ckroll

Thank you, spell check failed me. I'd hate to run afoul of forum decorum.

Indeed it was and that is exactly point. While volunteers may have a more extended shorts season and as a rule less attractive gams, the original point inferred that on scene attire contributed to the quality of firefighting. As someone who once helped mount a courageous attack on a chimney fire in hip boots and a mini skirt, how you look on a ladder is not so important as what you do when you get there. Now, I've got to know. Do the career FF's lotion their legs? Is it OSHA approved or is that an NFPA standard? Not something oil based, obviously. What are the favorite products? Finally this thread has gotten serious about stuff that matters.

I was going to say.... they wear shorts in Peekskill in the summer. Great looking legs, I might add. Acrimony aside, money talks, or at least it should. It is no mystery what paid or volunteer departments have as budgets. In tough economic times it is up to the mayors and supervisors and town boards to get each municipality the best value for its money. If that is a paid service then so be it. If that is volunteer service, so be it. There are economies of scale in high density areas that do not apply to lower density suburbs and semi rural communities. Where there are a significant number of multiple story commercial buildings and a tax base to support it and a high call volume, then paid or part paid makes financial sense. Where districts run to 80 square miles and have 5000 households, not so much. If there were vast differences in quality of service town to town, I think that would have made the news, or at the very least be reflected in insurance rates. Does anyone know if insurance rates are markedly lower in 'uniform' districts versus those served by 'knuckleheads'? All of which has nothing to do with the benefits of being a 'knucklehead'. If this a fishing expedition, then yes, there are some lunkers out there. Volunteer departments get away with what they can get away with...... as do paid departments. Arguing which pig has its nose deeper in the pubic trough is just laughable.

Full Article in LA Times

This may be an old horse, but I think it's got legs. There is a good piece from the Wall Street Journal that addresses the issue. http://blogs.wsj.com/law/2008/12/19/good-s...y-for-rescuers/ If correct, as descended from English common law, there is no obligation in the US to rescue. Hence, there is liability if one chooses to rescue. What a good samaritan law covers is highly debatable. California law states in part: 1799.102. No person who in good faith, and not for compensation, renders emergency care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission. The scene of an emergency shall not include emergency departments and other places where medical care is usually offered. The ruling of the majority that a civilian rendering non-medical aid is not protected in the California case has been supported by a number of learned individuals on the grounds that good samaritan law is intended to provide immunity for trained professionals who stop to render medical help. New York law is at least as restrictive in its language. "...any person who voluntarily and without expectation of monetary compensation renders first aid or emergency treatment at the scene of an accident or other emergency outside a hospital, doctor's office or any other place having proper and necessary medical equipment, to a person who is unconscious, ill, or injured, shall not be liable for damages for injuries alleged to have been sustained by such person or for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such emergency treatment unless it is established that such injuries were or such death was caused by gross negligence on the part of such person...." There is chatter on legal sites, so this decision is being followed by legal professionals. I wonder how much protection even a volunteer fire department...who does not field a rescue squad... would have. While I do not agree with the interpretation that good samaritan means medical aid rendered by medically trained people, it could well be that judges in New York could come to the same conclusions as those in California. It would be great to get lawyers familiar with NYS law to weigh in on this. We all have family and friends, who are not professioinals, that would without hesitation, stop to help at an emergency. What protection does NYS offer them if they do?

From the New York Times www.nytimes.com Opinion Editorial I’ll Have to Call My Lawyer Published: January 2, 2009 “Good Samaritan” laws give legal protection to bystanders who courageously come to the aid of people in emergencies. Last month, the California Supreme Court gave its state law a disturbingly narrow interpretation that could discourage future good Samaritans from providing help out of fear of being sued. The ruling came after the victim of a car crash sued her would-be rescuer for negligence. On Halloween night in 2004 the car in which Alexandra Van Horn was riding crashed into a light pole. When her co-worker, Lisa Torti, who was in another car, saw the accident, she rushed over to help. Worried that the wrecked car would catch fire or blow up, Ms. Torti lifted Ms. Van Horn out of the front passenger seat. Ms. Van Horn, who ended up being paralyzed, sued, contending that Ms. Torti’s negligence in moving her caused her paralysis. In her defense, Ms. Torti invoked California’s good Samaritan law. All 50 states have laws of this kind, but the protection they offer varies. By a 4-to-3 vote, the California Supreme Court ruled that the state’s law did not give Ms. Torti immunity from liability because it applies only to people who offer medical help. The justices in the majority relied heavily on the fact that the California good Samaritan law is included in the part of the state’s laws that covers emergency medical services. The dissenters, however, had the better argument. As they noted, by its plain language, the California law — which speaks generally of “emergency care” — should apply to both medical and nonmedical help. The implications of the ruling are disturbing. When people see an accident, the law should not discourage them from offering the best help they can. Now, however, Californians will have reason to hesitate. If they offer nonmedical help — like pulling someone out of a burning house, or rescuing a drowning person — they may be putting their life savings at risk. California’s Legislature should rewrite the law to make clear that anyone who makes a good-faith effort to help in an emergency, and acts reasonably, is protected. Other states should examine their own good Samaritan laws and see that they do not discourage well-meaning bystanders from aiding people in harm’s way.

Well said Tanker 10Eng. I volunteer and I'm paid. I'm not sure we should limit the topic to benefits of being a volunteer. We do everything for a reason, be it love, money, power. One person works Fire/EMS and gets paid. Another does it for the big, red trucks and the sound of a siren. Another does it because a loss has touched them personally and they want to make a difference and give back. We do what we do because it makes us feel good. It buys groceries or it gives us a sense of meaning in our lives. And maybe it does all those things. I will hazard a guess that there is not a vollie out there that does it for the meal at the end of the meeting or the shiny blue jacket. I will also hazard a guess that not many paid Fire/EMS are in it for the money alone, as there are a lot of easier jobs that pay more. 20 years ago I made almost as much as I'm making now as a paramedic being a contractor for IBM. If I'm working for half what I could be making does that make me paid or part volunteer? The major benefit of Fire/EMS, irrespective of compensation, is how you feel at the end of a day. Jackets, LOSAP, golf outings, even the pay check aren't the reason that any of us get up in the morning and put on a uniform.

It's a very good question. The overarching legal principles ATTMBRRIAC [as told to me by riff raff inhabiting ambulance corps] and confirmed by searching it on the internet are the 'borrowed servant' and 'captain of the ship' doctrines. An injured party has the right to sue someone. The law recognizes that to be the 'someone in charge'. In EMS the 'someone in charge' will be the person of highest training whose name is on a Care Report. The person who accompanies a patient to the hospital and is listed on the report is the person who is responsible for the care rendered to the patient up to that point. If a paramedic asks a trained parrot [not EMS trained, obviously] to put a collar on a patient, the quality of the collaring will be considered the work of the paramedic. So, what a person can do [ i.e. collaring] is up to the person whose responsibility it is to provide care and their level of training. As I practice it, NO, not anyone can hold stabilization. A person who holds stabilization for a patient for whom I am responsible needs to be trained in holding stabilization. If I am turning a call over to BLS, then it is up to BLS how they want a patient packaged/handled. In an emergency..... and it's always an emergency, it's why we're there.... someone has to balance quality of care with the need for timely care. Skills may end up getting performed by individuals who lack standing, but only if it is at the behest of someone who does have standing and asks the person to perform the skill and consequently takes responsibility for it.

General Municipal Law Article 11-AA 219 f. section 10. Payment of a service award shall not impair any rights of volunteer ambulance workers under the volunteer ambulance workers' benefit law or any other law. I would take this to mean immunity from liability is not impaired by a service award, don't know about getting municipal health care. From Article 30 Section 3001. Definitions. As used in this article, unless the context otherwise requires: 1. "Emergency medical service" means initial emergency medical assistance including, but not limited to, the treatment of trauma, burns, respiratory, circulatory and obstetrical emergencies. 2. "Ambulance service" means an individual, partnership, association, corporation, municipality or any legal or public entity or subdivision thereof engaged in providing emergency medical care and the transportation of sick or injured persons bymotor vehicle, aircraft or other forms of transportation to, from, or between general hospitals or other health care facilities. 3. "Voluntary ambulance service" means an ambulance service (i) operating not for pecuniary profit or financial gain, and (ii) no part of the assets or income of which is distributable to, or ensures to the benefit of, its members, directors or officers except to the extent permitted under this article. This I take to exclude paid EMS from the Article 30 immunity clause. BINAL [ but I'm not a lawyer]

I guess we're all in the same church, different pews..... the way it was explained to me is all I've got. As explained to me by the riff raff that hang out in ambulance corps, the wording 'without expectation of monetary compensation.' was interpreted to mean a jacket or a coffee mug or batch of brownies did not cross the line and that the legislation was phrased that way to allow gifts but not salaries. As I recall, my volunteer corps had some heated debates with respect to buying jackets for members and then over LOSAP and a lawyer was approached for interpretation. There may be opinions of the comptroller and I will hunt that, but it takes time. Even that said, a law means what it means. Obviously one lawyer can argue it does and another argue that it doesn't and it is up to a court to make that determination. Until Thursday I thought a passerby could pull a person out of a car, but I don't anymore.

To clarify the clarification, yes Article 30 applies to everyone, but the immunity from liability clause only applies to volunteers. Any compensation denies the provider protection from this law.

Section 3013. Immunity From Liability. 1. Notwithstanding any inconsistent provision of any general, special or local law, a voluntary ambulance service or voluntary advanced life support first response service described in section three thousand one of this article and any member thereof who is a certified first responder, an emergency medical technician, an advanced emergency medical technician or a person acting under the direction of an emergency medical technician or advanced emergency medical technician and who voluntarily and without the expectation of monetary compensation renders medical assistance in an emergency to a person who is unconscious, ill or injured shall not be liable for damages for injuries alleged to have been sustained by such person or for damages for the death of such person alleged to have occurred by reason of an act or omission in the rendering of such medical assistance in an emergency unless it is established that such injuries were or such death was caused by gross negligence on the part of such certified first responder, emergency medical technician or advanced emergency medical technician or person acting under the direction of an emergency medical technician or advanced emergency medical technician.......... That's from Article 30. What law protects the general public? New York State may have legislation outside Article 30 that protects civilians. If anyone can quote it, that would be great. I am additionally concerned if what 'protects' fire service is the borrowed servant doctrine and their actions are considered as mine, then I need to be careful who moves/packages patients for which I will bear ultimate responsibility. The biblical reference is excellent, but I do not know how much weight that carries in a court of law.

I was fascinated that a distinction was made in California between extrication and medical care. It caused me to reread New York Law with fresh eyes. It had somehow escaped me that good samaritan only applies to medically trained individuals responding to a medical emergency. How does that affect fire/rescue? If one is a CFR, then there is coverage, but if one is not a CFR or better, then how might extrication with injury play out? I was working out of the hospital a few weeks ago when a patient came in improperly boarded and collared. The EMS crew's response was that the fire fighters had pulled them from the vehicle and onto the board. The person wasn't seriously injured, so the point there is mute, but fire does not formally train to package patients for removal from a vehicle. If the California interpretation stands, then we should expect a lawyer sooner rather than later to bring the idea East.

Never done a delivery have you? That's not an approach, that's a quote from 'mom'. There are almost no reasons to approach or expose a patient's genitals in the prehospital environment. In the rare event that one does find the need, the same rules apply that apply to every time we touch a patient. "I need to......., may I........."? Be it an IV or a blood pressure, the only time we have permission to touch a patient in any capacity without express permission is if they are unconscious. As for the 'popular' press, ignore it and do your job.

The call was for a diabetic emergency, see the officer. Leaning against the patrol car, was a 40ish male, wearing a James Dean leather jacket, hair slicked back and John Lennon sunglasses even though it was quite cloudy...very cool looking dude.... except for the blue rubber ducky pajama bottoms and fuzzy slippers. He is agitated, waiting for a film crew, when he spotted the snipers on the top of the nearby building. He is not the crazy one here and he is upset that we don't see the danger. He is diabetic, but it is no surprise that his blood sugar is fine. He wants to know where his film crew is, he is angry we won't help him. He will NOT get in an ambulance and then he pushes the officer. This is not a moment of which I am at all proud and I am lucky that the details were lost. The words were out of my mouth before I even thought about it. I turned to the fellow and yelled back, 'Of course the film crew isn't here, it's Tuesday.' He asked me what I meant and I said that they filmed at Putnam Hospital on Tuesdays, he could find them there. He said he had no way to get there. The very nice officer offered to take him, the fellow got into the patrol car and off they went. Weeks later I run into the officer. He was not diabetic, he was not an EDP. There was a film crew that he was waiting for. He had taken so many over the counter stimulants that he had been up for 5 days and had enough in his system to be up for several more. He was sleep deprived.

Excellent post 50-65. Second, I, too, was bothered by the phrasing "act like EMS". "Act like....." carries with it the connotation of pretense, that one either isn't or doesn't. We 'are' EMS. When following protocols either as a volunteer EMT or paid paramedic, then in the eyes of the law, we are an extension of an MD that is medical control. These are privileges to which certification entitles us so long as we maintain the standard of care. If we do not, we lose the privilege. These are MINIMUM standards and it is up to us, professionally, ethically to bring as much as we can to every patient. Any health care provider who does not cross the threshhold of a home asking him/her self "What is the most I can do to help this person?" is doing a disservice to the patient, to fellow providers, and is missing the opportunity get full enjoyment out of what he/she is doing. Someone noticed once that I had been issued a work shirt that did not have a paramedic patch on it. My reply was that if everyone didn't know I was a paramedic when I walked in, then shame on me. It's not a patch, it's who I am. If one takes pride in the profession, then it stings when fellow providers fail, it stings when bystanders and family accuse us of having no conscience, it stings when we lose faith in each other. Someone noted that the difference between a doctor and a medic was what took a doctor 8 years education, 2 hours with a patient, three blood tests and an Xray to do, a medic could do in 30 seconds. [in context they were making fun of medics.] And sometimes we get it wrong. It's important that when we get it wrong that it's for good reasons, not that we didn't care enough to get it right.

There is a wonderful book by Stephen Batchelor, Buddhism without Belief. It's short. He brings up the topic of Agnosticism and makes the point that " I don't know." Is a very good answer to many questions. Most of the time we don't know. It is an honorable way to live one's life. Not to be ignorant or not to care, but to admit that there are things we do not know. If the thing is important, then we need to know, if it is not, then we don't. We don't need to guess. In so many threads I read people who have good hearts, who obviously care about doing the 'right thing' that jump to conclusions. This is horrible, this is great. But their emotional response is based on nothing but rumor, an "I've heard..." or "they say". It is a worthy cause that good should be rewarded and bad expunged, but please, patience. Do not assume the worst, do not assume the best. With our patients, with our fellow providers, take the time. Be in the moment, the future will reveal itself. Franz Kafka, along with writing a number of fairly disturbing short stories, also wrote a list of 104 aphorisms. This is my favorite: Franz Kafka You do not need to leave your room. Remain sitting at your table and listen. Do not even listen, simply wait, be quiet, still and solitary. The world will freely offer itself to you to be unmasked, it has no choice, it will roll in ecstasy at your feet.

asked to prove they're expecting??? I hope he had a warrant before he did the pelvic exam. The best question is..."Do you want a boy or a girl?" If the answer runs along the lines of..."Well, we've got a boy so a girl would be nice..." this is not an emergency. If the answer is a stern " I WANT IT OUT" well that woman is about to have a baby, and unless you want to deliver it, this is not the time to write a ticket.

I just read the Washington DC paramedic protocols, at least the pertinent sections. They have a remarkably complex and thorough procedure for any RMA and any call of an ALS nature needs to be RMA AMA. Supervisors need to be contacted as well. So this should be pretty straight forward. If the patient was properly RMA'd there should be a significant trail. If the patient was not properly RMA'd then the burden of proof for EMS becomes overwhelming.

You need to present some evidence to back up that allegation.

We had one years ago where a dad was doing 100 mph on the Taconic for broken water, refused to go to the closest hospital when the ambulance came and insisted we take them to Columbia Presbyterian. The cop wrote a ticket on the grounds that if they didn't need the closest hospital it wasn't an emergency. Like doing 100 on the TSP isn't child abuse....

What a remarkable amount of anger here. I have to ask why the rush to condemn providers when so little is known about what happened? There is a follow on story indicating there may be two sides to events. It bears noting that family members who do not use particularly sophisticated grammar also refer to failure to follow protocols...... as if someone else is guiding this situation towards litigation. Given that events described by distraught family are so egregiously criminal, I think we owe it to our fellow providers to withhold judgment until emotions have ebbed and an investigation is complete. Apparently there were 6 firefighters including a paramedic on scene for 25 minutes... and the family was capable of taking the victim to the hospital themselves. Many things contributed to this man's untimely death and as health care providers we bear the lion's share of responsibility for seeing that all patients of concern seek definitive care, no one questions that. That said, launching a tirade against any and all EMS on wild speculation is inappropriate.

Lots to talk about here. None of us know what happened on scene. The EMT did not kill the patient, the heart attack did. EMTs of any flavor do not diagnose, we have 'impressions'. To take the role of devil's advocate....[ and I bet no one knows where the phrase comes from ] Documentation is not the solution; it's transporting the patient. I think whether we are aware of it or not, when we take on the 'keep it covered' attitude that it spills over into the quality of the work we do and the patient and family sense this. Our patients... and by extension the crew.... are best served when we are teaching and practicing patient/assessment skills that focus on getting the patient to definitive care. I am fortunate to work in systems that are not so busy that I can't take time with patients that need it. Any patient with a life threat knows they are in trouble. Chances are they are either angry or in denial. Standing over that person and giving them the "Listen, buddy if don't go you'll die." lecture may be coverage, but you're going to need it because it will only make the patient more intransigent. Consider getting at or below eye level, taking off the gloves for skin to skin contact when holding their hand and letting them know how serious it is and that EMS is not leaving without them. If you believe it, they will. Pull up a chair, put your elbows on the table, let the patient know with what you say and how you present yourself that you will wait them out. Sit on the floor with them. It takes about 10 minutes to wear them down with patience...... in the end, less time than it takes to document, document, document.

Great photograph! So what do we do next? Can every fire/EMS agency draft a plan... even if it only says that someone else will be in charge? Every town has some sort of animal control. Contact them to see what they will do. Contact law enforcement to see what they will do, and get dispatch in the loop as they will often end up as a first contact. What does an SOP say? 1. When determination is made that there is a pet in need of assistance, dispatch and X will be alerted. 2. Pet will be secured in a manner safe to pet and responders. 3. Owner will be asked for information and preference for care. 4. In the event owner is unable to assist in pet triage, pet will ..................? 5. Officer in charge will contact X to confirm that care for pet has been addressed. Contact information: ACO: Emergency Vet: In house emergency contacts: Humane Society: Something like this? In tough economic times it is one more thing to show to government and the residents as something we are doing to deal with other people's emergencies.

This also sounds like an opportunity for patient/pet advocacy. Remember WHALE for car seats? we have a little emergency? Pet owners are the best advocates for their pets and what will happen if the owner is injured is a great question. When I travel, even in a small plane... 'dog is my copilot'. No one would know what to if we couldn't direct them. We have a camp in the Adirondacks and friends with pets, so I had "Visitor" name tags with a local number printed on them on a separate collar so visiting dogs have a local ID. Once a dog that 'never left the sofa' took off and a passerby found her over a mile away staggering at the side of the road exhausted and called the number. I see a need to get vets and emergency services to ask the "What if" question of owners. It would be so helpful if pets had a meds/vet/emergency contact/ sheet at home and for travel. There was a program for noting on doors what pets inside needed to be rescued. Maybe a card holder for crates or leashes that directed rescuers what to do? What about ESART Empire State Animal Rescue Team? They recognize the need to shelter animals in natural disasters so that people will evacuate. That might be an avenue. How about a PET entry in cellphones?