chovesh

Normative Jewish law dictates that In a life or death situation almost all rules are off. Many people get very caught up on not touching and forget about that energencies override that. In the end of the day you just have to be respectful and understanding just like on any other call. Explain what you are doing and why and most of the time there won't be a problem. Having worked in tel aviv in some of the most religious neighborhoods in Israel I have never been given a problem about touching women. It is important to keep them covered (don't carry them out with their bodies exposed) bc it'll make them uncomfortable and be cognizant of the fact that while with most of your patients a soft touch on the arm is comforting for some this may be very uncomfortable. If you respect them they'll respect you and you'll find they are not as different from you as you may imagine.

Which (if any) of the voluntaries in the city are hiring? I heard NYP-EMS recently rescinded their hiring freeze. When I asked if they were doing interviews they said they have no idea when they'll be doing interviews and that they'll call. How do you submit resumes to the other hospitals? (Places like Lenox Hill or St. Luke's that have EMS but don't advertise it anywhere, you can't search EMS job openings on their website, most don't even list EMS in the phone directory)

Which VACs are hiring Paid EMTs? (Either to cover set shifts or to fill holes in the volunteer schedule)

Scary Stuff: http://wcbstv.com/local/fdny.dispatch.system.2.1013579.html

In response to that: I agree. As is evident from my previous response, I am a HUGE fan of CPAP. Even I, however, have my reservations about BLS CPAP in Westchester. For certain agencies (empress) it may be beneficial but we have to take it on an agency by agency basis. For example, Mamaroneck probably doesn't need BLS CPAP because they have medics on every call (and if the MEMS medic is unavailable, LVAC is just down the road). [i don't mean to pick on MEMS, it's just the first agency that came to mind because this thread was created by a MEMS member. MEMS here = any VAC in westchester county]

I tried to do a clinical study with BLS CPAP. I had a few doctors who were interested in doing the study but none of them came through in the end. Anyway, in my research leading up to the study that never was I found there are something like 5 states that have BLS CPAP. (Here is a very good Powerpoint on it: www.paramountems.com/hospitals/CPAP%20for%20Medical%20Directors.ppt) The goal of our study that never was, was to analyze ALS calls where CPAP was used and to see if BLS providers could handle calls alone that would otherwise be ALS thereby freeing up ALS units for other calls. (This would obviously only be useful in very busy places like NYC and yonkers where ALS providers are a rare and precious commodity.) I know I'm going to be attacked for suggesting EMTs can "handle" an ALS call without medics, and I know people will say they lack the assessment skills that ALS providers bring. I understand. However, I've seen studies that showed EMTs and Paramedics were equally able to assess patients for CPAP eligibility (I'm sorry I don't remember where the study was, I'll post an addendum if I do find it). As far as CPAP in our area is concerned: I believe it is definitely worthwhile from a patient-care perspective. It maybe expensive to train providers and outfit ambulances with CPAP but when you think about it you are saving the patients and insurance companies thousands of dollars. The goal of CPAP, when you boil it down, is to keep patients from being intubated. The first day of intubation costs $8,000! Not to mention the high rate of infection amongst intubated patients (the rate of infection is even higher amongst those intubated in the field). Patients treated with CPAP spend less time in the hospital, have a 45% lower morbidity rate, avoid the dangers of sedation, and are most comfortable (that's got to count for something. A few agencies in the city have adopted CPAP (NYP-EMS, Hatzalah, ??) in Westchester I heard Empress has it. In Rockland County, RPS just started using it. I heard a rumor Westchester EMS was looking into it, I don't know if they got it. If you want my powerpoint or sources PM me.

What about Medic jobs? Are there more agencies hiring medics?

What about the voluntary hospitals in the city? Are any of them hiring?

With all due respect, what will transporting to the nearest hospital do for a patient with major trauma? The patient doesn't need an ER. The patient needs an OR. Only a trauma center has an OR and team ready all the time. Think about it, the normal ER won't do MUCH more than EMS to stabilize the patient enough for surgery. Think back to the golden hour: from trauma to definitive care whereas definitive care is surgery.

To my fellow first responders: I am working on a paper about disaster preparedness. I would love to get some comments/quotes/ideas from you all. You can either post them here or PM me. (Please include what department/specialty you fall under: Law Enforcement, EMS, Fire, Rescue, Communications, DES, etc.) Feel free to answer any/all/none of the questions: Do you feel you are well prepared for large scale disaster on the magnitude of 9/11? Do you feel you are being provided adequate training? Does your department/municipality conduct drills? Do you feel prepared for a non-conventional attack? (i.e. Chemical, Biological, Nuclear) Do you believe we are better prepared now than ten years ago? In what areas do you feel we still need improvement? Have you been trained in recognizing/responding to terrorist attacks? (Special scene safety issues etc) Have you ever attended a drill? Thank you for your help.

On an MCI do we need to get an RMA for everyone involved? Do crews assisting at the scene have to write 004 PCRs (Treated by this unit, transported by another)? For small MCIs (three car accidents) writing a PCR on everyone isn't a big deal; but when you have a situation like that 51 car pile-up in New Hampshire a few weeks ago you could be writing PCRs for days!

For the record: hatzalah issues all the equipment required by Part 800 to its members (both ALS and BLS). Each car is registered as a fly car. They have state DOH inspection stickers. And yes, Hatzalah members like Acuras... almost as much as they like big black SUVs

Does anyone have any suggestions for EMT jobs in long island or queens in the 911 system. Preferably Part-Time or Per Diem?

Invisible pending correction of copyright infringement PARAMEDICS could barely find a pulse when Oluchi Nwaubani was pulled lifeless from a swimming pool. After spending 18 minutes under water, the two-year-old was not breathing and doctors put her chances of survival at only one in 50. Surgeons even discussed with her parents the possibility of switching off her life-support machine. But Junior and Tayo refused and, three days later, their daughter started to breathe again. Five months on, she has made a full recovery. Brain scans revealed that Oluchi had been starved of oxygen for 18 minutes after falling into the pool at a friend's house. The brain usually dies after around six minutes without oxygen and the heart usually stops after ten. Mr Nwaubani, a 40-year-old prison officer, said: 'Doctors were telling us she was never going to pull through because she had been under the water for too long. 'If by a miracle she did survive, she would be very severely disabled and would have to be looked after all her life. 'They told us it might be better to turn off her life-support machine but my wife and I are both Christians and we just prayed to God that she would pull through. 'The doctors said there was a faint pulse so we clung on to that When Oluchi started breathing, we were told not to get our hopes up because she was still very poorly. 'But Oluchi is a fighter and she shocked everyone with her progress.' She was treated at Great Ormond Street children's hospital in Central London. Mark Peters, an intensive care specialist there, said: 'When she was admitted she had suffered a terrible and prolonged cardiac arrest which was right at the limit of what is known to be survivable. 'Paramedics, the receiving hospital and ourselves went to enormous lengths to restore her. Although we knew the odds were stacked against her, we were determined to see what we could do. Obviously we're delighted she pulled through and delighted to hear she's doing so well.' Oluchi, who has two sisters, is recovering at the Princess Royal University Hospital in Farnborough, near her home in Petts Wood, South-East London. Her father says the only evidence of September's drama is a minor problem with the speech of Oluchi, who is now three. r.kisiel@dailymail.co.uk DEFYING THE ODDS IN most cases where the body is under water and starved of oxygen, brain cells start to die off within four or five minutes in a condition known as hypoxia. Even if they survive, patients usually suffer some form of brain damage and might also be left with long-term slurred speech, muscular problems and other neurological difficulties. But surgeons say that cold water can slow down the rate at which brain cells die by lowering the pulse. Ffion Davies, an emergency paediatric consultant, said: 'It is extremely unusual for a child to survive after being that long under the water. It is even more unusual that she has made a full recovery. The cold water must have slowed down the body's metabolism.'

Does anyone know what is going on with the St. Vincent Paramedic Program. As I recall, they used to have a website. Now, there is hardly a mention of it on their website. Does it still exist?

Does Presby usually hire continuously? Any idea when the hiring freeze will end? What about other voluntary hospitals like St. Vinny's? Are they as hard?

In Israel Hatzalah Volunteers and Volunteers from Magen David Adom (to a lesser extent) have been using motorcycles. They have motorcycles with a box on the back that holds O2, first in bag, AED--just enough to get things started before the ambulance arrives. Volunteers keep the bikes at home and are dispatched using pagers and nextels. Because of the agility of the bikes their response time is unbelievable. I had the pleasure of working with many Hatzalah volunteers when I worked in Israel. Here is a picture of a hatzalah bike. (The kid is not a member ) http://www.hatzolahisraelusa.org/photos.ph...Rechovot%5B.jpg

What skills would you like to see added to the EMT curriculum? EMTs in Israel start IVs, in North Carolina they Intubate, in a number of states they use CPAP, in other places they use combitubes. Nasal Narcan is up and coming for ALS and potentially BLS. What do you think about adding skills for BLS and which skills would you like to see added?

There may be a summer class in the New Rochelle fire Department.

Is it possible to be on a rescue team and not do fire? I would like to join a team or local fire department that does technical rescue but can you do it without doing the fire part as well? (I have no interest in going into a burning building) Do you have to be part of a department to be trained or can you take the courses alone just to have them under your belt.

Masterfully said. Sounds like you're writing from experience. It is unfortunate that we have to walk a tight rope between patient care and financial care. It is for this reason I don't like to know the prices of anything we carry, I don't want to have a price tag in the back of my mind every time I open a kling bandage, O2 Tank, or start a line. To my mind if the patient needs it they should get it; let someone else worry about the billing. There are certain techniques that are currently available with equipment almost all of us carry in our BLS bags today. For example: I read this month's FDNY EMS CME article about asthma. They recommend that their medics give Epinephrine 0.3mg (0.3mL 1:1000) IM (for adults) when albuterol is not working as effectively as one would hope. After looking at 300 patients who did not improve with albuterol they found 76% improved with Epi (3 patients deteriorated because they where using cocaine). So I thought: why can't an EMT (with permission of OLMC) use the EpiPen in their BLS bag to help this patient who is not responding to albuterol? [Aside from the readers of this forum who believe that EMTs are stupid. :lol: ]

By that logic why should a paramedic be able to push drugs? Just because someone is "trained" that doesn't mean they know the material or are proficient. We've all met plenty of incompetent EMTs, Medics, RNs, and MDs. That doesn't mean because some people don't know what they are doing we should never allow anyone to do anything. If the protocols say make sure the patient has no cardiac history before giving albuterol it is fair to assume EMTs are doing so. This goes not just for Albuterol but for all skills: when we talk about writing protocols we have to assume the providers follow the protocol. Just because there is a minority of people who can't remember a simple protocol that doesn't mean we should make the public suffer. If a provider gives an improper treatment because they didn't do a proper assessment that is not a flaw in the protocol that is a problem with the provider and in that case the provider needs to be disciplined.

When I originally posed the question I had CPAP in mind specifically. I agree we shouldn't throw skills at EMTs for no reason but there are times when a skill/therapy will greatly benefit patients. Let's take CPAP as an example: the first day on a vent costs $8000 and puts the patient at risk for a whole host of infections, with classic ET Intubation there is also the possibility of knocking out teeth and discomfort for a while after the tube has been removed. So the advantage for ALS is clear. What about in systems like NYC or Yonkers where ALS is not as readily available as it is in Westchester or Rockland. CPAP is a pretty low risk way for a provider to aggressively manage a serious respiratory patient, (I plan to investigate but will assume for now) CPAP maybe used by an EMT to treat serious respiratory distress when ALS is unavailable. Most of the protocols I've seen from states that have BLS CPAP require the EMT to request ALS. I wholeheartedly agree with everyone else who has said EMTs need more patient assessment. I also agree quality over quantity, what good is having an EMT every ten feet if s/he doesn't know how to assess a patient and recognize emergencies. That is, after all, how the textbook describes the the job of an EMT--to recognize emergencies.