WAS967

To go back to the Narcan discussion, I was just talking to one of the docs the other night. She wondered why I called for her preference on using narcan on an overdose. I told her that while protocol says use it if you suspect it, I know many docs (and QA people) would just use it for the hell of it. Thankfully she agreed with my outlook of not using it and even said, if the patient is breathing and vitals are stable, let em be - you don't want em yacking all over the back of your ambulance and risk having an unstable airway to boot. THIS. Way too many times the only time we hear from people is when they have something to b**** about. Why not call if there is something GOOD to report. One company I work for recently put into the public a form where people (anyone, but mostly other providers) can report back on positive feedback. I dunno if it's been used yet or not (I'd be saddened if it hasn't) but I think it's a step in the right direction. Would be nice to see some thick employee records not because of bad write ups, but good ones.

Reminds me of the guy out west who was hiking/scrambling solo and got his arm stuck between a mountain a boulder. http://www.wsbtv.com/news/2191472/detail.html

Explains where the older pumper (Durdham FD?) on the flatbed trailer in Brewster last night was going.

http://www.prlog.org/10683742-white-plains-hospital-center-adopts-new-capability-to-expedite-treatment-serious-heart-attacks.html

Up next, yet another retarded outcry that games are responsible for the violence in society.

Funding is from the municipalities of Cortlandt, Peekskill, and Buchanan (I'm not sure if Buchanan contributes directly or via town taxes).

Just out of curiosity, what is the effective date of the Yonkers contract and the term (1 year, 3 years, renewals, etc). The idea of Cortlandt Peekskill Paramedics extending coverage to include Yorktown has also been discussed.

Found this while surfing LoHud today. Props to WP for recognizing it's EMS workers. http://www.lohud.com/article/20100527/NEWS02/5270318/1018/NEWS02/TransCare-EMTs-honored-in-White-Plains

Worst case too, if you don't get anywhere with the Albany office, try calling the MARO office which serves the NYC Metro area up to and including the HV region.

The rumor about Yonkers has been around for some time now (since about the time TC trumped MV). Empress is indeed deeply rooted in Yonkers and it would quite an upset if the contract were given to someone else. TC/Alamo was a longtime provider of EMS in Poughkeepsie but that was lost to MLSS. Stranger things have happened so who knows. For now rumors are just that, Rumors. Only time will tell. Admittedly tho, if TC wants to be the "Driving Force" like their motto says, they need to start getting into arenas that other providers are in but they are not yet. Things like tactical EMS, hazmat operations, etc. Agencies like Empress and MLSS have had RSI and CPAP for years yet TC is only starting to get CPAP in some areas. Some could argue that Yonkers going to TC would affect patient care with the lack of RSI and CPAP provision. But that is just one arguing point. Ironically I think the coin was on the other side when Amiodarone first came out. TC was carrying it in NYC and FDNY wasn't (yet) and TC was harping that as a selling point saying they were better. To each their own I guess.

Thats a question for NYS DOH.

How many gallons does a typical residence have for propane storage. I have a 225 (I think) gallon oil tank in my basement (I know it's apples and oranges but it's still volume) and 1000 gallon seems HUGE in comparison.

Hell yeah, I would have lined both patients. Narcan for the first (SLOWLY and in the aforementioned small (0.4mg) doses. Fluids for the lady (making sure she's no going into APE), try to ID the pills, consult with MC and PC, and treat what we can. Did they find out what antidepressents they were? Some ODs, especially psych meds, can be tricky. Related: How many people make use of end tidal capnometry on non-intubated patients? (IE....the nasal detectors). I would likely have used such on both patients as well. EDIT: Oh yeah, don't forget to 12-Lead the lady. EDIT EDIT: To play devil's advocate, there could well have been reasonable explainations on why they had no line in the field. Short TXP times (where did they come from?), difficult vasculature (did they at least TRY?), busy doing other things (BLS before ALS - were they by themselves in the back and getting the basic stuff done and just didn't have time to get the LINE done?), etc etc. But I'm sure in many cases it does come down to laziness which is disturbing.

Sorry if my comment landed too hard - perhaps ranting was the wrong word? But I would indeed call it constructive discussion. Let's continue. On the note regarding IV starts on drug ODs, here's my thoughts as I've had a related call not too long ago. You have a young man who recently relapsed into his heroin addiction....found unresponsive by family (who gave rescue breaths for a brief period) but now conscious and alert but still slightly somnolent (barely if at all - converses well). Patient is nonviolent and cooperative but refuses a line or IM narcan. Transport is uneventful, patient remains awake with good vitals and SPo2. Do you force a line and meds on this patient risking him becoming uncooperative, or do you transport as is and respect his refusal despite his drug abuse in the interest of crew and personal safety.

You'd be surprised how often positive feedback comes back about a medically bad situation. I've seen thank you cards come back from cardiac arrests, fatal car accidents, etc. Remember when you're at a patient's home working an arrest (or any call for that matter), it's just as much about how you treat the family/loved ones as it is about how you treat the patient. I'm not saying to take focus away from the patient care, but tossing a little reassurance, explanation, etc at the family in the process does wonders for overall satisfaction scores.

Bad link, try this one: http://northernwestchester.lohudblogs.com/2010/05/14/firefighter-puts-out-neighbor%E2%80%99s-porch-fire-in-goldens-bridge/

Gotta go with Goose here. Ranting to the masses on here won't get the message to who matters - the people causing the problem. I know if I were the medic on either side of the example, I'd want someone to give me feedback on the care I provided (preferably in a constructive manner). If I gave good care (both medically and psychologically) then let me know I'm doing something right - cause frankly we don't often get to hear from "the other side" about how we affected the outcome of the patient. If I'm being a lazy douche, I'd hope someone would call me on it and set me straight before I do something that would have a negative outcome for the patient (or my career).

Does it have a "super gun" like the one in LA?

I don't believe there is such a thing. Medics for the Cortlandt side of Peekskill Cortlandt Paramedics are actually employees of Hudson Valley Hospital. Medics for LVAC and MEMS are employees of the Town of Mammaroneck Ambulance District as mentioned. I've no idea how they are hired.

3 saves in one year? Nice. Job well done and well deserved.

Okay, now that the dust has settled, the sunburn has likely set in and people are done stuffing their faces with burgers - how did the drill go? Any reports/pictures?

Combination of things. Do they LOOK uncomfortable? Do they rate the pain over 5-6/10? In mnay cases I ASK them - "Do you feel like you need something more for the pain?" If they say yes, then I strongly consider it. And the paperwork to give a narcotic isn't THAT bad (what? a continuation form and having to make some copies for QA? Ha!) and is far better than having to deal with the legal issues should a patient turn around a sue you for neglect because you failed to adequately address their pain.

What about analgesia makes it difficult to evaluate a foot injury? Even the old fashioned mentality of not treating abdominal pain because "the surgeon will need to evaluate them and analgesia will mask the pain" is right out the window. I'm not saying we need to jump right on the Morphine (or Fentanyl if you are lucky enough to have it - Albany area does, dunno about anywhere down here) bandwagon but in this day and age we're obligated to address the pain in one fashion or another. Some agencies that are affiliated with hospitals are (arguably) required to treat pain appropriately.

INIT915: Next beer is on me. Translation: What he said.

Where's all the Somers people? We must have some pictures around of when they were doing standbys and they kept putting up signs labeling other departments as Somers Station # X. I think they got up to 9 or 10 if I recall.