roeems87

A couple things... 1) You make the assertion that you would much rather have a "competant, paid EMT or Medic." I'd like to know where you all of a sudden determined that the only competant emergency medical providers are ones who get a paycheck when they leave. 2) Along those lines... I don't know how it is everywhere, but I don't think there is a single EMT or paramedic at our VAC that doesn't have (PAID) experience from somewhere else... 3) VACs are not a thing of the past. Many times they need to be supplemented by paid staff, but that doesn't mean that it works without volunteers. We need volunteers to fill out our crews. The reason we have paid is because of volume. Sure, all voly works (or should) with 300 calls a year. That's slightly more difficult with over 2100... 4) We're a VAC. We have crews in quarters. Our average response time is around 4-5 minutes. That's received to on scene. Granted, if you're reaching the 3rd call at one time, it may be slightly longer, but except for large city services, there aren't many places that can handle that at once without a delay. It's called redundancy... i.e. FD gets there to handle immediate emergencies when EMS may not be readily available... or police... Quite frankly, someone is going to have problems with cardiac arrest regardless of when you can get a crew there. The 3-4 minutes it takes to get called in and dispatched could be their life. Never mind (being already there) the 5 minutes it takes to get to the scene. The person is already dead. NYC EMS's average response time last year on their website was 8-9 minutes... forgive me, but does our VAC (the V stands for volunteer) have a better or equal number there?? 5) No one is trying to put anyone on any higher level than anyone else here. I think the constant badgering of voly vs. paid on this site is ridiculous. Speaking in EMS, 9/10 providers do both (go back to my #1 and 2 here and see why I think your point is way off from the truth). So what is the problem here? The problem is not wanting to put yourself up, but it's fighting for equal ground with people who constantly try to put you down... I won't comment on who that is in general, but if you get the feeling in your gut that I'm (and others) are talking about you, then that's probably true...

TCCC (TC3, Tomkins/Cortland Com. Col.) has fire science degrees I believe. For other examples of live-in bunker programs, I know Tomkins County NY has many, both EMS and fire. Dryden Ambulance comes to mind, as does Cayuga Heights FD off the top of my head. They both have websites...

Rather than type out a reply to this one... This is topic we have discussed EXACTLY in the past about intial assessments of the scene. We talking about it with fire and EMS and the value of it, etc. Some of the points made were pretty good and others brought up issues about wasting air time (though I don't think 10 seconds is ever any kind of waste unless your whistling). If anyone can find the old topic, that would probably bring some good points back. I can't seem to find it... I looked for about 5 minutes...

I'm curious about a few things... Just based on the website that is in the link about, take a look at the graph showing the results... Those "best fit" lines don't seem to be entirely accurate. If any, only the top one seems to be correct. If you take a look at some of the data points, they are relatively (extremely) high compared to the actual reading taken from the blood gas... It's fine if you obtain this reading and on scene (and especially in the transport decision) this will help to know what's going on with your patient; HOWEVER, there is no way the hospital will ever act on such a reading... That said, the type of treatment they will render will depend on the blood gas they are going to get anyway (and would get anyway with the given symptoms). I guess the only real benefit would be in deciding what hospital you may be transporting to (and convincing someone they need to go) and who needs rehab (in the case of internal use). I'm wary of it's use though when lots of the readings shown on that website seem to be abnormally high... Lastly, how does this thing work? A pulse oximeter is a colorimetric device... I'm curious how the CO version will work. One of the false positives you get with the PO2 is in the case of CO poisoning. You will get a 100% or close to it (i.e. a nearly perfect reading) when the patient in fact is binding and perfusing CO and nothing else (or very little O2). It appears to have the same finger probe as the PO2 has, but I am curious how this thing works... If anyone knows, I would like to understand it... If it really does work effectively, then perhaps this is the next level of technology in pulse-oximetry as well. If it can tell what's CO and what's O2, then perhaps many of the false positives with PO2 (some others included) can also be eliminated...

Does anyone know if Yonkers ever (I'm sure long in the past--if ever) used horns for any reason? There is a "fire horn" located right by my house (just off Grandview Blvd in 314's first due). I'm not sure if it's an old "air raid" siren or some other kind of public address system, but it definitely could be a fire horn as well... Anyone know anything about this?

Building a rapport with the people you work WITH is the best way to do this job. You are typically going to interact with the same people (at least some that you know) where ever you are working. If that means some people who don't know you see the way others that do treat you, it will all be beneficial for everyone. Working as a team will always work best...

60-Control is COMMUNICATIONS, that's all. They will do what you tell them and advise you of what they know. Their job is not supervisory. If you tell them, "57B1 to 60, I'll be taking the job on Main Street, I'm two minutes away, you can have 57B2 disreguard or take in the job on [blah]," they will respond with "10-4, 57B2 do you copy?" Their purpose is to keep track of where people are and dispatch, not to tell you what to do... They do their job and do an excellent job of that, moreso than any PD would do simply because they don't have the time or ability to keep track the same way. As for a cohesive system... what other entity in this county would be more able to be a "cohesive" body for EMS dispatching than county control (in addition to their EMD and training in dispatching)? By the way, I believe the only time the New Ro ambulances were known as ambulance 1 and 2 was when they were dispatched by NRPD... which incidentally, those dispatchers are typically supervisors as well... (someone correct me if anything I have said is not correct)

This is an incredibly simple arguement. I don't see what the problem is here. Emotionally disturbed people have medical problems, that is why it is our job to take care of them and to get them to a hospital or appropriate facility to get more definite care. Our job is to deal with sick people in safe scene situations. If the patient himself/herself is the danger, then that must be contained through the entire call. Meaning if the patient has the potential to be a problem (or is a problem) then you need police to be with you. That's their job--to keep it safe. So we're working together, not separately. It's really not that difficult to comprehend... You would never, ever, have a patient in the back of the ambulance with a knife... would you? That's the same potential... even if they themselves are the weapon, they are a DANGER. If you want to say that you never need police, you will get killed or hurt by someone one day. I have never had someone allow me to restrain them. Many people have problems with you tying their hands down so they don't reach while in the stairchair (and they don't have some mental issue to deal with at the moment). What makes you think they're going to let you tie them down in the ambulance? More so if they have some neuro or psychological problem...

They are indeed receiving hospitals, but their patients don't only come from ambulances. It's not only protocol, but it's common courtesy to let them know what you're coming in with. If you're coming in with a twisted ankle, they may advise you to go straight to triage. In that case, they won't stare at you for 20 minutes and you will be in and out. If you have something that needs a bed right away, it all depends on the nursing manager whether or not you will get it. My experience is that getting a bed immediately is a matter of who the nurse in charge is. The ER could be dead or crazy busy, and no matter what, with some nurses you will wait, with others you will get in right away. Getting to know the people you're working with (emergency medicine is both hospital and prehospital care, so you are "working with" the ED staff) and building a rapport means when you call, you will get your bed or whatever it is you need. Here's a reason to call with a less-serious patient: You are two minutes out, they have three open minor rooms, but the hospital has three minor patients also in the waiting room. If you call, they save you a bed. if you don't, you sit in the hallway and suffer the consequences of having to wait. In the end, everyone is more informed (BETTER COMMUNICATION) and everyone is happier. It just makes sense to call ahead if you have the chance. It doesn't require all that much effort...

Anytime you think you don't agree with an order or direction, ask about it. There is probably a reason you gut (or preferably your brain) is telling you it's not right--either you've never done it before or you shouldn't be doing it in the first place. Repeat the order back to the person giving it (just in case you were mistaken in hearing it), let them confirm. If you still have question, then tell them your concern. "Doc, I'm sorry, that's really not within my protocols, are you still asking me to (do this)?" If they say yes, then I think the ultimate rule is that you are following the direction of a higher medical authority. It's just confusing when it's something you are theoretically not capable (i.e. not trained, even if you know how) of doing...

If you go to the AHA website and check out their newest journal release, it explains all the changes... there are MANY... CPR is almost much of the EXACT opposite we have always been taught... here are some examples: 1) the 30:2 ratio is so that we get more blood moving. It usually takes the first 6-7 compressions (if they are done correctly) to get the pressure buildup necessary to move the blood around anyway. This compression change also has psychological value for lay rescuers. (it's now going to be 15:2 for both peds and infants as well...) It's "keep it simple, stupid" and makes their notion of "push hard, push fast" and lets people do the right thing when in a situation they don't face very much. For rescuers, the purpose is to move more blood through the heart and lungs (and to perfuse) to reduce acidity and increase gas exchange as best possible. The thought is that enough air is moving into the lungs from the negative pressure your compressions make in the first place (after all, we breathe by negative pressure anyway). 2) Rescue breathing is being changed... they are now recommending much more time for the exhale and CO2 outward movement. The beginnings of acidosis are setting in when someone crashes, the build up of carbonic acid and CO2 needs to be moved out more importantly... The rate of diffusion for Oxygen is much faster and will get in anyway. They are recommending that Rescue breaths be a smaller depth (6-7mL/kg, roughly 600-700mL for your average adult, compared to the 1100mL recommended now--or 800-1000mL on O2) and only over a period of one second. This is quite counter-intuitive to the "slow and deep," "breeeeeeeeaaatthhhhh" mentality we have now. 3) holy crap AED companies will be making money! Just about every AED out there will need to be reprogrammed. The AHA now states that there is no purpose for stacks of 3 shocks. Data now shows that 90% of all rhythm converesions will convert in the first shock, and if they don't, there is only a 3% (some low, single degit number, not sure if it's 3) chance that it will convert to a stable rythm again anyway. Now they are stating, if it is witnessed arest, apply the AED and shock ONCE immediately. If it is known down time of >5minutes, they now say to complete (get ready!) 1.5-3 MINUTES of CPR before using the AED. The reasoning is that after 5 minutes, your chances of recovery are not much different after 8. If you still have a shockable rhythm at 5 minutes, then hopefully it holds on. They feel it is now more important to begin circulation before attempting defibrillation. The ACLS protocols are changed a bit as well, with drugs (doses, sequence, options) and defibrillation, but listing all that may be more long-winded than necessary. One last thing I thought was incredibly well pointed out and something everyone can learn from (even if you hear it a million times), the AHA includes the following sentence: "In the most dire of cardiac emergencies and cardiac arrest, no ACLS measure can compare to excellent performance of BLS skills."

The AED will in fact give you a print out (after the fact when given in for investigation). Additionally, the newer front-line EMS AEDs all have screens to view the rhythm, so they would have been able to see it. An EMT cannot pronounce, so at least a medic must have been present. Even for a DOA, the cops will want to know who pronounced, so a medic must have been present no matter what, so he must have had access to a lifepak... I'm curious as to why you would have to call to deliver shocks...?? I have never heard of that and, quite frankly, it sounds kinda stupid to me if it really is a protocol... "uh, yeah, doc, patient has a shockable rhythm, can I go ahead and try to save his life? or would you like me to discontinue? Oh and hurry up, his shockable rhythm has converted to asystole while I was on hold..." Just sounds a little ridiculous to me, but I could be wrong (certainly wouldn't be the first time...)...

It's true... Medics and other resources as well... Let's the dispatcher know whether or not first response FD is necessary, or whether or not the "fall" needs a lift assist or an ambulance. Let's them know if the unresponsive has a pulse and just happens to not be answering questions (because he's mad at his wife) or is simply not breathing... It lets everyone know better what they're in for and what resources are best needed to send to the scene.

Careful with the idea that Westchester hospitals aren't busy or that "real reasons for calling" don't exist up here either. The city is a new ball game, obviously. Throw 10million people on top of the population of westchester and you would have the same situation... I can 100% guarantee you that if I ever called Lawrence and said "broken toe," either I would get a sharp attitude or get hung up on. So the principal stands no matter where you are. If you have something "triage" worthy, might as well just take it there. If you have something that needs a room immediately or will need to see a doctor, needs noification. In Westchester, it's nice to have a rapport with the people you are calling. If you go there enough, the nurses and doctors recognize your voice on the HEAR or you call them and say exactly who it is. They are more willing to hear you out and know what you have than not. You should give a call on anything you have a chance to that is going right into the back. If you as the EMT can't give a call, have the driver. If they're not an EMT, give them a quick line to say "Xage, problem, vitals." On a side note: if you call... 9/10 you're more likely to see a friendly nurse ready to give you a room when you get there... If you don't, they may not be so willing, because the ambulance coming in the door behind you WAS nice enough to call...

I believe it has been relatively recently (within the last few years) that all dispatchers at 60-control are EMD (Emergency Medical Dispatching). That's the system you are talking about that they give instructions to people who need them to care for the patient before help arrives. The benefits of it also allow the dispatcher to assess in a more detailed fashion what is actually going on. In the case of an "unresponsive," that can be quickly determined about whether or not the patient is breathing, what the cause may be (i.e. stroke, diabetic related, etc.), and whatever other information they can gain. This the the very first step (and crucial) in eliminating discrepancies in dispatching and what you are actually going to encounter. Take the "my son is having trouble breathing and says his chest hurts." Original thought is that your patient is a child... when the EMD is completed, you find out that the caller is 75 years old, her son is actually 53 and having an MI, not a small asthma attack likely in the child scenario. In any event, the one negative is clear as well... There are only 4 dispatchers (I believe, sometimes 5? sometimes 3?) on at a time, and one very large county... EMD in the middle of a storm may prove incredibly taxing on the other 3 dispatchers... All in all, awesome system that is growing across the country to be somewhat universal. It's been in place for a few years (e.g. not in 1986) I believe in westchester, though one of the DES guys can probably be more specific.

There are many past distinctions that used to be made for EMTs, but the EMT-D is being phased out. Defibrillation some years ago was not part of the EMT curriculum. You were considered an EMT-A (just the first letter of the alphabet, though the A was rarely used) or EMT-B (meaning basic, that came after EMT-A was phased out to the National Registry/DOT curriculum of EMTB). If you were trained in defibrillation after that, you were then denoted as an EMT-D (defibrillation, even though it's AED only). Now, all EMTs are trained in defibrillation as part of the national registry/DOT curriculum of EMT-Basic. Therefore, all EMTs are EMT-B... EMT-D no longer exists in this state (and most states) as a certification. All EMT cards say Basic... Additionally, basic EMTs are not required to recognize any EKG rhythms. There is no manual interpretation whatsoever, only defibrillation by AED (recognizing the rythms by itself). The only amount basics need to know is that the AED in fact shocks in only two rhythms: Ventricular fibrillation (V-fib) and Ventricular Tachycardia (V-tac). Asystole is known to the basic as no heart electrical activity (i.e. "flat line") and the AED will not shock. That is the extent of curriculum knowledge...

Doesn't necessarily stand for something directly... means Ethyl(EDIT) (Et) Alcohol (OH), i.e. the kind you drink. It's just a simple way of saying "drunk" without saying it, because we can't, and the patient doesn't know what you're talking about.

Based on the apparent stupidty of the EMTs here, seems like his chances of winning the lawsuit are much better than powerball... winning the lottery and getting struck in the same day...?? hey, ya never know...

Whenever you have an EDP, plain and simple, have a PD car follow you. They can typically see right in the back of the ambulance if they are behind you. If anything goes wrong, you say your partner's name and they pull over. The cop will be in the back of the ambulance before you can say "help." It's an interesting thing to remember with a possibly combative EtOH. The nearly unconscious versions are not necessarily what you need to worry about, but the ones who are more reluctant to cooperate (or when the have the choice given to them of the back of the ambulance or the back of the police car), you should have a cop follow you. Bottom line, if you don't feel comfortable, you have to make a decision. If a cop can't be spared, you call your supervisor, medical control, or the dispatcher and figure it out. On a side note. I had an MVA patient, drunk (possibly slightly altered), 17 years old, not very happy in the back of my ambulance. We had two patients, two EMTs. Both boarded (bench and cot), one EMT in the captain's chair and I was in the aisle between the two patients. The patient on the cot got slightly combative and broke himself off the backboard (broke the buckles and ripped right through the tape holding his head down--and he was down tight, it took him a few tries, despite our attempts to calm him down). We were on the BRP en route to the medical center in the Scarsdale area. Once he broke off and started swinging, the driver had already seen this coming, pulled over and was on the radio calling for PD. 60 did an amazing job with that (getting us PD and checking in about every 30 seconds to make sure things were ok and to see if PD had arrived yet). We had a light show on the BRP at 2AM with about 10 cop cars: Scarsdale, County, and Eastchester (many of them, without being sent, flew up the parkway). The patient was "restrained" to say the least and we were able to continue to the hospital with a PD car behind us. In any event, the bottom line: whether expected or not, prepare for the unexpected and ask a cop to follow you. 9/10 times they will offer and rarely will they not. Keeping them in the back may be necessary for some, but remember that they are cops and oftentimes make the patient less cooperative. Have them follow, it's better for the patient, you, and everyone's safety.

Cornell University awards 6 academic credits (3 each of 2 semesters) for basic, and 8 (4 each of 2 semesters) for Advanced/Critical Care...

It's plain and simple, you cannot close Westchester Medical Center. Not right now. Not until there is something to replace it. Other hospitals in the area are swimming as is... throwing that load on any given hospital in the central-Westchester just won't work. United closed and the craziness that caused is evident. PCRRBVAC has 20 minute transports in either direction putting them way out of their response area (may not be a problem for some places up north, but they're quite busy). Luckily, Westchester has trauma centers in very close proximity. (Don't try the "we have 20 minute txp to a level 1" argument, where i go to school in NY, we have to fly anything that needs a trauma center.) Closing WMC would put other hospitals at too great a strain. Try WPH for example. I use them alot, but they're a good example... They are building a dual-floor ER... You can go in there at 3:30 in the morning and have a full waiting room, 30 patients in the ER, and 4-5 ambulances in the bay. That tells you that they're handling plenty of traffic. It's a city-style ER, but they have lots to handle for a hospital that doesn't have another one two blocks away... Bottom line, closing Westchester MC is a problem. Westchester needs a level 1 and just the presence of another large hospital... any other opinions on it? what do you guys think?

probably shouldn't happen, but these things do... instead of writing "txp w/out incident to ###" at the bottom of your PCR, change it to something like, "while unloading pt. at ###, the stretcher legs were not fully locked and pt. and stretcher fell to the ground..." At that point, I would describe what happened to the patient and what you do to rectify the situation. Likely (hopefully) it caused little (if any) damage to the patient, but should something happen to him (even in the future), you bet your bottom dollar that someone will be coming after "that ambulance crew" that "dropped him on the floor." Your only saving grace in court two years from now is a well documented PCR that can replay the event for you and everyone else involved that way you look both credible and honest with what happened...

Just wanted to enter a disagreement... I find WPH to be one of the best hospitals to bring patients to. I am in and out of that hospital. If you're sitting and waiting for your patient to go to CT, I'm not sure what you're waiting for. They may not always be waiting for you to walk in the door (most hospitals aren't) and they're always ready to ask you what you have. Rarely, if ever, have i been ignored at White Plains. This is unlike some other southern Westchester hospitals... It's not only a matter of getting to CT. The facilities are at WP and ready to be used, they may not always be there in other places. Your patient is better suited at a Stroke Center, that's their purpose. It's the same analogy of your trauma (legit) patient going to a trauma center...

Just a quick note, I would be wary sometimes of wearing a badge when you're working (especially in some districts). While it may not be much of an issue in Northern Westchester, it certainly can be in lots of places in southern westchester. When you have a badge on your navy blue uniform, you look like a cop. While in a case or two, that may be a good thing, most times, it's probably not. That's not degrading to law enforcement (make sure you get my point right), but many calls you are sent on, looking like a cop, would certainly be a disadvantage. Many of the people you deal with simply don't like cops, or care to deal with them, for whatever reasons. Note, this is not granny who's weak and dizzy, but it certainly applies to your stabbing victim. On the flipside, when you hear gunshots as you're pulling up to a scene (or some scene becomes unsafe at somepoint), the last thing the public likes to see is "cops" moving the other direction. It just makes you look like something you're not, and that is not a good thing... keep it for your car, or formal events, or parades or whatever, but I wouldn't wear it while working unless you're required to...

Cornell EMS is run as a student activity funded thing. There is some $$ from the university I believe for the service it provides, but perhaps you should talk to your student government (or whatever you call it--or whoever is in charge of "student money") to see if they would be willing to fund the starting costs. Tell them the benefits. Give them some statistics about response times without University EMS. Give them some stats about what could happen in that time frame that could mean someone's life. Make a good presentation and give them some hard reasoning why it makes sense to be student run and student funded (i.e. training organization over anything else, open to students interested in EMS--not just EMTs, community education--start a CPR teaching thing)... Work with it, but go for student money, then if you get that, go to the university for some capital costs... Good luck...