Goose

If he wants to go ahead with all of that then he can have his vehicle inspected and certified part 800 by the state. Looks like he's from westchester and in westchester i think you're better off getting the bus out.

Bottom line, don't do it. Just respond to you're station and get the bus out - you're doing the patient a bigger disservice by buffing a job in a battle wagon when they really need an ambulance.

Who the hell cares? All buses suck in one way or another. Lets just hope that they have a spectacular experience with their new investment.

Rest In Peace.

the government tends to walk a fine line with these sorts of things...they could justify just about anything under the auspices of "keeping you safe."

any additional capabilities not detailed in these photos?

Very true. Many of the most progressive systems are county based EMS services that are directly funded by the tax rolls - you figure county wide they probably more than make up for not transporting a non-viable arrest on whatever they collect on billable patients.

Is that inflatable skirt a standard safety option on Bell helicopters or is it a universal safety option available to anyone who wants to include it?

I believe the front end of the helicopter was bent upon impact with the water as per local media.

Very key point. In the most progressive systems medics work arrests from top to bottom where they find the patient, if they don't get ROSC they field terminate...if they get ROSC they transport. Not only does it make sense from a transport perspective, it also makes sense from a hospital resource perspective.

Personally, this is an all or nothing proposition. Either the county does it, does it right and does it the first time or don't bother at all. The problem state wide, but especially in Westchester, is the whole local control issue. You get a gross duplication of resources an and outrageous tax bill.

This is definitely a complex issue. In a perfect world we would have a centralized dispatching agency that handled all incoming 911 calls and preformed EMD on all requests for an ambulance. This agency would prioritize said requests based on national standards and dispatch units appropriately. And the SOG would dictate how to respond to each priority level. This is never going to be perfect - i've worked in putnam and dutchess which both use priority based systems and while they get it right 95% of the time, i recall a few times i was sent to an MI that got sent Alpha and a courtesy ride was sent Charlie or Delta. The inherent flaw is that it's all based on the availability and accuracy of the information the dispatcher receives. Westchester has a few problems. The county cannot mandate that 60 control or a hypothetical Westchester 911 Center be the only PSAP county wide. I wish they had the power, i really do. I think it would be more benificial to the dispatchers (ie: greater career path and increased room for advancement) and it's a win/win for county residents and Fire, Police, and EMS. No transferring calls 50 times or anyone being in the dark. Give every rig an MDT and send jobs to units on that so everyone can see the particulars and responding units and give dispositions via the computer and save valuable radio air time. The biggest benefit would be an EMD certified staff that would prioritize jobs accordingly. Westchester's biggest problem is that we don't have the above. We have some 48 or so PSAPs, most of those being police departments, who answer the 911 calls. I think there are some inherent benifits to being dispatched by PD in small communities, but as far as this topic is concerned - i don't know of any off the top of my head that have EMD certified desk sergeants, patrol staff, or independent dispatchers to prioritize EMS calls if they do the dispatching. This creates a conundrum. If i call for a bus at home and say hey, i think i'm having a heart attack the desk sgt is going to say ok, we will send you a bus right now. He will dispatch the sector car and the bus to a possible heart attack. Sounds legit, no? Maybe, suppose it could go both ways - could be an MI or it could be anxiety, costochondritis, or maybe i just have a headache and didn't want to wait 15 minutes for a bus. In a system like that, from where i sit, it almost behooves the agency to respond emergency to every job because there is very little to go by Complex topic, but no matter how you decide or are advised to respond, do so as safe as possible.

Never knew mr. teal personally, but i do believe i saw him on a few jobs when i worked in the area. From what i hear he was a special person. Thoughts and prayers go out to his family, friends and PV Fire/Rescue.

Agree with X635, guys like this kid need to get the book thrown at them. As far as his troubled life - unless he's got a severe diagnosed psychological condition - he knew right from wrong.

The 9th anniversary of 9/11 is coming up quickly and i thought it appropriate to properly remember are fellow brothers and sisters in EMS who gave their lives so that others may truly live. I can only hope that this does some justice as the sacrifices of these brave men and women are consistently overlooked. God bless them all. Paramedic Carlos Lillo, FDNY EMS (included in FDNY's 343) Paramedic Ricardo Quinn, FDNY EMS (included in FDNY's 343) EMT David Marc Sullins, Cabrini Medical Center EMT Keith Fairben, NYPH EMT Mario Santoro, NYPH EMT Richard Pearlman, Forest Hills VAC EMT Yamel Merino, Transcare (Metrocare @ the time) EMT Mark Schwartz, Hunter Ambulance

Hopefully centralized dispatch is what the end result is. Can't tell you how helpful it is to have a MDT screen full of information from a call taker on the way to a job, thats one thing NYC got right.

Guess we can thank Rudy for that lol... One of my bigger concerns is how exactly they plan to merge the dispatching facilities...aren't they in two different locations on two different radio systems?

I appreciate that and those who added to the roll of honor. And to you're friend for his sacrifices. It's a sad reality, something that pains me. What's so remarkable about so many of these men and women is that they made multiple trips to and from the scene to find, treat and transport patients. We're talking about two and three or more trips to and from the trade center - fully aware of the existing and potential dangers. It's simply beyond humbling.

I think everyone needs to take their fingers off the hair triggers here. Nothing was snide or inflammatory about my question. The problem was not that they are a "social club", the issue was a lack of persons willing to respond to so many calls for free! That's what was said. I don't understand that. You're not willing to respond to emergencies for free? Isn't that what a volunteer signs up to do? This was my question in response to the above. Simple, straight forward, cut and dry. The statement doesn't make sense and if anything it reflects poorly on volunteers. Look, I get out the door in a timely fashion (granted i draw a paycheck), so none of this is really my problem, but for discussion sake i just don't understand how a volunteer could say something like that. If members of a volunteer organization are not willing to respond to runs because they are too frequent or because they are not getting compensated then it seems to me that it all boils down to being a social club - i'm talking generally, not about any one organization. I would think that those who take the time and effort to do the best they can would be a bit taken back by such a statement - or at least call for clarification. I know it made me read it twice...

I don't understand that. You're not willing to respond to emergencies for free? Isn't that what a volunteer signs up to do?

It's a good step that at least the first due ambulance is a guaranteed thing 24/7/365. I'm not going to say it's progressive, this is 2010. If anything it's reactionary, but its good none the less. I say reactionary because i have heard for years from friends/colleges that northern westchester has had very serious issues with getting busses out the door in a timely fashion. We may never know how many people suffered unnecessarily because of long response times and the aversion, of some, to paid solutions. But, i guess they say better late than never.

I can't see how the king doesn't do a better job at protecting the airway than an OPA...if you're talking upper airway trauma, the proximal cuff completely isolates the oro/naso pharynx from the glottic opening. Additionally, the distal cuff - while it sits in the esophagus is not guaranteed to prevent aspiration, so i correct myself there - but i feel that it does a superior job at preventing gastric insufflation which leads to less gastric distention and less chance of subsequent vomiting and aspiration. From where i sit it seems preferable to the combi-tube and far superior to an OPA. Good discussion.

I think JBE hit the important things...it's kind of hard to tell exactly is going on with the patient...can't tell if he's unconscious or just got the wind knocked out of him from the impact. Either way, take care of the BLS - ABCs, C-Spine. I would also include ALS interventions...IV, cardiac monitor, etc and then move on depending on what's going on with him...again, it's hard to really elaborate beyond that because we can't really determine whats going on. Interesting though.

Didn't get a chance to actually respond to the original post. You can't misplace a king airway. It's a blind insertion (and devices like this are a BLS option in other states)...lube it up, shove it down and inflate the cuff. The definitive option is always going to be endotracheal option (it's the gold standard) but intubation isn't a particularly easy skill - especially without paralytics, bright lights, a table at hip level and 3 or 4 other sets of hands. As was mentioned, it's considered a "rescue" airway...ie: s you can't get the tube, this will secure and protect the airway effectively enough (like i said, you can't beat passing a tube into the trachea and occuluding the lower airways below the vocal cords, but this is better than nothing..). As far as it being better or worse than an OPA...i think it's a better option. If you're getting good chest rise, good SPO2 and good central/peripheral perfusion with an OPA keep it (or so says the AHA)...but the biggest thing is that the king will do a better job of keeping vomit, blood, etc out of the trachea than will an OPA. As far as gastric distention...it could have been a result of the bagging the patient with a BLS airway and no cric pressure or maybe the patient was just that heavy or maybe they had some sort of hepatic congestion going on...who knows... Hopefully that answers some of you;re questions!

As was stated prior the king airway is a rescue airway. As a rescue airway I have found the two times I have used it, it has functioned flawlessly - protected and maintained difficult airways that prohibited intubation in the field.