FireMedic049

You should re-read the posts. The "union" aspect of the discussion has nothing to do with "'taking jobs' from union people".

More than likely these employees were being allowed to leave work to go on fire calls without loss of pay rather than actually being "paid to leave work to go on fire calls". It's very similar to the "get paid to sleep" assertions regarding paid firefighters. I don't get paid to sleep. Like the vast majority of career firefighters, I get paid to be at my fire station, available to immediately respond to calls during my shift along with being paid to respond to those calls, maintain my station and equipment, perform inspections and other tasks. It just happens that if not on a call, sleeping at night during a 24 hour shift is allowed. Call it semantics if you want, but I think they are important distinctions.

This assumes that all of the employees are unionized. If they are, it may have to be done more than once if multiple bargaining units are involved. Regardless, the employer would have to agree to the provision and considering that the Mayor would likely be the one to have to agree to it on the employer side, it may not happen.

If anybody here sounds like they're from the "saving the foundation of the structure is good enough" crowd, it's YOU. Everybody going home when the call is done is not a reliable assessment of the performance that yielded that outcome. By that standard, a fire department could go to a fire, do absolutely nothing and then return to the station with everybody that responded and be said that they did a "good job", when you'd be hard pressed to find ANYBODY that would think a fire department that does nothing to combat a fire did in fact do a "good job".

"Legal" and "right" are not always the same thing. The mayor may be legally allowed to restrict the town's employees from leaving work, however it may not be the right decision. When you consider that the municipality is ultimately responsible to ensure the provision of fire protection within that municipality (which oftentimes means using a non-municipal VFD to do so), the decision to prohibit municipal employees from responding to emergencies within the community during work hours is not necessarily the wisest of decisions. Additionally, if the issue is ultimately paying the employee for time not actually spent at work (lost productivity), there's a couple of pretty simple solutions available. Allow them to respond, but they don't get paid for the time they are absent. Allow them to respond, but have them "make up" the lost time in some fashion. At only a 1000 or so calls per year, these employees probably aren't missing a substantial amount of time.

Additionally, if the law is like the one we have in PA, it would not be applicable to the situation described in the article. The protections only apply to situations in which the response occurs before reporting to work, not when you leave work to respond (especially when you leave without the employer's consent). It protects your employment if you are late or miss your shift entirely due to an incident. From a quick read of the bill, it strikes me as being the same way. However, I would imagine that the employer could terminate employment if a pattern of "abuse" can be proven. Stuff like being several hours late to work, when you could've only been slightly late or skipping work altogether when you could've reported to work.

What fun is that?

There's no engine, just a couple hamsters on a wheel.

The only regulation that I'm aware of that might be applicable would be that of seatbelt law compliance. Like musical chairs, if you don't have a seat (and seat belt) when the music stops, then you're out. Are the agencies that are running these mega crews operating more than one ambulance? If so, they should not be sending a mega crew out on most calls if they don't have a guaranteed crew for other units. You're not meeting the (EMS) needs of the community if you put 4-5 people on the first out unit and then can't crew for a second call.

No problem. I'm just helping you out with that.

Correct, however vans and pick ups are subject to crash testing currently.

I think your line of thinking is a little off on this and to an extent, incomplete. When you talk about occupant safety (for providers) in ambulances, it has to be a two part conversation. You have to look at both the cab area AND the patient care areas of the vehicle. Furthermore, you also have to look at the type of collision. I'm not sure about crash-testing of the medium-duty chassis, but the light-duty chassis being used currently has been crash-tested. So, for a crash involving the cab part of a Type 3 should be pretty much the same as a Type 2. It's probably debatable as to whether a Type 1 is "safer" than a Type 2 or 3. In a typical front end collision, the "safety" aspect of the pt care area should be limited to how equipment and occupants are or are not secured in conjunction with some aspects of the interior layout since the box isn't taking a direct hit. The "strength" of the patient care area will be tested in situations where it takes the direct hit or in a rollover. I would suspect that a box is going to hold up better than a Type 2 in a rollover situation since the top of a Type 2 is fiberglass and would probably be more likely to be compromised. I know for sure that Horton has been doing crash testing on their patient modules for quite some time now. A brief search of the web revealed that most of the major manufacturers also perform crash testing to some extent. I would certainly agree that there should be some universal crash worthiness standards for ambulances and I think we're headed there. We'll see how long it takes.

Maybe they aren't finished getting everybody trained to do this? Maybe there was some other circumstance that caused them to deviate from doing that? Maybe they did it in training and decided afterwards against doing it that way?

If you really think about it, a lot of what we do, particularly at the ALS level for most patients is not truly driven by medical benefit, but fear of litigation and/or the rare chance that a stable patient might "crash" for essentially an unknown reason. I've started countless IVs over the years for really no reason other than the protocol says I have to and the ER nurses will get pissy if I don't do it. I've had to board far too many patients just because. Fortunately my state modified our immobilization protocols a few years ago to allow for more provider discretion and common sense in deciding who gets boarded and who does not. For the most part, if the patient doesn't have pain and a significant mechanism isn't involved we can avoid boarding them. Very helpful for the elderly "hatchbacks" that take a minor stumble.

I put far more stock in what a person's comments are than whether or not they are "anonymous" on a forum since it's so easy to create a false profile. It doesn't take long to figure out who the posers and pot stirers are by their own comments.

I kind of subscribe to a couple lines of thoughts on this matter. 1) If I'm not posting offensive comments or causing problems, then my actual identity is largely irrelevant for others to assess the validity of my comments. 2) My comments are my own and not specifically reflective of my department, with the exception of explaining how we operate. So, knowing specifically where I work is largely irrelevant. 3) If a person really, really wants to know specifically who I am, they can always ask. 4) What's the guarantee to other forum members that the information I might list in a profile/signature is the truth?

Why is that? He could easily get to the point of needing one, but I'm not seeing anything in the initial post to support the need for a tube.

I don't think there's enough information provided to draw any definitive conclusion. One of the most crucial pieces of missing information for this patient is the lung sounds. The 12-lead is going to be important too. Based solely on the info provided so far, I'd be looking at a respiratory cause since pursed lips and accessory muscle use are typically signs of a respiratory problem. I'd also be suspicious of additional medical history not revealed, specifically COPD or CHF. Knowing the patient's meds could reveal that. Skin color/condition, temperature and blood sugar level would be helpful too. Based on my local treatment protocols: If the patient has wheezes present and/or there's reason to suspect a history of respiratory problems, then I'd likely start with an albuterol treatment and see what effect that has. If the lungs are clear, then I'd suspect that his condition is either cardiac related or cancer related. The 12-lead EKG might be able to help sort that out. I'd start a NS bolus and re-evaluate. If that doesn't improve the BP, then Dopamine might be in order if I'm thinking cardiogenic shock, but given the additional information about "failure to thrive", it's more than likely not going to be cardiogenic shock. If it appears that there is fluid in the lungs, then depending on the level of respiratory distress, I may just give O2 or start CPAP.

I don't think you have the experience or the information necessary to make the assertion that you are.