roeems87

Wisconsin Ave and Prospect Street NW (between M and N streets NW), Georgetown neighborhood of DC.

ALS protocols vary by region. It may be the case in lower parts of NY that CCs cannot operate without a medic enroute or present, that is not true in many other upstate areas. And CC's do in fact "free up" medics because medics are not necessary to supervise CCs in many regions in upstate NY. There are NO ALS skills/medications taught and tested of paramedics that are not taught and tested of Critical Care techs as well. By region, it varies which they are allowed to perform (with standing orders, medical control orders, or not at all). The major difference between CC and Medic is the design of the curriculum and training--NOT the skills. CC and Medic ALS treatment of a patient will not vary at all. The difference exists in the focus being technician vs. clinician (though both must make field diagnoses and treatment decisions based upon them). Training for CC requires extensive rotations throughout the hospital and ambulance systems, supervised by nurses and doctors--very similar to paramedic programs, with some differences. Medic (from my understanding) typically involves strictly doctors and additional time. If anyone has questions about differences in Medics, CCs, and/or Is or is interested in how this type of system works in places like Central NY EMS or other regions in "upstate" feel free to PM me. If you want some examples of protocols, i'd be more than happy to provide those as well. Unfortunately in westchester and NYC (the only two regions in NYS currently not recognizing CC protocols) don't utilize this level at all, though it's purpose in the area would obviously be grossly different than the one it serves up here in the middle of the state.

There are some MAJOR differences between CC and I levels... careful not to bunch the two together...

No doubt... that's why they're not in charge. And I made that point, so I didn't miss it. My point was that the EMT skill difference between the two won't be all that great. Their ability to handle more difficult situations comes from experience (that's just about word-for-word from the first post), which they will then learn from older members/EMTs. Incidentally, I wouldn't expect a brand new EMT (lets say e.g. a 32-year-old one) to handle a "hot job" all that much better than a 16 year-old. A new EMT doesn't know all that much no matter how old they are and how much life experience they have. Granted, yes, an older person will have more life experience to draw from and adapt to the situation, but they will be having just as hard a time doing it... That's exactly my point. Only difference is that I say train EMTs at 16 so they can learn the skills and become better ones as they get older and more experienced. The baseline knowledge and skills won't change whether you learn it at 16, 18, or 45. The ability to deal with them will, yes--as you said--come with life experience... That will also come with EMT experience. So why not start at 16 (when you're not in charge and can assist a great deal)? The being in charge and "handling a large, hot job" argument is * and void. They aren't the ones handling them by themselves, so I even think it makes sense to use it. That's the exact problem with the situation. Perhaps you need to meet a few more mature and capable 16 year-olds. Believe it or not, they're capable of a lot more than Biology homework and taking acne medication... And what's more, they're much more willing to learn... I would, yes, rather have a 16 year-old learning EMT being around helping me (just remind yourself about the "not in charge" point) than some of the older, "more mature," pathetic EMTs I see on a more than regular basis who are less than willing to learn anything from anyone... But you're probably right, they don't have zits, and really have about zero idea about the biology behind most things they practice...

You can be an EMT (that is you can start the EMT class) at the age of 16 in New Jersey as well. A LOT of people make the "too young" arguement, but I don't agree. When I took my class (at 16) I'm pretty sure I would trust 9/10 of the 16 year-olds in the room before I would trust ANY of the 30-40 year-old adults. That's not to say either group has any overall ability, but just to point out that just because someone is 16 doesn't mean they aren't capable of being an EMT. EMT is NOT rocket science. In fact, there isn't all that much difficult about the skills you learn as an EMT at all. Perfecting them, and learning to adapt to more difficult situations and complicated patients is where more challenge becomes evident. And that is all part of learning and experience (whether 16, 18, or 40 years old). In NJ (and I'm sure it is the case in CT) you won't get hired as an EMT anywhere at age 16, and there are restrictions as to what you can do and what you can be in charge of. To the best of my knowledge there aren't any voly corps that allow 16-year-old EMTs to be in charge of care. In fact--if I'm not mistaken--that is a statewide policy. I personally agree with EMTs at age 16. There isn't a damn thing you learn in EMT-BASIC (BASIC for a reason) that can't be understood and done by a 16 year old. In just about every single case I would say any 16 year old taking time out of his or her day and every other activity HS kids are involved in is going to be dedicated and fully interested in being an EMT. That was the impression that I got and I'm pretty sure it's the right one. Dedicated kids are just as good (if not better) at learning things adults do. What are the arguements to the contrary, really? -They're too young and too inexperienced? Um, not valid. Everyone who comes out of EMT class is generally that way, no matter how old they are (speaking about strictly EMT experience). -They're too small and weak? I beg to differ. Many are stronger and in better shape to do the job than your typical 50 year-old 3-packs-a-day smoking "experienced person." -Legal or not? There isn't going to be anywhere where a 16-year-old is in charge of care. And if there is, I would say that is wrong (not because they are too young, but because they are too inexperienced, similar to anyone coming out of EMT class. But you can be sure that a 16 year-old is a new EMT. You can't assume that with e.g. a 32 year old.) I think the extra two years I was able to be an EMT was a huge help in developing skills that I have now. (Incidentally, I'm from NY. Always have been. Took my EMT in Jersey for the reasons that I have been describing. Became a NYS EMT at 18 and have been doing that (and now ALS) ever since.) If you know the skills from age 16, you learn and assist others for a few years until you can get on your feet. Then, when you are 18, you're miles ahead of the people becoming EMTs in charge of care in other states. I would say it's far more dangerous having your brand new whacker/buff/sparky EMT in NY who just got his card yesterday in charge of care than having a 16-year-old EMT in the first place. Think about it...

Lets be honest here... There was no leadership coming from that man throughout the entire ordeal. Not once did you see our mayor on the TV yelling at the government for not helping. Not once did you see him complain or take a dig at the president. Instead you saw a leader. A man capable of leading a city through its worst days. New Orleans unfortunately has none of that. They have someone who was totally incapable of handling the situation and ungrateful for every piece of help he got from EVERYWHERE in this country (including the very city he takes a swipe at). He is a disgrace to leadership. He always has been, and always will be. I just wish that city would see that, but apparently they would rather follow along in his political--and quite frankly ignorant--rhetoric.

i would say he had a fair evaluation of Mt. Vernon ER, wouldn't you?

Having been on the scene, without violating anything we've been told to do (for the investigation and/or HIPAA), the patient was by no means conscious and breathing enough that anyone was going to talk to him. There were 5 EMTs in the back of that ambulance at the time. If that tells you the patient's condition, then that's why she wasn't back there. For the record, the majority of the descriptions from every news agency are flawed as to both the patient's condition and the scene itself. News12's is perhaps the worst of them (imagine that, sucking at another news opportunity... that pathetic excuse for a news organization).

This is going to turn into a political discussion... I can see that coming quickly... The point of the topic was to point out that this is a lot of information for anyone to have access to (perhaps noting a hole in "good security"). If the government thought it in our best interests not to know, we wouldn't. If you really think you are the ultimate knowledgable citizen who knows everything the government does, you're an idiot. There are things kept from the public on a daily basis for our safety, peace, and best interests (whatever they may be). Have a little trust, rather than arrogance and defiance. It works better that way. We should probably put all our ships where we're fighting right now. That would make sense... leave every other place on the planet vulnerable, but still, makes sense, right? Last time we kept all our ships in one place the navy learned a very valuable lesson... that and we entered into a world war.

I wonder how many people out there really think this is how modern medicine operates in EMS... if they look at that, they must really think we're all pretty low-life and pathetic...

Not for anything, but i'm not sure a rural town in the middle of North (or South, who cares?) Dakota (with, as the article states, a population of 200) is anywhere near an accurate, fair, or non-ignorant assessment of volunteerism in this country. On a side note... In a town of 200, there are 5 EMTs. That's 2.5% of the population willing to volunteer in their ambulance program. I can't imagine they have many calls, but that's not the point. If 2.5% of a town of 20,000 people volunteered, that would be 500 people in the ambulance corps. Assume that only half that amount actually care enough to do it. That's 250 people... There aren't that many towns with that amount of committment from any population. Only serves to prove further how ridiculous (and IMHO pointless) an article like this is...

In case anyone is interested, the NYS DOH EMS Bureau sent out a memo a bunch of years ago outlining the "FAQs of DNRs" and such. No where on here does it talk about a tattoo or another means to express a DNR sans paperwork or a bracelet. Though if a bracelet is acceptable (under the conditions outlined on the website), I'm not 100% sure that a tattoo is out of the blue... Take a look for yourself: http://www.health.state.ny.us/nysdoh/ems/policy/99-10.htm

I think that's one of those get on the phone with medical control and say "hey doc, he's got 'DON'T EVEN DARE TO TRY CPR' tattooed across his chest... think it's ok if I don't?" haha...

I think this is hilarious. I don't disagree, you're right, people b*tch continuously, but they just don't know how good they have it. What is a long response time by someone's definition living in Westchester/NYC? 15 minutes? 20 minutes? 25 pushing it? Where I go to school in upstate NY, the PAID AMBULANCE SERVICE which covers most of the county (minus a few voly corps, and we won't talk about those here) could take 25-30 minutes (full lights and sirens) to get to where you may be. People don't understand how good they have it. Next time they have trouble breathing, and call 911, let them think about how that would feel for 25 minutes before someone got there, not 8 minutes.

I think NYS DOT says that you can operate your vehicle with lights and NO sirens only if you are NOT ASSUMING/REQUESTING THE RIGHT OF WAY. i.e. the purpose is to alert people to the fact that you may be driving slowly (i.e. with a pt.) than the rest of the traffic, or alerting them to your presence without requesting they stop or move out of your way. Emergency mode requires both, though as everyone knows, sirens may not always be on anyway... As for the silent approach thing. If someone requests it, it's for one of two reasons: (1) it makes them nervous and they've done this before, or (2) they don't want everyone in the neighborhood to know what's going on. In either event, they requested that you do that. Remember it's their emergency, not yours. If they want you to slow down, take it easy, and not utilize "lights and sirens" then that's their risk, not yours. Turn the lights and sirens off when you get in the neighborhood. If it makes it more dangerous for you (e.g. a busy or narrow/one way street) then don't. Do what will keep you safe and honor their wishes. They may have called for chest pain, but they also asked you didn't respond RLS. It's not anyone's god-given right to use break-neck speed to get to someone who may be in need. Do what you can and honor their wishes. On a side note... if you have rules against not responding with the whole noise/light show, then they may want to be reconsidered. And if they do, whoever is dispatching you should (a) know that, ( b ) give that information to the caller asking for it, and © there should be no reason for them to dispatch it with the "silent approach" suffix. It seems to me a contradiction in logic to think the two situations co-exist.

Angelina's is on Lake Ave... on the south side of main street...

just to clarify... the child didn't die at playland because of someone's negligence... Again, this woman should definitely lose her job. If I were in her shoes (not like I would ever do something like that), I would quit. I wouldn't be able to handle more 911 calls knowing the way I handled one resulted in someone dead. One thing to note: The outcome may not have been different based on what she did. Perhaps the autopsy, investigation, or something showed mom was down for 8-10 hours or something along those lines. So what the dispatcher did may not have resulted in the death of the woman.

I would venture to say smoking is pretty close to being as responsible for deaths (if not incredibly) and sickness as obesity is... Just on a note that hits home with 98% of people in EMS and fire... Besides... what would be the harm in having an ambulance like that designated for Westchester? One purchased by the DES and in the event that a person "that" big needs transport to the hospital, isn't it our responsibility to help them? Would there be any other case where you feel we should not have the capabilities to transport someone? In the same way that we have all different types of FD trucks and toys that can fight all different kinds of fires and handle all different situations, we should have EMS equipment capable of handling this. Similar to the county's response with the bomb squad, it wouldn't be unreasonable to request the "X-bus" for transport of a patient requiring it. I think the need for this says a lot about the direction our health nationwide is going (down, in case you were wondering), but it's just another aspect of Emergency Services we need to face when we're providing the best care to our districts.

I think a key point is being missed here. In busier systems, this is not a problem. EMS is readily available because either (1) they are paid and on duty, or (2) they are volunteer, but staffed in quarters or on the ambulance. In those same places, mutual aid is generally not that far away. And when someone doesn't sign on, there is a corps/dept. officer or paramedic requesting mutual aid immediately for whatever reason they are unavailable at the time. The problem with response times is not necessarily a "problem," but an aspect of a system that only does 1 call a day--or even one call a week. Sure, we would all be benefited by having EMS, Fire, PD, whoever around the corner and ready at a moment's notice to respond to whatever emergency you are having. That's not always possible, or quite frankly efficient. With slower (meaning the 1 call type places I'm talking about above), having members responding from home, is perhaps the most efficient use of their time. Before you jump down my throat on that one... let's realize the response times of paid agencies as well--that is to say because they are staffed and "readily" available, the paid factor has nothing to do with my point. Except for those paid locations who are accepting of mutual aid, you could wait 15-20 minutes for an ambulance in a paid system. I live in a larger city in Westchester (figure that one out) and it took 23 minutes to get an ambulance to my neighbors house when she was having difficulty breathing. Sure, we had an engine in 3 minutes, but until we're putting stretchers on the hose bed, it's not much use. So what's my point? The response times are all a part of the system, flaw or not. If you have a system that doesn't require 24/7 paid and staffed service, then you don't have it. The point stands for fire, EMS, and in some places PD. Currently going to school in upstate NY, many towns are covered by the state police, or ambulances from the county. Your response times could be 30 minutes with them responding from quarters. Tack on the extra 10-15 if they are voly's... even more for voly FDs... (There is no such thing as a staffed VAC here without being paid.) It's all part of the way things are. Not to say that can't be improved, but until there is a greater need, there may not be much difference...

not all volunteer agencies respond from home...

just cut the person in half, then you can use two real size ambulances... kidding of course...

Just to settle whatever heat maybe brewing, no one is saying the kid was intelligent about this, or right in doing it, or anything like that. He was stupid. He did something stupid. He touched a piece of equipment he was not trained to use and hurt someone with it. All that said, the kid is going to live with killing someone for the rest of his life. That--no matter what you all may think--will be the worst punishment he can feel. Jail is not going to change that, not at all, nor will it ever surpass the punishment he has in his heart right now. The victim's family--when the original emotion of the event, trial, etc. calms down--will realize that in time. He pled guilty. He knows what he did. He is being punished for it. But the point a bunch of people are making here, and one, I honestly agree with, is that it was a joke at first. In the same way that EVERY SINGLE PERSON ON HERE has played jokes at their fire house, VAC building, etc. (heck, it wouldn't be the first one someone has gotten hurt--or at least soaking wet--from a practical joke going on where i'm from). This one went waaaayyyy to far, no doubting that, and entirely unfortunately, the results were tragic. All that said, take a look at the person who committed the crime... Not every kid in the world dedicates their time to not only becoming an EMT, but doing something as a hobby that many people make a career out.... Not everyone has the dedication, or quite frankly the heart and mind, to spend their time learning how to help other people out. We should all wish we had so many more of this kid in our society... He didn't intend to kill someone that night. His joke did, and that's sooooo unbelievably unfortunate, but he will be regretting that, and paying the price for that his entire life. I think people are right in saying, cut the kid a break... P.S. I doubt the kid put the paddles into the correct positions on the person's chest for defibrillation. Didn't this happen from him reaching from the back of the rig to the passenger's seat? that would be nearly impossible, and probably just as much the victim's fault for allowing it. P.P.S. This is a topic for another discussion, but basic EMTs with AEDs that shock, SVT... stupid idea in my opinion. The primary treatment for SVT is not a shock like a defibrillator, it requires a synchronized cardioversion or adenosine. While the AEDs I've heard that can deal with SVT can sync CV, I don't think we should be putting that responsibility in the hands of a basic EMT who doesn't know what that means or what it does, or how to post-care for that treatment. It's not part of BLS CPR... it shouldn't be on a BLS truck. Not to mention that fact that basic EMT says put the defib on when you lose a pulse... patients in SVT have a pulse... unless they're in PEA... a combination not usually found... So why would it be on in the first place?

Lay off the negativity for God's sake... I'm with the above mentality... Go online to galls.com and take a look at some of their "first responder" bags... Don't buy them from galls, you can easily supply one yourself for half the price, but they have good comprehensive lists of stuff and basic amounts to get...

amen (btw, nice job mikeinet)

I think the topic is being beaten to death... but I really don't like the notion of paid vs. volly attitudes. Granted, there is a HUGE difference in EMTs based on experience. Straight out of EMT class, you're just plain useless. 15 years as an EMT and you can probably do anything. That said... THAT is the difference I think exists... not paid vs. volly. And to think that volunteers are always the ones without the experience is where the fault lies. At least I think that's the distinction that's not correct. A significantly large portion of vollie's in EMS don't only volunteer EMS... they have in the past (or continue to) worked in paid systems... Additionally... the "wacker" ("buff," "sparky," whatever it is where you are) attitude is along the same lines... that is more of a lack of experience, rather than simply being volunteer. There are plenty of wacker paid people, and plenty of non-wacker vollies... I won't go into the notion about VACs being a social affair either, but it's a group of people you work with and hang out with... The people working at the time (i.e. the ones in uniform taking the calls) aren't the ones who are completely lost or staggering in to hang out... But that's a matter of policy... and I don't think it affects the way people behave on the bus or for that matter how patients are cared for at all... so I don't understand the relevance... Lastly, what about this notion of preferring the "professional, paid" person walking through the door. Before I ever called the paid service where I live I would call my VAC to come pick up anyone in my family. I would prefer any single one of the people I work with in the volunteer setting (again, many of them also paid) to take care of a loved one (or myself) before someone from the paid service... I would have called them "a burnt out EMT," but who would want to make generalizations about the attitudes of another provider? I would question the abilities of a paid provider long before I would a volly. You know for sure that if someone is inexperienced on a volly crew, they're not alone, and someone with greater experience is with them. You can't always say the same for a paid crew... (oh, wait, should i say, oh yeah, they did 6 months of transports right out of EMT school, that makes them qualified.) I'm on both sides of the fence here with having been voly and paid, but I can't see the point objectively from the other side, honestly...