JJB531

Sometimes the Boy car (or Adam car for that matter) may be assigned to another detail (warrant service, etc.) that you won't hear over the radio. Each REP is basically responsible for a part of the borough (patrol borough that is, Squad 1 is assigned to Patrol Borough Manhattan South). Typically there will be an adam and boy car.... although 1-Truck will turn out a Charlie car quite often.

REP's will be assigned multiple jobs within their sector as the jobs come up. Typically they'll switch over to the division's frequency and ascertain from Division whether or not they are needed to respond. Certain jobs, like EDP's, are automatic dispatch for ESU. If a precinct sector determines that there is no need for ESU, the sector will cancel them. Then they will move onto the next job. 54 Rescues are also automatic dispatch for ESU. ESU will switch over to that divisions frequency and determine if they are still needed to respond. Alot of the jobs in NYC are unconfirmed... if ESU gets a specific request from a precinct sector, or the job comes over as confirmed, they'll typically handle the more serious or confirmed jobs before going to something like an evidence search or a non-priority. 54 Rescues are people stuck in elevators, an aided down in an apartment who can't get to the door... and you'll also hear 54 Water Rescue, which is pretty self explanatory.

This appears very true. VAC's, typically being a busier entity then VFD's, do see more wear and tear on their rigs, are constantly replacing supplies, constantly paying for gas, and now even paying EMT salaries to ensure that their rigs get out the door when the tones drop. While I'm not very in tune into tax districts, maybe BNechis or someone who is knowledgeable on this topic can justify or dispute the claim that VFD's disproportionately receive more funding from a town than a VAC does.

Well at least I can make someone chuckle Oneeyed... but you are absolutely right, PRIDE is what EMS needs. Why is there a general lack of it? I don't know. Maybe because a lot of people involved in EMS know that they are just using it as a stepping stone to get onto a PD or FD, and know that they're not a "lifer". If you're not going to commit to something as a career (from the paid standpoint), perhaps some won't put forth the effort to improve it. The majority of the great paramedics I've had the pleasure of working with have all moved onto PD or FD jobs or moved onto careers in nursing. I think there is an inherent sense of pride within the Law Enforcement and Fire Department communities. Wearing a uniform that you know so many others have died wearing while fighting for a COMMON cause (whether it's fighting criminal activity or fighting fire), the way you are viewed by the public as a professional, the fact that you belong to a regimented organization that has standards (haha, can't really say that for the NYPD lately, but that's a different topic), all instills a sense of pride. I think a lot of my comparisons come from comparing my career as a paramedic to my career as a police officer. When I graduated medic school, we celebrated in a South of the Border restaurant. When I graduated the police academy, I was in my dress blues with an actual ceremony. Did I feel a sense of pride graduating medic school... not really. I felt pretty drunk, that was about it. Did I feel a sense of pride graduating the police academy... absolutely. Because of the atmosphere that surrounded the whole event. Even now, when I put on my medic uniform, as crisp and clean as it might be, people aren't interested in talking to me. People only want to talk to me when they are either sick or need directions. But when I put on my uniform for the police department, people are drawn to that. They want to ask you questions, take pictures with you, and so on. That kind of interaction with the public does instill a sense of pride in a person, and that's interaction that very few people in EMS get to experience. This even goes back to what I had previously mentioned. I know when Westchester County has medal day for it's law enforcement officers, officers from all over the county gather at the County Center for a nice ceremony, everyone is in their dress blues, the media is there, and they are honored for their achievements, heroism, and service. When Westchester honors its EMS personnel, its done at Playland, with cheeseburgers and keg beer while everyone mulls around in shorts and t-shirts. I'm not knocking the gesture because it is a genuinely nice one, but which of these do you think is going to instill more pride in a person?

I agree that a volunteer shouldn't walk around all day in a uniform, but are you saying that it's professional to show up at a job in sneakers, jeans and a t-shirt? Even if it's a t-shirt that has your agency name on it? I sure don't. The uniform itself is both and identifier and a way of setting a professional public image. I wish more volunteer agencies would consider jumpsuits that they can put on over their daily dress attire so at least they look uniform. Agreed that you don't need 40 year vets to start pressuring people. But as I stated before, the way things are in EMS right now, this is the accepted way things have been for 30 years. There is such a shortage in EMS, especially in the volunteer sector, that alot of agencies won't say "this is how you will do it if you want to continue with us". They don't want to lose the volunteer personnel they have, and a lot of volunteer agencies are very against hiring or contracting out paid personnel. As it is right now, a lot of agencies (paid and volunteer) can not eliminate people because there is not enough manpower to cover the tours! I'm sorry that you feel this stuff is crap, but I can't say that I do. This discussion was about why EMS is at a different level than FD and PD. Go to any public function, look at members of an FD all in their Class A's. Look at Police Officers in their Class A's. They all look sharp, uniform, and sometimes wearing those Class A's gives off a sense of pride. Then look at the EMS guys. 3 different styles of BDU's, all different shades of blue. A duty uniform shirt with a ketchup stain from last night's meal. Duty boots, all scuffed up, instead of patent leathers. Maybe a few people here and there wearing an agency baseball cap, instead of a dress 8 point or round top. Now imagine how that looks in the eyes of the public. If you want to be treated as professionals, you have to set a professional image. The majority of the public has no idea what we do, until they need us, and with the expection of the occasional frequent flyer, we only get ONE chance to make an impression on someone. That's it.

I understand what you are saying, and I do agree to an extent. I guess the only points that I can respond to this are: In terms of uniform appearance, members of a VFD respond to calls in bunker gear. They're not required to wear a uniform, their bunker gear is their uniform, and although I was never a volunteer firemen, I know their boots don't have laces to tie and I think it would be a little tough to tuck their turnout coat into their bunker pants VFD's have been around for considerably longer that VAC's have. Typically from what I have seen there is a decent amount of pride and tradition associated with being a volunteer firemen (or a career one for that matter). EMS still being fairly young, doesn't have that same long line of pride and tradition that you see associated with a VFD. Do I think this is a poor excuse? Absolutely. It's not uncommon to see people volunteer at a VFD for 50 or 60 years. With a lot of VAC's the turnover is so high, sometimes you're lucky to get a few years out of someone. That leaves few senior people out there to set the standard, and the standard that a lot of them were taught was that it was okay to go to calls in jeans and a tank top, because that's what's always been done. This standard ends up being passed down from one generation of leadership to the next. I agree that the people in charge and senior members have to set the standard.... absolutely. But the way things are now in terms of uniforms and etiquette is what many believe the standard is simply because they don't know any better!! Dress uniforms for EMS is one thing that has always been a pet peeve of mine. I've been struggling to get the agency that I work for to adopt a dress uniform for parades and public events. It's just something that for whatever reason EMS has not adopted yet in this area. EMS, also being a busier entity than fire, even at the volunteer level, leads to increased burnout amongst providers, especially volunteer providers who dedicate so much of their personal time that sometimes it can be too much (almost like a second job). Burnout leads to sloppiness. Along with the tradition concept that I mentioned before, from the little that I do know, I believe alot of VFD's require members to participate in house duties where apparatus are washed quite routinely. I know where I work, our agency runs approximately 2,300 jobs last year, meaning that ambulance is going out the door on average 6 or 7 times a day. The local VFD did about 480 runs last year. Only going out once or twice a day, obviously your apparatus are going to have a better appearance. Once again, not an excuse, but just something to throw out there.

I was gonna ask the same thing.... blood pressure comparison between right and left arms?

I absolutely agree that sloppy appearances and poor attitudes are not the products of EMT/medic schools.... but I think that it partly does stem from lack of discipline while in the training stage. For example, when new recruits enter the police academy or fire academy, what would happen if they showed up to their academy class with a dissheveled uniform or unshaven? They would be running laps until they pass out. Their uniforms are expected to be clean and pressed, they are to be properly groomed (haircut, clean shaven, etc.), and so on. This is how police and fire academies promote professionalism and a professional appearance, from the first day of the academy. I could show up at my EMT or medic class wearing sandals, shorts, a tank top, and it's perfectly acceptable. You can't build a house without a strong foundation, and I just don't think that EMS programs really build that strong foundation. They may turn out some good or even great EMT's and Paramedics here and there, but they do not instill any type of discipline, and there are some people out there who need it. So what happens, students graduate and then go to their respective agencies with the mindset that it's okay to go out on jobs in shorts and a tank top, and unless the agency follows a strict uniform code (which most of them don't, and now we can start to shift the blame to the agency), the EMS community will continue to be viewed the way it is now in the eyes of the public. Then again we are talking about grown adults who are State certified medical providers. An agency shouldn't have to tell them to tuck in their shirt, shine your boots, shave, or even take a shower for that matter. I'm not blaming EMS instructors or any programs out there, because this is just the way it is. I also understand that you can't have EMT or medic students out there running laps, but I think if EMS providers were trained in an Academy-like atmosphere, maybe we would be turning out providers who did have a little more discipline than what we're seeing now.

I wish there was ways I could single-handedly create regional improvement, but I do what I can. I'm sure it's been said here before, and I think you even addressed it, that EMS in this area as a whole needs to step up to the plate in order for regional changes to take place. More people need to get involved, more people need to attend meetings, more people need to have the desire to work towards change. I'm not trying to bash the MAC or WREMSCO or Advisory Committee... they do what they can do. Do I wish they could do more, absolutely. I think that there are some very dedicated individuals there who are already overworked and they too can only do so much. This is why I suggested maybe some form of Association made up of regional providers who are willing to take the time to assist the MAC and WREMSCO. Similiar to how there are law enforcement associations (i.e. NTOA, NYS Tactical Officers Association, etc.) who promote training and provide discounted or free training to it's members, they improve view of the service in the eyes of the public, etc. Another example is while it may be difficult for an individual agency to train, equip, and maintain an Honor Guard for LOD deaths or active-duty deaths of members, perhaps an association could pool resources to have a county-wide honor guard that can do funerals for EMS personnel or other functions. I'm just using these as examples from looking at what types of details are typically seen with Police and Fire. If providers want to bring EMS up to the level that FD and PD are, I think that this might be a start. While the whole system does need serious overhaul, I think that any improvements that we could start now would be a step in the right direction. To improve the way we're seen by not just the public, but also how we are perceived by members of other emergency services.

I don't necessarily think that the EMT program itself is inadequate. I would like to see EMT students spending more time doing field rotation hours than the 8 or 16 hours they're doing now. My initial comment regarding EMT programs was the fact that there are programs out there that are a little too generous with graduating students. I don't feel I'm improving "my EMS world" (as you put it), because very little of what I do benefits myself. In fact, nothing that I do really benefits myself. The stuff I do within the agency that I work for benefits the agency and the community that we serve... the benefits certainly aren't reflected in my paycheck. You are right, if we already have substandard training, how do we justify extended the scope of practice... I agree 100%. But unfortunately it's been done. Especially at the BLS level with the introduction of albuterol administration. I will not go into specific stories of the number of times I've seen albuterol given to patients clearly in CHF with no ashtma history. I guess when I refer to expanded scope of practice, I'm thinking of all the great paramedics I've had the pleasure of working with, and how this expanded scope could benefit our patients. I've heard rave reviews from other systems on the use of CPAP, and I've seen other agencies that are extremely progressive and are even using field-induced hypothermia of post-cardiac arrest patients. Obviously medicine is not an exact science (just look at how many times the AHA BCLS and ACLS protocols change), and years of studies go into such procedures and protocols. I was informed by my agency that they contacted the WREMSCO for extra slots to this event and were denied. Obviously they could have been blowing smoke up my you know where, so if I am mistaken in my initial statement I will retract it.

So to address a few of your comments to my post. Yes EMS providers must show "competence" in order to pass the state exam... yet so many who graduate are GROSSLY INCOMPETENT. I've seen individuals who have been EMT's for YEARS and still cannot perform an adequate patient assessment or even take a blood pressure for that matter. Just because someone has book smarts to pass a written exam and the cookbook scenarios given during the practical exam, in my opinion, is not enough. EMT students should be doing more time on an ambulance, practicing their skills, until an experienced (and competent) EMT or Paramedic says they are competent to sit for the state exam. Maybe Phelps doesn't push people through the state exam to get their share of money from the state, but there are programs out there that do. What do I do for EMS? I act professional. I make sure my uniforms are always in order. I attend as much training as I can, even if I have to pay for it out of my own pocket. I take as many train-the-trainer courses as I can so I can offer these courses to other EMS providers FREE OF CHARGE. I have taken a very active role in a number of progressive programs the agency I work for provides to the community. I have written articles for trade magazines, and written editorials that have been published in newspapers promoting EMS. I have done numerous public education programs at schools and career fairs. If you would like me to keep going, I'll be happy to PM you my resume and portfolio. I understand nurses and doctors have to pay for ACLS and PALS, but this discussion is how EMS compares to other emergency services. If a police officer wants to get radar qualified, do they have to pay for it out of pocket? If a firefighter wants to take any of the courses offered at the DES, do they have to pay for it out of pocket? NO! So why does an EMS provider have to pay out of pocket for ACLS, PALS, NALS, PHTLS or any of the other courses traditionally available to EMS providers? In case I studdered, yes, I said only a few are permitted to the EMS dinner. Each agency is permitted a certain number of slots. At least that was the reasoning I was given when I was bumped off the list of attendees for the last dinner. With the exception of award recepients, the majority of people attending the dinner are upper level management (Line Officer, Supervisors, Managers, etc.). I would love to attend MAC meetings and Advisory Council meetings, but I unfortunately can not afford to take off of work to attend such things, so I try to make up for it in other ways. I've spoken with regional faculty... I've talked about RSI, CPAP, hemostatic agents, expanded scope of practice for specialized paramedics (i.e. TEMS providers), clearing C-Spines in the field, etc. I'm asking for it, personally, and am still waiting to get it.

This is and issue that has been discussed NUMEROUS times on this site. It makes for good discussion, but as long as we continue to just talk about it, that's all it's going to stay... a good discussion. There are so many problems with EMS that one doesn't know where to start. If we were able to narrow down the problem to one or two things, then it would be considerably easier to possibly correct these things and bring EMS "up to speed" with other parts of the country. There is a considerable shortage of EMS providers, especially experienced providers who are respected practicioners in the field of prehospital emergency medicine. Many of the respected EMT's and Paramedics out there end up leaving the field to further their careers, or leave to join fire or police departments where there is more stability, room for advancement, and opportunity. So what ends up happening? Agencies (paid and volunteer) end up placing individuals, whose ink is still wet on their EMT and Paramedic cards, out there to learn on their own. There is no standard for field training, and many agencies don't even have any type of field training program in place for new EMT's and Paramedics. So do we blame the agency? The same problem is being encountered with EMT and Paramedic Programs. Unlike a Fire or Police Academy, where the goal is to graduate "competent" police officers or firefighters, who will then go to their respective agencies and endure some kind of field training program, EMS programs are about making money. EMS programs receive funding from the State depending on the number of students they graduate. The more students who graduate, the more funding the program receives. So do we blame the program coordinators/instructors? What about EMT's and Paramedics. In any emergency service, there are those individuals who are dedicated and promote professionalism within their respective field. Unfortunately though, in the field of EMS, there is a general lack of self-respect by EMS personnel. Paid personnel (especially in the field of private-for-profit) who walk around shirts untucked, stained, baseball hats on backwards, unnecessary/excessive jewelry... I can go on and on. And volunteer agencies where providers go on calls in jeans, shorts, sandals, tank tops, etc. etc. We should have some self-respect to look in the mirror before we go out in the public's eye, and the agency should be enforcing a dress code. So, are we to blame for our own misery? What about our EMS Advisory Council, Department of Emergency Services, or NYS Bureau of EMS. What do they do for EMS? No training except for the occasional CME topic, protocols that are outdated, having to attend call audits that are, IMHO, a complete waste of my personal time, no public education to promote EMS, the one dinner they do a year to honor EMS where only a few people from each agency are permitted to attend, and the barbecue they do every year at Rye Playland. While it is a nice gesture, I personally think it is a little ridiculous that you're honoring EMS providers for saving a life while people are looking on slobbing down cheesburgers and keg beer. I personally think it's a disgrace. I would rather see our Westchester EMS Region coordinate with the local villages, towns, and cities, and do something in conjuction with the municipalities to honor EMS workers for their service. We have an EMS Advisory Council that is headed up by a Police Chief.... not a Paramedic. I still haven't seen one thing the Advisory Council has done to promote EMS... the last time the minutes on their website were updated was in 2003. So do we blame those who basically have EMS oversight in Westchester County? Is a union the answer... maybe. I wouldn't mind seeing a local association made up of EMS providers to speak on behalf of EMS providers. To go to the media to promote EMS and the things EMS providers do every day. To go to the Council and our Medical Advisory Committee to get the protocols that we want. To unify all of the EMS agencies in Westchester County, to provide training (why should I have to pay 200 dollars out of my own pocket for ACLS and PALS?), to establish standards for field training, maybe establish a county-wide EMS Honor Guard, to set standards for EMS agencies, to learn to work together instead of all the home rule garbage that's out there. I think for EMS to begin to advance, the first thing that has to happen is that EMS providers themselves have to learn to stand and work together. The agency patches may be different, but the State certification patches are all the same.

hahaha, yeah in my 9 years I've learned how to sleep with my eyes open...

I don't feel our profession gives us leeway to do anything "normal people" cannot. We are held to a higher standard, aboslutely. But that means we should be setting a good example for the rest of the "normal people". Not doing whatever we want to do because our professions supposedly entitle us to do it. JM15 posted the NYS VTL regarding the use of mobile phones which covers personal vehicles. Note that it says an emergency situation... that doesn't mean if you're chatting with a co-worker or a superior regarding certain work related issues (i.e. covering a shift, ordering equipment, discussing a job that occurred last night) that you're exempt. Nothing annoys me more when I stop 10 off duty cops, fireman, or paramedics/EMT's a night for various violations. I always show courtesy, but when someone drives past a marked police car blabbing away on the phone and doesn't put it down for those 10 seconds until they get out of sight, is just plain disrespectful. It's an annoyance and a waste of the on-duty police officers time.

New York State is broken up into Medical Advisory Committee regions... in order to practice prehospital medicine in a particular region, EMS providers have to attend a certain number of audits over a period of time. At the audits, an ER physician will pull prehospital care reports and discuss the jobs with the attendees. Discussion is usually geared towards the nature of the call, the care that was given, any positive points, anything that could have been done differently, and sometimes patient outcomes (discharged, admitted, deceased) I personally hate going to them and think they're a huge waste of my personal time... but.... whaddya gonna go...

I was just talking to another medic last night who was interested also in these mega audits... I'm hoping to get all of my audits done by going to three or four of these things...

I certainly would be... I need audits and can't find the time to go to one here and there...

That is very true.... typically I've found that when a Medical Control Doc gets to know you and trusts your skills and/or judgement they'll give you whatever you ask for (within reason obviously)...

All the jobs may be coming up in Adam's sector... hence the reason you only hear them getting assigned jobs...

EMS used to be run by Health and Hospitals.... maybe someone is on the air who used to work for EMS when it was run by H&H can tell us if the working conditions (in terms of the employer, benefits, retirement, etc.) were better, worse, or the same as they are now in NYC...

There are civil service EMS agencies that are still considered a 3rd service... so saying that if EMS was run by a municipal service they would get more respect is not really the case. Look at FDNY EMS. Underpaid, terrible retirement, etc. etc. in comparison to NYC Police Officers and Firefighters (notice I said in comparison, because all are underpaid). Even up in this area, EMS which is run by a municipal service is still relatively treated like a 3rd service. No Line of Duty benefits like the PD, no comp time like the PD, different sick time procedures from the PD, terrible retirement as compared to the PD, it goes on and on... and this is a PD run EMS System! The only benefit is that you're civil service and prone to civil service laws which means they can't just fire you like a private agency can.

In order for an individual to be found guilty (not just arrested, but convicted) of resisting arrest, the initial reason for the arrest has to be an authorized arrest. Whether or not an arrest is authorized is often up to the court system to decide, which is what I stated before. The case will either be dismissed or the prosecutors office will decline to prosecute. It should not be up to the individual to decide whether or not the arrest is authorized. Saying that individuals have the right to resist an unlawful arrest, means that the everyday Joe who doesn't agree with the fact that they are being arrested has the right to fight the police, without any legal basis for their claims that their arrest is unlawful. This is the reason the statute INIT95 posted exists. Suggestions like that are dangerous in a public forum.

A citizen DOES NOT have the right to resist ANY arrest... whether unlawful or not. That's why he have a court system. Subjects of an unlawful arrest will either be found not guilty in court or the prosecutors office will decline to prosecute the case based on the fact that the arrest was unlawful. To suggest that citizens have the right to resist a lawful authority just because they feel the arrest is unlawful is absolutely ridiculous. You know how many times "street lawyers" think they are so well versed in the law and claim that an arrest is a false or unlawful without having the slightest clue what they are talking about. Suggestions like that are what get law enforcement officers hurt.

NYPD ESU is an ALS level agency. Typically individuals in the department who are paramedics who have the opportunity to get assigned to ESU will be assigned with Emergency Service as Tactical Paramedics. Many of these Tactical Medics are assigned to the ESU Apprehension Team (A-Team), which conducts full time warrant service for the department.

They use either... depends how many are assigned to the conditions team and how many vehicles they have assigned to their unit. When I was in conditions we were in unmarked autos until they all got totalled, then we ended up either all in one van or two seperate RMP's. They address "condiditons" within the precinct. Prostitution, disorderly groups, narcotic sales, club enforcement and state liquor authority violations at establishments, trespassing in buildings prone to narcotic sales, etc.