Goose

Bringing up the questions no one wants asked is not whats being done enough these days. You call someone out and they come down on top of you like white on rice, but if your concern is valid and well articulated you have nothing to fear. Now, heres a question. Because i have only limited experience with DC911, if something is requested - like in this case a FAS Team or Truck Company - from a department farther away while a closer dept. has the resources, can they bypass this request and call the closest unit? What about the DC coordinators can they play a role in straitening this out?

Your talking about "Wag the Dog." Not exactly the same thing. In the movie they fabricated a war for the sitting President to end and thus get reelected. Good movie though.

At least he didn't kill anyone...like Ted Kennedy did

I think the answer is pretty simple. Never buff calls you happen to hear on the Police/Fire/EMS bands. Even this "at the request of an officer" bothers me. What the hell is that? If someone wants you or a specific truck have them relay through the dispatchers. The bottom line is accountability, and having things put through the CAD/computer makes it far easier to keep track of everything. Obviously, if your flagged at an incident or come upon one absolutely do your thing, but remember to have dispatch generate a call in the computer for it. The only other instance of "self dispatching" i find acceptable is probably only applicable in the EMS/PD (maybe?) world - IE: a unit gets dispatched to a job and you happen to be getting a soda at the local store down the street from that location, you click dispatch and ask them if they want u to handle as your closer. I know there are those out there that are extra anxious to hop on the trucks and give the lights a good workout but god gave us a brain for a purpose.

Maybe i'm missing something, but i don't see whats so wrong with some of these proposals.

Interesting article. Never heard of it being down in the pre-hospital setting. However, it's not surprising this is being done down south where they are far more progressive than we are here in NY.

ALS, i threw in "along with a full set of vitals" just to cover all my bases. Now, as far as upgrading to a Code 3, i as you, transport 99.9% of my patients Code 1. From where i sit as a BLS provider, if this individual's vital signs and breathing difficulties didn't alleviate themselves via natural pathways, it is clear that this patient needs to get either an ALS intervention or definitive care immediately. There is little i can do other than support his ABCs and prepare for possible total system failure - so for me supporting those ABCs and getting him to most appropriate definitive care is my biggest concern.

Ah, thats what he looks like! Ha! Talked to you on the phones a few times pal. Well, have a happy and healthy birthday, wishes for many, many more!

Very interesting response ALS, chock full of a lot of good insight as well. If his HR didn't come down would the adenosine slowed the rate down? I looked up adenosine and it mentioned that it could be used to try and chemically cardiovert or temporarily slow down the HR in the case of A-Fib. From a BLS perspective, if this guys vitals did not come down to within normal ranges in a reasonable amount of time i think i would have made the call for ALS and upgraded to a code 3 response to the hospital. Now, from an ALS perspective, what would be the proper action? Should this guy have been thrown on the monitor along with a full set of vitals ? Maybe a vegal maneuver? Prior to turning over full patient care to a BLS crew? Likewise, i can recall having a patient with A-Fib (if i recall properly) sometime ago when i went to go take his pulse on scene it was all over the place...so someone must have felt something...no?

Seeing as the guy was running up and down stairs, a heart rate of 150 - 200 doesn't seem to be out of the norm. It seems that much of what this individual was experience could have hinged on his physical condition. I don't know of any ALS intervention that could have brought down his heart rate or alleviate his SOB if this was all from running up and down the stairs. It could very well turn out that this person had a previously unknown cardiac or other condition that was exacerbated and led to the death of this individual. Hopefully, a speedy resolution is at hand.

I'm pretty sure that blood becomes acidic in a cardiac arrest situation. My understanding is that there are a lot of reasons why metabolic acidosis occurs including lactic acidosis, ketoacidosis and renal failure. I believe that is one of the one of main reasons ALS can administer sodium bicarbonate to reduce the adverse affects of acidema?

I was under the impression that they use a Glock 17 9mm. Likewise, the .45 has great stopping power. I'm very pleased to see that our Troopers will be getting some very well deserved upgrades. The reflective vests are going to improve personal safety drastically while operating on streets and fairways in both day and night time operations. Glad to see they will be using AEDs as well!

I was sent a link to this website through an email. I have no idea who wrote this (apparently a former member of NYC*EMS and now member of FDNY*EMS) or how accurate any of the accounts or data actually are/is. After reading through the website, i think some interesting points and recommendations are made. It should be known that this website dose contain controversial and offensive positions/assertions about the FDNY. On a personal note, i am not employed by the FDNY or a participating hospital and thus have no agenda to push. Seeing as this is a website of opinions and issues, i thought i would be interesting to get everyone's opinion on some of the more salient issues brought up. http://hometown.aol.com/fdemswebsite1/index.html Did Rudy really cut funding from HHC to undermine NYC*EMS? If true, this is extremely disturbing. Discuss away!

This reminds me that all TV service is being switched over to digital in the near future as well. Those old dusty Quasars aren't going to cut it anymore!

Interesting topic, Seth. This reminds me of the lax attitude towards leaving an O2 cascade outlet on the floor - its a medical gas (aka medication) we don't throw our gauze pads, ET tubes or IV catheters on the floor or at the bottom of our jump bag. While post injury infection isn't our primary concern, everyone in the public safety continuum should do their best to maintain clean material and practices.

I ran a few searches on Googel and through my College's science database/journal search and nothing came up pertaining to tissue preservation. Isn't the point to ensure perfusion so that the organ systems don't have to shut down? Whatever the effect, i have a feeling its small and has little or no effect on survival rate from an out of hospital cardiac arrest. As far as a CVA, blood wouldn't even be getting to a particular part of the brain, so i dont understand how giving supplemental O2 would have any effect on the tissue in question.

I wouldn't go that far. There are plenty of emergencies to go around and lots to learn everywhere. I've heard plenty of people who have spent significant time in the city come up north and admit they have never seen some of the things that occur up here, most notably the trauma. As far as transports, lets not write them off. There is a lot to be learned on your average transport. While they surely aren't adrenaline pumping nor do they make the papers, you can learn a lot of medications, medical conditions and treatment modalities at the hospital level. I'm not quite sure what what was expected out of working EMS. Low pay, long hours, high risk and little appreciation is and has been part of the deal for decades. I guess I'm a bit confused as to the exact point of the comment altogether.

So this will be dispatched on all Working Fires, Rescues, Haz-Mat and Scuba jobs? I suppose if the call volume for incidents requiring this truck are there its a justified expense.

Yeah, but WHY?! Like Chris said, the important threads - those that teach, inform and provide for an exchange of ideas on salient topics - die quicker than they are posted. That's why I've found myself not visiting as often. Debating how much a volunteer can get away with in terms of transforming his Ford Ranger into a battle wagon dose nothing for me, nor do i care what light bars the state police use or what flashing sequence they use. There are so many more important things going on in public safety. I can think of a handful of things, regarding EMS in particular, that deserve an honest discussion. But, ihey, i know a full size light bar on a geo prisim is a lot cooler than a combi tube.... /rant off

Please, everyone, its HIPAA not HIPPA. There is no way we can sit here and have an honest discussion if people can't even get the name of the legislation correct!

Sucks...i guess?

Health Insurance Portability and Accountability Act Unless they are dishing out medicare, medicade and policy numbers HiPAA (note there is only 1 p!!!!!) is not an issue.

It was a ballpark number, but i do know EMTs that make that rate working for privates. Just gotta research man, all the information is out there Either way it beats the roughly 10 dollar salary i'm making now.

The benefits are compelling and so is the 12 hour tour, however can't afford to live for 14/hr in Westchester. Simply doesn't cut it. If they were to finalize 12 hour tours and bump that starting salary closer to 20 then i would more inclined to look there than OLM or another private. Likewise, the attitude from Fire towards EMS is pretty disturbing and turns me off.

'2. The program shall be limited to persons who are employed by the New York City Fire Department or who are in practice in the following counties: Delaware, Fulton, Hamilton, Montgomery, Nassau, Otsego, Schoharie or Suffolk. The commissioner may limit the number of participants in the program, except that such limit shall be no less than four thousand participants.'