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Please, don't leave EMS out in the cold on this. Ambulance Corps, how do you do it? And heaven forbid we should ever discuss something more than once on this forum.

I had an opportunity to be a BLS 'provider' this last week that may be worth sharing. It happened way out of town at the graveside service for the father of a dear friend. As we were leaving the cemetery, an older gentleman walking with me appeared to lose his balance and slide to the ground. After a few tense moments, that included being shoved by a poorly mannered physician who then did nothing, I made patient contact, sat him up in my lap to keep him off the cold ground. I told him who I was, did a quick check of vitals, a stroke test and established he had no significant history, and then we just chatted and tried to stay warm. By the time an ALS ambulance arrived his color was improved, pulses were strong and he and his family made the decision to refuse immediate care. ALS found nothing wrong with him, we stood him up and he walked back to a waiting car. At the gathering that followed I saw him and his family, and I urged him to tell his physician what had happened when he returned home. He smiled broadly, nodded to his son and said "He knows." The patient, it turns out, also had been a physician and was still teaching at a medical school. After we had a good laugh over the physician who made such a fuss at the cemetery, he hugged me and thanked me for my help. I said, "I didn't actually do anything." To which he replied, "Yes, but you did it well." The message here is that field work, both ALS and BLS has as much to do with people skills as it does with medicine. Just as ALS has as its foundation good BLS, good BLS is built on providers' ability to connect with the patient, to develop a sense for what is going on and to meet the needs of the patient. Part of what has happened to EMS, not just BLS, is that we have let clip boards and toughbooks,--even oxygen tanks and blood pressure cuffs--get between us and our patients. This week I had the chance to be nobody doing nothing, and I had forgotten how much fun that was.

Norman MacLean wrote the telling of the Mann Gulch Fire of 1949. 13 died. It is the seminal event for the fire service and wildland tactics as we know it. If you haven't read it, please, stop everything you are doing and read it now.

Stop. Brush fire 101, you set a backfire to scorch the grass around the truck and save it all. Has no one read Young Men and Fire? It is one of the greatest true stories ever written about fire. Everyone just stop and run to a library now.

My understanding, and someone please correct me if I'm wrong, is that narcan is relatively short acting with respect to some narcotics, the effect being that narcan can wear off and leave the patient yet again in need of resuscutation. If a pt wakes on his own, then the high may be manageable without intervention. It is much the same with diabetics in that those taking insulin with low blood sugart can be turned around with D50 and let go in some circumstances, but those taking oral medications have to be transported because oral meds have longer action and will drive the blood sugar down again.

By that argument, we can't RMA anyone eating a Big Mac. Letting someone die solves our problems, it does not solve the patient's problems. EMS absolutely must leave their personal prejudices at the station door. Our job is to improve outcomes, not to pass judgement. That's a different job that pays much more. As it was described to me many years ago, anyone who has overdosed and has regained consciousness prior to intervention is a candidate for refusal if they so desire. Anyone who has had interventions needs to be seen in an ED. Are we not supposed to titrate the patient back to breathing and airway patency without making them mean and ugly?

As would we all. Point of the discussion is duty to act. The trifecta of negligence is injury, duty to act and malfeasance/nonfeasance. If a person is having an MI and you have been assigned to treat that person, and you never get there because you found something better to do along the way and if care is delayed even 10 minutes and the outcome is poor........ You are going to be explaining to a jury why you DIDN'T do something for that patient. Not responding to a call to which you have been assigned is pretty much the gold standard of nonfeasance.

Then we don't help drunks, or fat people, or people who don't exercise, or who people drive on bald tires or text or pretty much ANYTHING that happens to a teenager. I guess we just deliver babies.... No wait, they did that to themselves, too.

How do other services handle this situation? 1. Does a fire truck stop enroute for a PIAA if it has been assigned to a car fire somewhere else? 2. Does a police officer stop for people in front of a bank that are waving him down if the unit is already assigned to a domestic dispute? The only certain thing about dispatch information is that it will be inaccurate. The weakest link is almost invariably the civilian who panics and calls 911. What makes EMS different from fire and law enforcement, by and large, is that there is more depth, either in numbers of responders or in levels of supervision in the other services. As was brought up on another thread, EMS does not have the luxury of readily available supervision. Long distance triage is problematic but its solution is critical to EMS. Consider another scenario. There is a natural disaster. There are multiiple calls for aid of all kinds over a large area. Do on duty responders start helping people as they find them, or do we handle calls as they are assigned to us? Just going out and doing what feels right is also known as freelancing. When dispatch has assigned a unit, they have every right to assume that the unit is committed. If we in the field start picking and choosing what we handle, it will quickly become chaos.

This is a fine topic, that as far as I have read has not yet been answered. There are separate issues. What does the thoughtful provider do to provide the most help to the most people? And...all else being equal, does the call at hand take precedence over the call pending? It's not being chicken to want to know that. Months ago, I was sent out of district for a PIAA for which dispatch had no additional information. Enroute, but also in that district, I came on a motorcycle into a guide rail, the rider unconscious. No fire, police, ems on scene. Dispatch couldn't tell me if they even knew about the motorcycle yet, they knew nothing about the call to which I was assigned, and when I asked if I should remain on scene or continue to the other PIAA the response was 'I can't tell you that, It's your decision.' [i stayed with the motorcycle on the grounds that whatever the other call was, it was going to be hard to top what I was looking at.] That said, when, as a single provider, one does not know what units are assigned to either call or the severity, how does one make a good decision? Law should be clear at least on the starting point. Is the duty to act for the assigned call, or is the duty to act for the presenting call? We will hopefully all make the best decisions we can case by case, but we also ought to have a clearer basis from which to make that decision.

Oh, you sweet young thing. A good day is when you have at least one option. EMS is remarkably different from the fire service. Every fire has one and frequently multiple officers actively engaged in the response. In EMS, officers are rarely at a scene unless they are crew. For standard calls the crew chief alone is responsible for the response and managing a scene. Even if an officer is on location, he or she does not direct patient care. I've been a captain and can tell you that getting paperwork filed, keeping records up to date, ordering supplies, figuring out why there is oil all over the floor and settling the cat fights does not require extensive training on the uses of a cravat. As one of our finest past captains said, "The corps doesn't need a captain, it needs a mommy." As organizations struggle to provide services, it is often for lack of management, not lack of medical expertise. With so many agencies working with dwindling pools from which to choose members and officers, I think agencies are missing opportunities if we pass over the individuals who may bring needed skills and enthusiasm to the organization.

Perhaps there are two questions here. Should a line officer of an EMS organization have medical training? Yes, they should. Should agencies mandate that their officers be medically trained? I think the answer to that is No. If faced with the choice between a good EMT who is a poor manager and a good manager who was not an EMT, I think I would choose the better manager. It is an option that should be left available to organizations and judged on a case by case basis..... a.k.a. an election. If individuals feel it is that important, they can vote that way, but agencies should not preclude the option by fiat.

. 1. Not many. 2.What the average person does not know about foreign is staggering. The US is a warrior culture. We don't do anything that is not of immediate benefit to us. There are 3 reasons why any country gets aid from us. 1. the country has geographical significance. 2. the country is sitting on vast natural resources we do not have and that we need, or need to control. 3. We want them to buy our stuff. Genocide in Rwanda..... barely makes the news because all they have is dirt and they weren't going to buy our stuff anyway. Iraq invades Kuwait..... now that's a humanitarian tragedy. We send foreign aid so that developing countries will develop in such a way as to buy the things we make. Foreign aid dollars come back many fold in the form of goods and services bought with the money we send. It isn't bleeding hearts who want a TV in every hut in Pongo Pongo...it's US manufacturers.

1 percent of the federal budget goes to foreign aid, compared with 20% for social security and 20% for defense. Large parts of that go to 'developing nations' like Iraq, Afghanistan and Israel. Compared to other world powers, only Japan spends less as a percent of GDP. Right now, our commitment to 'developing nations' is nothing short of embarrassing and in fact, a majority of AMERICANS think foreign aid should be 'cut back' to 10% of our budget, which is about 10 times as much as we currently spend. Out of pocket it's something like $50 per household. Am I willing to give up one dinner out a year so some third worlders can have clean water and a school for their kids? I wish I were giving up one dinner a month.

From 11-01: "Please note that VTL §1194 is permissive. This means that an AEMT (Intermediate, Critical Care and Paramedic), is authorized to legally obtain a blood sample at the request of a police officer for the purpose of alcohol/drug screening, but the AEMT is not mandated to perform the procedure. When the AEMT is acting pursuant to a request by a police officer relying on VTL §1194, the AEMT is acting independent of physician or medical control oversight. A patient/care-provider relationship between the AEMT and the person from whom the blood sample is to be taken does not exist. Consequently, it is important for AEMTs intending to act pursuant to VTL §1194 to prepare for such law enforcement requests. This policy is intended to assist AEMTs and EMS agencies in planning with respect to this law, but should not be considered complete and exclusive guidance." [emphasis mine] Actually, it offers no guidance whatsoever. AEMTs will not be under any medical supervision, which I must assume means that they will not be operating under agency protection and I cannot imagine that personal insurance or good samaritan law will offer any protection. I am alarmed at the possibilities for this to go wrong, not to mention the ethical quicksand of engaging in activity that can only serve to harm the patient. Topic for discussion, anyone? I am preparing for the request by planning to answer "No."

My apologies, I missed it. Could you direct me to the thread as I can't find it. Thanks

I am thankful everyone is OK. 'Just' being thankful isn't sufficient for those of us in emergency services. If the helicopter was in fact operating 20 feet from a rock face in high wind and dark, it was nothing short of a miracle that the rescue was successful. When we ask brothers and sisters in arms to risk their lives, we should do so knowing that all other options have been exhausted. It sounds like it was a spectacular rescue. The question is was it a necessary rescue?

Yes, I read a news article. Severe weather and time of night were two of the reasons that any option other than helicopter made sense to me. If they rappelled down, look for a rope tied to a tree and see if there's weight on it. I'd look there. Yes, I can ascend in sub freezing temperatures, it's not rocket science. These are West Point cadets, no? I wouldn't expect a weekend hiker to do it, but ability to function after 8 hours in harsh conditions seems reasonable for a warrior in training.

My favorite is the Texas loveknot with a cravat. Never fails. It is pre-tied and can be put on your own wrist; hold hands with the patient and slide it on. Of primary importance is to have a system that works for you, know where you will attach it to a stretcher, and practice....because you shouldn't be needing it more often than once a year. I'm not a fan of medication because psychiatric emergencies should be talked down and pharmaceutical emergencies.. well I don't know how more drugs will interact with those already on board. And duct tape! Let us not forget duct tape.

Why did this happen? OK, obviously because the cadet's ropes did not reach the ground. Anyone competent to rappel knows not to rappel down farther than one can free climb back up with ascenders. If I had gotten myself in that position with my high angle rescue team, I swear they would have left me there. Much faster, cheaper, and infinitely safer would have been to lower the cadets 2 pairs of ascenders or have one rescuer rappel down, give them a 10 minute lesson and assist them ascending back up. Or drop them a rope that reached a point of safety and switch over? Unless there is more to the story than has been printed [and that's never happened] it appears that vast expense and unreasonable risk were assumed for a situation that had faster, easier, safer solutions.

Curious indeed, especially given that Mayor Bloomberg doesn't live there.

Congratulations. New EMT's deserve a point. It's only the beginning. Certification is the piece of paper that lets you turn lessons into a craft. Never stop learning and never stop asking questions. Keep an open heart and an open mind. Best wishes on the beginning of a spectacular experience. Make us proud.

Accuweather has it at 3.4 inches, and no offense boys, but this girl isn't going to get excited over 3 inches.

Answers, no. but sympathy, yes. It was...22 years ago.... and yet I still remember the wait, it is unbearable. Instant scoring is no better, the print out for my medic being the longest 2 minutes of my life. All I can say is anyone who goes the distance and finishes EMT is a hero in my book. Trust me, you passed. If you didn't, then you practice and test again. At your tender age you still have a lifetime of community service ahead of you. Another week or two won't kill you.. but I know it feels like it will. Deep breath, you're going to be fine.

Caliifornia does not offer 'good samaritan' protection to untrained individuals, if memory serves. Wasn't a civilian held responsible for pulling a friend out of a vehicle when the result was permananet injury? Good samaritan is sometimes interpreted as off duty people who have training using that training without anticipation of compensation. Until the issue is litigated, one does not know how a court will interpret it. See Van Horn vs Torti. I believe PA is quite restrictive. I wouldn't help my own mother at the side of the road in PA. HIPAA is the acronym for Health Insurance Portability and Accountability Act. Its privacy components are secondary to the purpose of improving electronic access to medical records. There is a lot of disinformation about HIPAA, much of it promulgated by a certain law firm.... who also misspells it... and may be profiting from undue hysteria. For a quick easy reference, wikipedia has accurate information on both topics. Here's an idea for a new forum: Really? and What ever happened? We get these stories.... 'california woman sued' or ' off duty EMS lets person die' then we talk about it for a week and never go back. Maybe we should go back and see how some of these stories that do affect us turn out. We could also use some fact checking on the legal points. For now, I'll stick with the bird watching app.