NWFDMedic

I think it's all a matter of perspective. This article came from a paper in Plattsburgh. Although they are still part of New York State, the climate of Clinton, Essex, Franklin, and St. Lawrence counties is really like a different world than what we are familiar with in the Hudson Valley. When I lived in Potsdam, you would never get a paramedic to your house and when you were lucky enough to get a level 3, it was a volunteer from one of the larger villages or towns that could be 30-40 miles from your home. Northern New York is one of the most economically depressed areas in the country and they rely heavily on the volunteer services to provide fire and EMS. If you look at Westchester or the Hudson Valley, you'd probably think this article is a joke. We've come to expect paramedic care as the standard and we are even expecting a higher level of care and training from BLS providers. With the decreasing availability of volunteers, communities are realizing that they have to spend dollars to maintain the level of service they expect. Upstate, I would imagine that they'd be willing to take the trade-off of less training for more people able to respond, especially at the volunteer level. With that being said, I took my first EMT class in 1993 in St. Lawrence County. The class that they taught up there was 100% different than the EMT classes you would find in the Hudson Valley, even at that time. They really focused on patient assessment and finding "true" emergencies because of the limited ALS resources in the area. Where "contact ALS" is a staple in the discussion of patient care scenarios in the EMT class down here, they were teaching technicians to do a lot more before getting a volunteer from 3 (large) towns away up for a routine workup. I'm not saying that it's right or wrong; it's what worked up there.

HEMS is a private service, so the town has no right to review their books. They can, however, require statements of financial solvency as well as a periodic audit performed by a third party. The town also has the right to require certain things in their contract, which I've seen in several contracts, especially with these "quasi-municipal" services. If the town wants to require, for example, $100,000 of the money provided to go to training, HEMS could be asked to provide documentation of that. If the town wants to pay a contract based on covering the "gap" between billing and recovery for town residents, they can ask for that documentation. I was treasurer for one town ambulance that had a contract with the town stipulating that all funds received from the town had to go directly to operations related equipment/supplies/training and we provided documentation of that quarterly. In fact, we maintained separate accounts for donations and such that we used for non-operations related expenses. HEMS does not, however, have any requirement to "open the books" for the town. As a not-for-profit, a lot of their information is available publicly anyway. Although they are not required to do so, a lack of cooperation between a town and the "quasi-municipal" service generally ends up spelling trouble for the EMS service.

This topic is one that we've been arguing about for years in the EMS world. Agency policies come as a result of our litigious society and lack of common sense on the part of providers. Regardless of your agency policy, when you arrive on scene of a call, it's your job to document what you found. If you arrive on the scene of a car that has literally just driven off the road due to snow and ice (a common theme this winter), then it's perfectly acceptable to document that there is no patient. However, writing "canceled, no injuries" does not suffice. Instead, you should document what you found and why you felt it acceptable to state that there were no injuries. This should include the names of the occupants and that you offered them a medical assessment. If another agency cancels you, be sure to document the agency and, if at all possible, the name/shield number and rank of the person canceling you. Remember that the State (in New York, at least) puts the duty to act on the highest medical provider responding. If you pull up to a scene with significant damage and the PD is taking the driver into custody and they are denying him a medical assessment, you should explain to them that the patient should be assessed and sign off in the best interest of all involved. If they continue to refuse you access to a potential patient, obtain the name and shield number of the officer taking the patient into custody and, if possible, their signature refusing care of the patient. Sometimes, asking them for a signature will actually change their minds and at least let you do an assessment. If a person has a complaint, no matter how vague, they become a patient. "I'm a little shaken up but I'm fine" is a complaint and warrants documentation of an RMA. If the patient has no complaint but there is damage or reports of mechanism indicative of potential trauma, that also warrants documentation of an RMA. If you have any question about either of these two, it warrants documentation of an RMA. If your agency policy states that you do something, then you do it. However, if you don't have an agency policy, use some common sense and document, document, document, even if your survey of the scene and occupants leads you to the impression that there are no patients.

They look like a good purchase for Empress, especially as the cars will operate primarily in a city environment, even if it is pretty hilly. I'd imagine this less expensive alternative could also allow them to extend the service life of their SUV's and have them available for use when the snow and ice really start flying.

There was a time when that plant employed half of Massena and I'm sure it was the town's largest employer. The economy in the North Country, particularly St. Lawrence County is worse than most of us down-staters can imagine. I hope they can do something to keep Alcoa there.

We often think of MCI's as trauma because they usually are. One place where I think a physician would be particularly helpful is the "medical MCI". Specifically, HAZMAT incidents, potential chem/bio attacks, etc. You're right that a physician would essentially be a paramedic, however, if a plan was developed with a hospital response unit delivering other needed meds or equipment, the physician could be extremely helpful. Heck, something as simple as a bunch of kids in a dorm falling ill after potential food poisoning would benefit from having a doc in the field. That's something that may not happen every day, but it does happen often enough.

If you're referring to the Wheeled Coach Modu-Van with the van chassis, small box and single rear wheels, they did indeed look sharp. We were looking at speccing one out for my volunteer corps in the mid-90's as we wanted to upgrade from the van but had very little money. We test drove one that a neighboring corps had put into service ... the worst handling thing I've ever driven and it felt like you were in a cement mixer in the back.

It will be interesting to see if the cavalier attitude of the commissioners costs them their position come election time.

You have to go out to bid (unless you're using state bid), you do NOT have to go to referendum. My fire district pays for their trucks using a truck reserve fund and has never gone to referendum for the purchase of a new truck.

Is it negligence on the dispatcher's part or a problem with established policy or both? We send police all over the place for 911 hangup calls, just to make sure the situation is safe, even if the callback produces a valid reply. We send fire and EMS departments to automatic alarms, even if the callback confirms an accidental or false activation. Why on earth would we not send the police to someone requesting the police? Maybe in the initial stages this may have been triaged below the GSWs and stabbings (although this would have been a mistake IMO) and the incident still would not have been avoided, but it should have at least been put in the system. Telling someone help is not on the way is deplorable for any system to allow.

This fight has been going on for at least 20 years. I can remember as a young buck when they were first establishing the 911 system, people realized that the numbering system was both random and really stunk. There were several proposed new systems, all of which were met by senseless arguments. They ranged from "who is going to renumber our vehicles" to "my department number from the state has a leading zero, what are we going to do with that" (not really a senseless argument, since it causes havoc in many computer systems) to "we're department 36, we don't want to change our number for the county" to "we've been doing it this way for X years, why change". Well, as usual, politics being what they were, we've gone 20 years and no improvement in the system. The first solution to this "problem" is having command officers familiar with the capabilities of their neighboring departments. Nothing will ever be perfect for the mutual alarm assignments as you can cross battalion, county, and even state lines but you should know what your neighboring departments' equipment for the first few alarms. For example, my department was dispatched mutual aid to a bordering department with a FAST team several years ago and, at the time, our FAST team's response was with our rescue. We were instructed by command (via county, a whole different communications issue) to hit the hydrant at the corner of street A and B. I was absolutely appalled that the command officer of a bordering department didn't know that (1) our rescue was coming with our FAST and (2) the only pump on our rescue was a portable pump. Once the poor training of command officers is dealt with, the poor information availability at county needs to be dealt with accordingly. Trying to make a standard list of equipment that has to be announced with every transmission to county is just making life more difficult for everyone and it will never deal with every special request. Get back to the basics: engine, tanker, ladder, tower ladder, rescue, utility, boat, misc. (add in squad or light rescue if it really meets your fancy). If you need a specific resource as command and you are beyond the area that you know, that's fine. "KEE-315, 36 Control, Orange 911, I need the next available heavy rescue, high volume engine, high volume hose vehicle, etc. etc." The CAD system should be able to have qualifiers on each piece of apparatus and allow the 911 center to dispatch the closest available unit to meet command's needs (that's if they listened to me because I failed to wait to be acknowledged). That's where your additional information is placed, not on some radio identifier. Departments also need to get over the whole "my department number is whatever follows the 360xx in the state system". The state system is not a perfect fit for your department's radio ID, nor was it designed to be. For example, Ulster County did not eliminate trailing zeros in their system, which is a communications nightmare. For example, is "Car Eighty Three" the third officer of New Paltz Rescue or the first officer of Mobile Life? Changing the radio identifier to "80 dash three" to eliminate this confusion was a patch, not a fix. It's only good until the first person forgets, then you have confusion. The Dutchess system starts at 31 and has no trailing zero companies, thus eliminating that confusion. Learn from the past mistakes or things that don't work quite right in other neighboring systems and come up with something that makes sense for Orange County. Put aside politics and petty gripes and get the knowledgable people in our county together at a table and let them hammer out a system that is truly beneficial for fire response. While they're at it, maybe they should look into an avenue for common communication between fire and EMS. The OC911 center is so concerned about the traffic coming through their radios, why am I always tying up 2 dispatchers and 2 frequencies to transfer information between fire and EMS? There are a lot of good ideas roaming around the county system, they just seem to all be off on different tangents.

I didn't understand that language either. I was guessing that it might have been added in for the air medical companies that employ flight nurses and want to certify them as medics too (as, of course, a medevac is an air ambulance and must have a medic on board). I surely hope they aren't planning on doing what NYS did with the fire courses way back when. My initial EF course had no requirement that you pass a test and then a short time later they went to the program of testing but you would still get a certificate if you failed; it just didn't have some stamp or sticker. The premise was that a firefighter can do the job without necessarily being able to pass a test. My personal opinion is that a firefighter has to have the basic knowledge and critical thinking skills to do the job properly and that can be evaluated with testing.

I am in the extreme minority but I think licensure is a bad idea. The CME based recertification is a quasi-licensure program and I believe the program leads to some erosion of essential skills over time. We have actually had some empirical evidence to support this claim. I think it's a lot different for paramedics that are practicing full-time but for the EMT that rides 12 hours a week for their squad that might do 1 call a month, I think the regular refresher programs are important.

I know this is just one person's interpretation of what is in writing but it seems that authority is being centralized at the state level. It also seems that they are simultaneously shifting a lot of SEMSCO and SEMAC's authority over to the Commissioner. As far as centralization at the state level, New York is looking to match several of the smaller states around us. I think that New York is a bit of a different animal though. Having lived and volunteered in St. Lawrence County, I can completely understand that some of the further regions of the state require significantly different protocols than the more urban or suburban regions of the state. I don't think one formula works for such a diverse state. Also, the bureaucracy involved with trying to get something passed at the state level will, in my opinion, hamstring those organizations that have traditionally been leaders in the progress of EMS in the state. Trying to get an aggressive new trial program approved to bring better care to our patients will likely be buried in red tape. The regional system has many of its own problems but I don't think that removing them from the equation is the right thing to do at this point in time. Fix the problems at the state level first, make that a smooth running organization, and then revisit the consolidation of the regional authority.

Wow, I sure hope this doesn't pass. It would be a huge step back for EMS in New York State.

Two things you do for that situation. #1. Protect yourself and set an example for the younger folks who may not know any better. #2. Vote that Lt. out at the next election.

Same concept with intrinsically safe radios and cell phones for that matter. Unless you have equipment set aside for these types of emergencies, I wouldn't trust a sticker on a device and assume it is safe.

Nathan's post was in English and stated the same facts that yours did. There were no word games, as you call them.

I'm not sure whether I agree with legalizing marijuana but I'm certainly not against it. This synthetic stuff, however, seems to be much more dangerous. I've brought in more patients under the influence of this synthetic stuff in the last 2 months than I have under marijuana (non-laced) in 5 years.

Am I the only one that thinks of the Allstate mayhem commercials when reading this? I've had 2 patients abscond from the ambulance in almost 20 years and a few others try unsuccessfully. One had a nicely dressed wound to his hand when he jumped out. It was quite a sight to see the guy running down Broadway as the roll of 4 inch kling unraveled. In all seriousness though, this is a good topic for discussion. How far does an EMS provider go in these situations to keep the patient in the ambulance, at least until they are in a safe location to exit if they choose to do so (assuming they are not an involuntary)?

It also puts firefighters out of the sight of command and reduces that urge to use firefighters in rehab prior to being cleared to return to duty. While the Rehab Sector has to understand that there are sometimes extenuating circumstances, the use of rehabbing firefighters as you're "backup plan" is poor planning. Taking tired firefighters and putting them back into a high stress situation can cause even more problems rather than fixing them. Command should try to operate as if those firefighters are not there and have or request sufficient resources to do the job without them until they are ready to return.

Actually, conventional wisdom says that rehab should be away from the fire scene. Rehab working or not working has nothing to do with its distance from the fire scene. If command constantly promotes an environment where rehab is routinely performed then it will become part of the firefighting process.

I am not putting myself at an unnecessary risk. There are plenty of other members who respond to that district. I will simply stay back and man apparatus for our district, allowing them to go mutual aid. I believe it is the responsibility of incident command to create a safe environment for all responders (or as safe as possible, we all know all emergency services cannot always be a 100% safe situation). If they are not doing so, I am reserving my own right not to participate.

I still find it hard to believe that some departments in this day and age don't have at the very least a BLS ambulance respond to all confirmed fires. As far as sending additional resources, I guess that depends on what kind of situation you have and how easy or hard it would be to mobilize additional resources. My department used to respond with its FAST team to a neighboring department that did not always have and ambulance on scene of fires. I actually told my chief at the time that we should be bringing our own ALS ambulance to protect our members if that department did not change their policy. When that was refused, I refused to respond mutual aid to that neighboring department and still will not go there to this day.

They must be getting paid pretty well to refuse OT. Wouldn't they eventually be mandated if minimum staffing was not met?