WAS967

I have to go and look that up. I recall you cringing at the thought of having to review that again at the AHLS instructor class. :-> But in the end it never came up, at least not in name. Maybe in concept.

I don't understand why such hostility is being directed towards one particular agency. There are problems with any agency be it obvious or no., be they carreer or volunteer or combination. Maybe Mohegan doesn't have what would be considered the most effective system of response, but the powers that be feel that it works, and that is the way it is set up. I can pick any agency in Westchester and nitpick how they do things till I'm blue in the face, but what purpose does that serve in the end? What good would I be doing? When someone types the words "What i am about to say IS going to piss people off." why do they even bother to continue? Perhaps instead of being negative, offer some suggestions in a positive. and constructive manner. Otherwise, keep your posts to yourself.

I missed the streaker....where the heck did he show up? I guess I was the only one at the SB party I was at that noticed the boob thing. As far as the overall quality of the halftime show, you are indeed right, it sucked. It seemed like it was all of 2 minutes. I'd rather see a full 2-3 minutes of one person than 30 seconds each of what we saw last night. I seem to recall ther Aerosmith Halftime being much longer, maybe because I enjoyed it despite Britany and N*Suck. But I Digress.

I like plain "idiot drivers" since it is global and can refer to anyone from Grandma Moses to the 13 year old kid out joyriding in daddy's porsche. And yes, I know the problem can be within as well. I came within a second or two of getting creamed by an Fire Engine in our favorite city once which blew through a red light like there was no tommorrow, and was in the back of a rig that almost flipped over in a snow storm because the driver just plain doesn't know how to drive in snow. Needless to say, I made sure I had my seatbelt on. :->

All operations on 453.225.

Could you elaborate as opposed to just saying it sucks and that people are taking it our of service? Is there a reason for it's being pulled? Is it a recall situation for defects? Design flaw?

Words? I think I'd be utilizing some kinetic energy of my own on the guy. Maybe we should post a topic about idiot drivers. But that would go on forever. I swear that people are taking offensive driving insead of defensive driving.

Absoultely you can continue to treat a patient after an RMA. It is a very common misconception that you only get a patient to sign an RMA if they don't want to go to the hospital. Not true! If the patient say, refuses to have an IV inserted, then they can sign off saying they refused IV access. RMAs are not necessarily all inclusive. In the case of the patient who requires the immobilization but cannot because of whatever reason (the one i stated is just one of several I can think of), then having them sign an RMA is inappropriate. They aren;t REFUSING treatment, they are UNABLE to recieve treatment because of certain contraindications. If you had a patient that was allergic to an active ingredient in albuterol and thus you could not give them a nubulizer treatment for thier asthma, would you have the sign an RMA? Absolutely not! Becuase they aren't refusing, they are unable. Regardless, the option to call medical control is under utilized (it's not just for medics you know), and talking to a receptive doctor about the situation (we'll discuss unreceptive MC MDs later on) is probably a good route to take when faced with an unusual situation. Especially when you have a patient that is refusing treatment yet you think thier refusal will have a negative impact on thier health. Talk to the doctor, and go so far as have the PATIENT talk to the doctor. You'd be amazed how quickly they change thier mind sometimes.

May i say that i was appalled at how few people raised thier hands acknowledging at least a basic knowledge of START Triage at the pediatric conference. My suggestion: everyone go to thier agency and have do an in service on both START and JumpSTART now. When I am in a room full of say, oh 200 EMS providers, I'd expect more than 6 people to say they know the START system. Maybe I'll just pretend that nobody wanted to raise thier hand for fear of being picked on by Jeff. :-<

Regarding EMT's reliance on ALS: I've recently put EMTs to work on patient doing assessments. (Of course on stable patients) I think they get more nervous than anything, thinking we are looking over them and ready to judge. But I'd rather see them practice the skills they were taught than to loose them to lack-of-use. Sometimes I need to give em a little help or a push to get started, but some actually take off quite nicely once they get on track. As far as relay of info to ERs, I would love to see more agencies carry some kind of camera that can take pictures of the mechanism and actually SHOW the ER staff what the car looked like, or how far they fell, etc. Some agencies carry polariods, but not enough if you ask me. In a perfect world, everyone would carry pocketsized digital cameras with memorystick storage or the like. Then when you get to the ER, you pop the memory stick into a computer and up on a screen (mmmm.....65" plasma) pops the pictures taken on scene. Put i know the moment anyone puts something expensive like a digital camera on a rig, it's gonna walk.

x625: Bottom Line: You can't lay the patient down. How do you immobilize? The "Call Medical Control" option is always there sure, but I'm looking for opinions on how you would proceed as a provider in this given situation. alsfirefighter: Good answer. That was my route of thinking. Problem is there is a plague out there called "all or nothing" thinking. People are trained to immobilize with whatever, but in the end they MUST be on a long board. If they come out on a KED, them aren't fully immobilized unless they are on a longboard, they say. (And the manufacturer supports this way of thinking.) But I wonder what the alternative it. If you can't go to longboard, what do you do? They say you do nothing. I have to disagree. Long story short, I had a similar situation where the BLS organization I was with refused to have even a collar on the patient if he wasn't on a longboard. It made me think long and hard about who is right, what is right, and how I would proceed if faced with the same problem again in the future. Some people say they wish they could do C-Spine clearance in the field. Funny thing about that. I was told recently that statistics show, that in agencies that started doing C-Spine clearance protocols in the field, actually immobilized MORE patients than LESS. Food for thought.

It definatly all hinges on a good assessment and a thorough understanding of events leading up to, events during, and events after the accident. I honestly feel that half the EMT class should be dedicated to history and physical. For those of you who are in EMT or medic class now, when you do those ER rotations, don't just sit there! Follow a nurse and watch as s/he does thier H&P. I've picked up a lot just listening to ER staff (RN/PA/MD) run through a quick H&P. Take the opportunity to do manual BPs. (PLEASE PLEASE PLEASE drop your reliance on LP-12 autocuffs now before it's too late. And swear that i shall strangle the next person that writes down the HR from the monitor as the patient's pulse. Actually take it! HR does not equal PR. Treat the Patient NOT the monitor). When the nurse/doc listens to breath sounds, listen along with them and ask them about what you heard. Assessments can often be challengeing, especially in cases of MVAs, since we often do not have the ability to get a good head to toe assessment for various reasons, be it weather (patient is bundled in twenty layers of fleece), vehicle damage (patient is wedged between steering wheel and seat), etc. It's Important to do a quick assessment on what you can, and REPEAT that assessment. How many people do a quick head to toe, immobilize, pile into the ambulance and boogie for WMC, only to sit there and just ask how the patient is doing? Get in there and go head to toe again, cause things can change and change rapidly, especially with mechanisms like pedestrians struck, falls from trees/roofs/etc. I had a case recently where the patient was punted by a car an unknown distance. First warning sign there is "hit by car" and "unknown distance". Always err on the side of caution. Patient initially only had pain in her shoulder and mentally is A/Ox3(or 4 if you follow that system). Patient later was found to have broken shoulder, pelvis, lumbar spine, and a minor brain bleed. With the arrival of VERY cold temperature (Bahamas anyone?) thick clothing can make secondary assessment difficult. Often we are faced with a dillema: Do you expose and assess because of the risk of further injury or do you get them out of the 10 degree weather with heavy winds? As EMTs we must all learn to "adapt and overcome". Often we have to get as much of an assessment as possible with the cloths in place, log roll to longboard, manually immobilize the neck (scarves and jackets often prevent collar application), and get into the ambulance. Set that heat to "max" - Don't adjust comfort controls to your comfort but to that of the patients. Elderly and Kids often require temps that make you sweat in order for them to maintain a safe body temp. Other hurdles include the cloths they wear. Once the patient is out of the cold air, you can get back to exposing and assessing. How many providers on a regular basis ask about how the accident happened, and really delve into that? Did the patient skid on the ice and crash, or did he pass out and crash? Does history indicate a possible deeper problem (diabetic, seizure, cardiac history etc). Back to the original topic now that my assessment rant is over (for now), it is very true that with the concept of crumple zones, cars can often appear worse than they are. Look at the big picture. How long are the skid marks? Are there any skid marks? Are there signs of rollover? What make year and model of car? (Older cars = less safety features). Is the spider in the windshield from a possible head impact? Or was it caused by airbag deployment? Is the steering wheel deformed/displaced? Does the seatbelt show signs of having been on in the accident? (Many people won't admit to NOT wearing restraints for fear of repercussions.) (Some cars have seatbelt systems that have a small charge that fires on impact and locks the seatbelt in place. In these cars a used seatbelt will appear "limp" and not spring back into place, an unused one will be stiff and stuck in place in the stowed position). Did the first person there see the seatbelt on or off? Did the airbag deploy? Is there a chance it can deploy while you are in the car? Are there a lot of "free" objects in the car that could have become projectiles during the crash and caused a secondary injury? Was the headrest in a position to prevent the patients neck from snaping back after impact like it should? What was the position of the seat? (Seats close to the wheel can be problematic when the airbag deploys, seats in the semi-recline "guido driving" position can be problematic too). The list I'm sure gets longer, but these are just a few of the things I think about when doing a scene size-up. But mechanism alone is definatly not a sure fire indicator of patient injury. How many people roll thier cars today and walk away? How many cars have you seen that were totaled, yet the driver is walking around smoking a cigarette and talking on a phone? How many accidents have we seen where the damage is minor, yet the patient is suffers some odd severe injury? In the end it all comes down to a good H&P and a good EMT to see the whole picture.

Wow, I'm suprised nobody even took a shot at the Ipratropium question. Guess there aren't too many medics in the forums. Anyways, it's not THE major but A major contraindication, and it's often overlooked or unknown by the people giving it: Peanutt and Soy allergies. Ipratropium Bromide is sy:nthesised from Soya Letchin which can precipitate an allergic reaction in people hypersensitive to Peanuts and Soy Beans. Since peanut allergies are some of the more severe allergic reactions I've seen, it's best to make sure you gather a detailed history before giving ANY medication. ;-> Do I win despite being the source of the question? :->

Hi Karl, Good to see you on the board. Just a point of clarificaion for all that are interested: STAT-Flight is no longer really run by the med center. Due to the ongoing cost issues of running the valhalla hospital, the operation was outsourced to the company that provided the helicopters and pilots, a company called Air Methods. (which bought Rocky Mountain Helicopters a year or so ago). Basically the operation is run similar to Albany Medical Center's program, all profits go back to the program instead of the hospital. I'm not sure how the staffing is, wether the nurses and medics are also employees of air methods, or of the hospital (I should ask them one day). Wierdest thing is: Dispatch for the helicopters is based in the midwest now, I think Kentucky? All the dispatchers at WestCom lost thier jobs basically,. -Chris

Surprised to see that this wasn't listed yet. Where are all our south county buffs? Seems there has been a streak of LARGE fires in Yonkers. What the heck is going on down there? NBC News 4 is broadcasting live pictures from Chopper4 with flames shooting out of the roof of the building. From News12: "Firefighters in Yonkers are battling a general alarm blaze at 147 School Street. Mutual aid has been called to the scene. So far there is no word on any injuries" ****See below for report******

Oh come on now With all the obesity running rampant in the fire and EMS services, the hike would do you some good.

Actually, Truck, I would have to disagree. It is my understanding that the highest geographical point in Westchester is Turkey Mountain in Yorktown. For anyone interested in a good hike, I highly recommend it. Access to the trails can be gained from a little dirt road just north of the Sanctuary Golf course on Route 118, just a short ride outside of the heights. The summit is accessable by trails of various difficulties, and offers excellent views of New york City (on a clear day), the Croton res, and the surrounding area. An awesome place to see the fall foliage.

Additional from News12: The structure is a Auto Repair Shop and Luxury Auto Dealership (Jaguar). No reported injuries as of 1800. General Alarm: All Hands Working. Mutual Aid requested from surrounding sources.

I just posted about it too in "Westchester Fire". Feel free to move her if you like, didn't see the post here until after .

FDNY had a brother firefighter die in the Line of Duty today. Thomas Brick was fighting a matress warehouse fire in Inwood (Bronx). I just head the news on Fox. Our prayers to his fellow firefighters and family. Apparently he was relatively new, graduating from the first FDNY class to graduate after 9/11.

Hey! I said that several posts ago! :->

Preliminary word is that Persico won. No verification of that as of yet.

The sounds at the end of Ossining's tones are exactly what you suspect they are, DTMF tones, ie, the tones you hear when you dial a phone (touch tone that is) or call in to hospital via HEAR Radio. The function they serve is unknown to me (perhaps you can ask our resident Ossining FD guy), but I suspect it is either a code to set of the siren (so some yahoo with a radio and tone encoder cannot easily do so) or to signal to the station what "box" the fire is located at. You often hear OPD dispatch a fire as "Box XXX". Perhaps that is what the tones designate. When I worked in Putnam, there was one department, (which slips my mind at this time) that set off thier fire siren using DTMF tones. Now that I think of it, It may have been Mahopac. You would hear the tones go out to trip the pagers, the dispatch. Then a few seconds after the dispatch there would be DTMF tones that set off the siren.

LOL. We need to get you a cable to connect that audio directly into the computer. We can hear you thumping around in the backround behind the mic. :->

My understanding was that Abbey Richmond was the wife of the original owner who had passed on. When the company changed hands, they kept the name probably because it was recognized or to honor her memory. Unsure. Next time I see Mikey D, I'll ask him.