WAS967

Does Pawling have more than one fire station? I live in town now so will likely be there, possibly for the fireworks, tho my daughter has decided this year that she is going to now be afraid of the loud bangs. Maybe I'll leave her home and just bring the wife.

If people complain about "dirty" with the wood chips, then they're really gonna b**** about sand. In the end I think a lot of it comes down to people taking responsibility for their kids and what they are doing. A playground is not a daycare, the swingsets aren't babysitters. A lot of these playground injuries could be avoided by simply watching your kids and making sure they aren't doing anything unsafe. Thankfully not all lawyers are useless. My brother in law is thankfully on the side of uncommon sense and has been an advocate for defending playgrounds from frivolous lawsuits. I fear for the day when someone is successful in suing a playground for some silly injury and all the toys disappear. God Bless America!

Most of the playgrounds I visit with my daughter have the wood chips on top of soft dirt as padding against falls. I don't think I'd allow my daughter on those black mats either because, as ALS mentioned, what happens if a kid simply falls on their hands, knees, or face. If they get so hot that they present a burn risk, then I semi agree they need to be removed, but at the same time you have to weight the risks vs the benefits. But at the sime time I can't help but wonder if there is a better material out there for the job.

What is and "excempt" fireman?

Heard Archville and Pocantico Hills being toned out late last night/early this morning to assist Mount Pleasant Police with a search. Was it a missing person or evidence search?

Thank you all for the information. Would be nice to see someone ELSE (perhaps with a more understanding mindset) do a youtube (or heck, maybe MSNBC) video where they actually sit down with the people of O'town and actually get to know them, instead of operating solely on speculation. Unfortunately, I fear the influx of curiosity seekers in the area is far from over.

Westchester has alway lagged horribly behind surrounding areas, especially the SouthWest region of CT. I doubt we'll see it in the field this decade unless as a "study". As for the Stamford save, thats awesome. Congrats to SEMS on a great call and perfect implementation of a new treatment modality and thus proving it works - well.

Just an FYI for all Paramedics credentialed under the Westchester REMAC. The treatment protocols have been updated to conform with the 2005 guidelines made by the AHA. These protocols go into effect IMMEDIATELY and all agencies are required to show that their providers have been in-serviced and brought up to speed on the new guidelines. ACLS/PALS are sufficient proof to show that providers are trained in the algorithms, however providers must STILL show proof that they are proficient in the protocols. Basically it's like the Aspirin in services all over again, just on the ALS level this time. Protocols are available here: http://www.wremsco.org/protocols.htm Some good changes: -No longer need to call medical control for permission to give things like Bicarb on codes. They say if you suspect it, treat it. -Diltiazem is now standing order for rapid A-Fib/A-Flutter. No more having to call for it. -Emphasis placed on obtaining 12-Lead ECGs. Some not so good: -Still need to call medical control for Beta Blocker and Ca-Channel overdoses. -It took them almost 2 years to get a simple update out to us. At this rate it will be 2010 before the BLS immobilization protocol is released.

Okay. Food for thought. The special procedures allows use of morphine on standing order for pain management. It says: "For patients presenting with need for pain management....." I interpret that to mean someone who is PRESENTLY in pain OR MAY BE in pain. Does that mean we can give it if we anticipate pain (ie, for cardioversion and/or splinting a fracture that is okay now but might be in more pain during movement?). I would say yes. Downisde of course is the fact, that regardless of the interpretation of said protocol, we would still have to contact M/C according to the VT/SVT protocol. Discuss.

If a Mod could be so kind to merge this post in with this thread: http://www.emtbravo.net/index.php?showtopic=23581 It would be a more cohesive post in the long run and better for future reference. (Kinda makes me wish I had mod status again *cough*SETH*cough* ). Anyways.... I revisited the proposed Paramedic protocols and spotted a few revisions that were quite noticeable since the open comment period. I'm guessing that everyone who spoke up about the proposed changes (either pro, con, or just plain for proofreading/typo fixing) made a difference. For that, thank you all for you comments. Here are some of the updated changes I've spied: -Most notable, Etomidate has been moved from a M/C option to standing order. Thank you god. -Embracing technology with the addition of consideration of CO-oximetry. (Still cost prohibitive for many, but price is slowly coming down). -Oxytocin moved to standing order in the presence of severe post-partum hemorrhage. Wishlist: -Move Glucagon back to standing order for possible Beta Blocker Overdosage/Complications. -Add ability to sedate for cardioversion on standing order. I'm still reviewing the draft at this time. Will update as the day goes on.

Seth must have read the same JEMS article that I just finished reading (from the June 2008 issue if people are interested). Basically we can all thank REMO of Albany for stepping up to the plate and getting Morphine added to the list of controlled substances that EMS providers can administer on standing order in NYS. They have also added Fentanyl to the formulary but it sounds like they need to get orders to administer that. The article cites the advantages of Fentanyl for use in Abdominal pain and Multi-system Trauma. But they key here is they have paved the way for other regions (like Westchester) to add Morphine to the list of drugs that can be given via standing order.

A problem that I have been seeing a LOT lately is people driving with the DRLs on and forgetting to turn on the rest of their lights at night. Sure the DRLs are as bright as the normal headlights, but most people forget it doesn't activate the rest of their markers making them sometimes invisible right until you are on top of them. Whoever decided to bring stealth to the automotive industry should be flogged.

It is in the proposed protocols for Westchester for us to give MS on standing order at a starting dose of 0.1 mg/kg I think it was. Will be a nice change if it goes through. Tho I would much prefer to see something like Fentanyl or Dilaudid used. Morphine is going the way of the dodo and Nitrous.

A while back the EMS room at Mount Vernon hospital was infested with FLEAS.

http://www.nj.com/news/index.ssf/2008/07/a...entified_b.html http://www.nj.com/news/index.ssf/2008/07/s..._hazing_in.html Kinda makes me wonder what kind of hazing incidents previous students have had to go through. Shame, Newark is a good busy system to learn in, I don't think Northeastern students will be returning anytime soon.

They only give you 90 days to do your observation?

So for those of you interested, I'll try to spew forth some Verbal Judo (<3 ALS for my favorite new term) and try to remember all of the RMA items we have to have documented at my primary employment. Phelps has a nicely made RMA card that is based off this protocol and can be obtained by visited the Hoch Center during normal business hours and subject to us actually having some in stock. -Patient must be asked multiple times if they would like to go. -Patient must be aware of the risks and consequences of the RMA, up to and including possible death. -Patient must not appear impaired by foreign substances (alcohol, drugs, medications, etc). -Patient must be considered competent to the best of your abilities, including ruling out psychiatric issues. (OMIJA) -Patient must be informed of "follow ups" (call doctor, call 911 again if needed, go to emergency room if needed, etc) -Must have patient signature. -Must have witness signature. -Must have witnesses name legible (print below is signature is not). -Document involvement of third parties (police, family, medical control, etc). -Document call type as recieved, and chief complaint. -Document 2 FULL sets of vital signs. -Document appropriate medical examination. I'm sure I'm forgetting something off the top of my head, but if anyone has questions ("WTF is OMIJA?") please feel free to ask.

BOCES does not offer a Paramedic class of any type to my knowledge. Barry is correct that the only Westchester based Paramedic original is at WCC. The BOCES EMT was also recently running on fumes (lack of enrollment) and may well have been cut or will eventually be cut.

We're actually starting up an EMT-I class in the fall. One of the motivating factors for a few of the students is pay. Some of the students are police officers for a particular agency and they get annual salary bonuses for the various levels of EMT (EMT, I, and P). Lets say the bonus for EMT is something like $4000, EMT-I is $6000 and EMT-P is $8000. It is more feasible for them to take the EMT-I class, get the extra 2k a year over EMT, but not have to dedicate a year of schooling for the Medic class.

The aforementioned couch used to be the old "Post 4" at Abbey across the street.

Next to MVAs involving an ambulance, RMAs are the second most common reason you may find yourself jockeying the witness bench in a courtroom. Sure it's easy for you to say "sign here" but does the patient really know what it is they are signing? How many people EXPLAIN to a patient what it is they are really doing and what the possible repercussions are? At my primary place of employment, the RMA protocol is rather extensive - so much so that it's actually EASIER to talk the patient into going to the hospital. Average RMA can take more than 20 minutes! To those of you who are quick to say things like "we would get them to RMA and move onto the next call...if they really needed to go...we'd be back soon enough" I offer you this. Wait until a patient dies and you have to deal with the pissed off family and their lawyers. Then you might change your way of thinking. People will suit you for looking at them wrong. Cover your asses. 9 times out of 10 if you tell a patient "YOU MAY DIE IF YOU DON'T GO", they will go. For the other 10%, well, they must be suicidal, so they can't refuse anyway.

What TC (Training Center) did you take the IC (Instructor Class) with? Best bet would be to touch base with them and see if any of their instructors would be willing to audit you. Whereabouts are you looking to teach the class? The other issue is that you not only need to teach the class with a full fledged instructor, but you also need to have a IT (Instructor Trainer) look in on the class and observe you while you are doing it. The IT and the Instructor can be one and the same however. Uusually the IT who taught the Instructor class for you is willing to audit you as well.

Phil: You bring up a good point. CPR is a requirement of the EMT curriculum and is required any time you take a refresher class. Even us CPR INSTRUCTORS have to do the CPR module of the class. So makes you wonder why the EMT card itself doesn't act as a defacto CPR card aside from the fact that our EMT cards expire in three years and CPR-PR usually expires in 2. I'll see if I can't track down the policy you seek. This might be a good question to field to the MARO office of the DOH since I'm guessing you got gigged recently.

In typical New York State fashion, the protocols for the spinal immobilization are rather a** backwards. I'd rather see a spinal "clearance" protocol of sorts like the NH one that rules OUT injury, than one that rules IN immobilization. And they specifically say that once immobilization is initiated in the field it can't be discontinued. One overzealous first aider or first responder who may not know the protocol and you end up with a whole lot of unnecessary work and possible agony for the patient.

http://www.americanheart.org/presenter.jht...ntifier=3012360 for AHA classes near you. http://westchestercounty.redcross.org/ for Red Cross Classes. I'm a little biased but if ALS or RWC don't have an offering that suits you call Phelps ELSP for classes at 914-366-ELSP. With enough students (4-6 minimum i believe) we usually can come to you.