HVREMAC credentialed Medical Control representative. 2) The remaining 12 hours of Physician Contact CME may be presented by non-credentialed Emergency Department Physicians or Physician Specialists if the hours have emergency care relevance.