Goose

http://www.wremsco.org/WREMSCO_POLICY_DOCs/REMSCO%20Policy-11-02-EMS%20System%20Resource%20Utilization-8-Feb-2011.pdf Enforcement is up for debate. I don't know all the particulars, but i'm not sure if the REMSCO has enforcement powers, i know REMAC does...but their scope may only be limited to ALS (again, i don't know how the law is interpreted). That said, the REMSCO is tasked with managing EMS in it's respective area of oversight as per the public health law, the REMSCO here requires agencies to have QA & QI...and it looks like they are looking at the response time in terms of a QI issue.

It's becoming more common, and eventually it will be the norm. As EMS runs go up and volunteerism / volunteer manpower pools decrease something is going to have to give, especially with this new future mandate...the agencies are going to be obligated to figure out a solution. Sometimes the volunteers get out...other times you're stuck waiting over an hour. It's nothing personal, there are a lot of really nice people that come out and volunteer their time on the bus and i enjoy working alongside them. The problem is that there needs to be consistency and fairness - the buses need to be able to get out the door quickly and without constantly relying on the same (often older retired) members. A county system is never going to happen - Astorino would never let that fly. That said, i think the next few years are going to be perfect for the formation of regional (encompassing a number of municipalities across medium/large land areas) solutions - which volunteers can be a part of. There needs to be guarantees that ALS units and BLS units will arrive at medical emergencies in a timely fashion. It's the only viable solution as i see it. My only concern is that the private agencies would come in and zero/under bid service....then you degrade into the ambulance turf wars and contract turnover of duchess county that occurred a number of years ago (may still be going on, i haven't been up there in a while) when i worked in the area.

You're going to see a whole lot more when the REMAC & REMSCO mandate that a bus roll within 3 minute of dispatch takes effect ( see policy statement 11-02 on the remsco website).

I recall one issue w/ a female who was an orthodox jew. She called regarding a lump she had found....her husband wasn't home at the time and i wasn't allowed into the house. I knew the neighborhood had a lot of orthodox families and had a general understanding of their beliefs. I let her know that i understood that we were not welcome to enter and asked her if she would prefer to have a female provider evaluate her....i ended up having a female medic and female police officer respond and she took the reigns from there. That said, i've never had to overcome religions convictions when a patient was acutely ill....i always try to keep the husband or wife present, explain the assessment process, explain what that assessment has uncovered and the steps that need to be taken to treat the patient. In fact some of the patients i thought would be the most difficult - given their cultural and/or religious backgrounds - ended up being the easiest to treat and most thankful appreciative people.

What was wrong w/ the radios that requires 30k to fix?

http://www.jems.com/article/health-and-safety/studies-show-dangers-working-ems Thought this was worth posting.

I'm not sure i would go as far as saying education is not the answer. The DARE program is a good program and something that should be maintained. The problem is information and access to information. Thats where education has a hard time keeping up - in fact, its probably an almost impossible task. All teens and preteens are likely exponentially more tech savvy than their parents and know their way around the internet. Factor in information aggregates like text messaging, Facebook and twitter and these sorts of things disseminate like wildfire at the sped of a nano second. If you want to stop this, its probably time to take the gloves off and incorporate some tangibles into the education process- bring kids in to the MEs office and show them what a fatal alcohol involved accident looks like. Scare the crap out of them.

They hold more or less a shots worth of fluid. I also don't see the vast majority of people getting hammered off this and i don't really see it making the abuse of alcohol by younger and younger teens worse. This is as much of an issue as the 14 year olds we pick up who are blitzed after two beers or two shots. Likewise, i don't see my treatment changing much. The bigger problem, as far as i've seen as i don't have children, are the parents who fail to properly parent their children. How many young intoxes have you taken to the ER who's parents have been "OH SALLY/TOMMY ITS GOING TO BE OK! I JUST WANT YOU TO BE BETTER AGAIN!" My parents always made me ride out the misery of being married to the porcelain queen for a night and made sure i payed for my actions despite the hangover. I think it worked.

Generally speaking, you're right. You want to protest? Knock you're self out. The problem i have (the obvious crime/health/etc concerns) is that their "message" is far from focused. Just listen to some of the interviews by the media of the occupiers....many will fumble verbiage for minutes to attempt to explain the goals while others will simply come out and say they have no idea what the goal/message is. So, rather then try to refocus their sloppy decentralized efforts and boil them down into some meaningful political momentum (like the tea party did, for example) they would rather engage in illicit narcotic activity, obstruct justice and antagonize police officers. So, if you ask me, many of them are just a bunch of over privileged ivy league graduates who feel disenfranchised because they didn't get six figures out of the box and are trying, fruitlessly, to harken back to the hippy movement of their parents. Oh, and lets not forget the millions in expenses that they are costing various municipalities across the country and world.... Thats just my issue with the movement, and i agree that the financial system is broken and needs serious fixing...

I think thats probably the best way to go. It's really easy now to request an abstract from the DMV, in fact you can do it online and as long as you have a credit or debit card you can get it virtually instantly and print it out. Shouldn't be an issue for the member.

Of course it's the reason. It's the cheaper and politically sensitive way out.

Nothing is going to change until the BLS agencies have their feet held to the fire by their respective communities or some county/state entity if they ever grew the stones. Now, let's not forget that the issue is generally compounded by the silly agency specific mutual aide agreements, which are often based more on politics than patient care & geography. I agree that EMD works and priority/tiered dispatching (ie: how Putnam & Dutchess do it) works....it just won't work here because the ALS flycars are the only guarenteed EMS resource to arrive in a reasonable time frame.

@ ALS....looks like he's from Suffolk....long island uses a lot of CCs if I'm not mistaken. But, I would have to agree - just get your medic, makes a lot more sense and there is far more opportunity.

Good BLS is great, but the real problem is that the we are often the only reliable part of the EMS system in many of the areas. Given that, we tend to show up before a BLS truck gets on the road...thus the we get stuck holding BLS jobs down until a bus arrives, obtaining BLS RMAs, etc. You want to free up the medics, start getting those ambulances on the road in a timely fashion (before anyone has a stroke, I'm speaking generally!). I guess my point is, we are really required on 100% of the calls 99% of the time because otherwise there would be no one else....

Exactly lol

You can always do a bedside call audit for .25 credit hours

There haven't been any deaths/injuries or fires related to the recall. The recall is a few weeks old (VWoA sent it to dealers) and owners won't receive notices until November. VAG has been having a number of issues with the common rail diesel engine they introduced in the 2009 MY. The biggest deal is the high pressure fuel pump's tendency to destroy itself and spit metal shavings across the entire fuel system but VAG has been trying to keep that hush hush for some time.

No qualms there. As far as the county sized solution - it clearly works well elsewhere in the country...don't see why it couldn't (politics and money aside) work just as well here, thats all. But things are often very different in other parts of the country

Honestly, a county wide system - when done properly - would fix the issue. Unfortunately, that simply is not going to happen for fiscal and political reasons. Until then (if it ever comes) i think regionalization is essential. Regionalization where there are contracted standards - response times, staffing, levels of care, etc. The biggest issue with EMS coverage in this county is the horrendously (and really, inexcusable disparity) large disparity in the type of service it's residents have access to. You could argue that those that reside in the lower portions of the county have a better chance of surviving injury and illness because those agencies are either completely paid, combination (in such a fashion that there is always coverage) or one of the few all volunteer agencies that get actually crew up and out. You simply can't say the same for the northern most sections of this county. Yes, you get medics on every call but they get tied up on the BLS jobs and on the ALS - while we may be able to stabilize or prevent further harm with some of our interventions - definitive care is still an ireplaceable piece of the puzzle. Paramedics or other first responders shouldn't ever have to consider transport in a flycar, police car or firetruck - unfortunately, it has happened and it will continue to until the problem is solved. Some agencies have stepped up to the plate and started to place paid EMS providers on first due ambulances during day time hours. This helps - but at 19:00 its often back to the same old nonsense. The bottom line is that some volunteer agencies do a very good job at maintaing coverage. Those agencies know who they are, and it's fantastic that they do it with such enthusiasm. However, these agencies are becoming few and far between - relying on one member doesn't cut it and is simply not fair. For those that come out of the woodwork to pound their fists and stop their feet in an effort to snuff out any of the things Chief Flynn spoke of...well..i can only say that i hope you are never put in the situation where a lone paramedic responds to you're residence and has to employ you or someone else in you're household to assist him/her in preforming CPR or ventilating a loved one because they are on the third round of mutual aid requests and the only ones answering the dispatcher are those pesky crickets.

lets explain cost effectiveness to the 50 year old male who owes his life to an LVAD because it took a bus 20 minutes to get there. Honestly, when is enough enough? How many people need to die (yes, people have DIED...don't act like you don't know) and/or suffer unnecessarily for things to change?

I thought the crew cabs were ordered so that crews could recline a bit more when 89?

The Wenckebach is an AV block (2nd Degree Type 1) which causes you're PR interval to elongate (heart rate doesn't really increase) until the sinus node's stimulus is not conducted through the AV node (you're ventricles don't contract). And i think you're referring to an elongated QT syndrome. I'm not a physician and no representative of the FDNY, but i think these types of cardiac conduction abnormalities may, in fact, become an issue if you were to go through the application process with the FDNY. I don't think anyone can tell you for sure, you would have to go through the process - i am sure you would get "flagged" and would probably need to go through some more testing/evaluation and then possibly appeals processes (if you were denied). More importantly, maintain a healthy lifestyle, stay away form tobacco and check in with you're physicians regularly! Good luck!

Just as an addendum to my initial comments - it's not like EMS members are incapable of being trained on providing care in "rescue" situations. FDNY*EMS has the haztac units and rescue medics. The latter proved themselves at the crane collapses in manhattan a few years back. UMDNJ EMS operates what looks to be a pretty impressive rescue branch of their EMS system which serves Newark. Pittsburgh EMS also operates similarly specialized units. UMDNJ EMS Pittsburg EMS Rescue Divison Again, these solutions are unique to their regions and fill voids and provide flexibility to those regions. It's not applicable everywhere, but it's not as if its impossible....the tone of the video would have you think otherwise, thats the only thing that bothers be a bit.

Wake County EMS is probably the premiere service in the nation (followed close behind by others like Austin Travis County EMS). I never worked for them, but have a close friend that did and my understanding is that some of the discord you see in this topic doesn't exist there, FD and EMS work rather well together and complement each other where and when applicable. Wish it was this way everywhere. I understand what you're saying, but i just don't see it as being necessary to complete a call- granted things are established and run properly on both sides of the isle. The way things are set up down there make it work, operationally speaking, as well as it does. Besides, the rescue operations side of it is only part of the picture - i'm not really sure Wake County (sticking with this example) would clinically be where it is if it were part of some other agency - simply because that their entire focus has been on propelling prehospital patient care and awareness forward based on the most cutting edge equipment, techniques and science. I think there are many ways to deliver EMS to the public (thats more or less a fact) and naturally an FD based solution is one of those. Its clearly applicable in some regions, while other regions are served equally as well both other models. I don't think it's accurate to generalize and say that fire based medics don't care about their patients and only care about fires - there are medics in every form of system who are in it for the wrong reasons and simply don't do the right thing. Personally, i think that an autonomous third service is what EMS needs to be - especially in this area. But again, that's just my opinion.

I'm not talking about the study. And my statement had nothing to do career or volunteer departments. I guess the whole operation seems like overkill to me. 2,100 runs is substantial, but not out of control - especially if less than 1,000 are fire related (given that the EMS problem was corrected apparently). The mechanic, the cleric, the stand alone dispatching...it just seems like overkill to me. Just my opinion.