Goose

ABCs and utilize diesle fuel

The only additional thing i want to add is that the majority of protocols regarding tasered patients seem to be liability driven - hence why PD calls EMS and why EMS agencies have unique protocols pertaining to the subject (remove/don't remove barbs, ALS patient vs. BLS patient, etc). It may be beneficial for the region to release a position and protocol regarding this.

with no prior notice...

barbs stay in, ALS patient w/ continual ECG monitoring, PD in the bus

Interesting way of looking at it. It does appear he has genuine remorse for his conduct that night and surely any sort of time in state prison is no vacation. But it still bothers me that (like you mentioned) if this was a law enforcement officer 1) it would have attained far more press and 2) he would have been convicted of a higher degree criminal act and would undoubtably be serving far more time. Couple that with the likelihood that the Davis family received little (when compared to the death benefits offered to police officers and firefighters) in the way of compensation for their loss, i can't help but feel upset about the outcome. God bless Mark Davis for his selfless sacrifice in his valiant attempt to help a fellow man. Rest easy brother and least we forget what you gave at such a young age.

If you reread my post, i said there has been some debate in regards to Crowley's claims (never said i dillly-dally on scene or agree/disagree w/ the golden hour). For the sake of an honest and intelligent discussion those debates/concerns should be discussed. I do, however, believe that air ambulance assets have a very narrow window of utility in westchester.

I think the bigger concern is why the helicopter is being requested in northern westchester to begin with. As a small side bar, there has also been some debate over the validity of the "Golden Hour." Some say it was a pitch by R. Adams Crowley to ensure funding for the U of Maryland Shock Trauma Center.

I don't want to get into a debate about narcan or how it's absorbed, but i did do a quick search before my original post to see if i could find the absorbtion rate of IN narcan specifically and found this: Source Additionally, i would rather see public funds directed to programs like DARE to target local youth and prevent future use of this crap. I just don't see the point of spending money in rolling out a program that expands the availability of naloxone in order to try and save people who very well may go back to cooking up some black tar the second they are discharged. That said, i respect where you're coming from and the study was an interesting read

EMTs are allowed to check blood sugars. http://www.werems.org/pdf/BLS%20Glucometry%20Approval%20Steps.pdf While narcan is a generally safe drug i don't really giving it to PD of FD (who don't always respond on EMS calls) makes much sense. As far as BLS providers....i still don't know. I was taught, and practice, the titration of narcan at intervals of .4mg until respiratory rate has improved to a life-sustatning rate & quality. Blasting someone with 2mg will either create for a violent situation or create the potential for an airway obstruction. It doesn't appear you get that ability w/ IN administration. Besides, if these people are found in asystolic arrest.....narcan isn't going to save them. Not to mention..Westchester is heavily saturated with paramedics....and don't a lot of those northern westchester ALS units arrive before (sometimes WAY before) a bus?

Interesting discussion - and some great points have been posted. It's nice to hear from some newer EMS providers. I think there are a number of issues at play when we talk about the quality of providers (EMTs and Paramedics) being graduated. For the sake of this discussion i will try to highly two of the larger (in my opinion) realities. 1) I think EMS education, nationwide, has become problematic. There are an awful lot of solid basic and advanced programs that exist out there, i think we are luckily to have a few locally. Unfortunately, some see the education EMS providers as more of money making opportunity than an opportunity to graduate thoughtful clinicians with the skills necessary to effectively care for acutely/chronically sick & injured of our society. I think this is why a very large part of me wants to see EMS education fall under the NY Dept. of Education. 2) As far as the strength of EMT basics more specifically, i think this ends up being a regional problem. The new york city 911 system (municipal & private) has some amazingly talented basic providers. I'm talking about incredibly seasoned professionals with a strong clinical ability. I was fortunate enough to come across a number while i was a paramedic student. I think there are a host of reasons for this - volume, retention and the design of the FDNY EMS system. The same exists in more rural sections of New YorK, in large part due to the design of the system and general lack of advanced providers in those regions. Westchester is fortunate enough to have an EMS system (if we can call it that ) that is heavily saturated with Paramedics. Many systems require a paramedic evaluation on every run. Combine this with low overall call volume and i think we have ourselves a recipe for "disaster," if you will. EMTs in some sections of the county may simply not be getting the experience or chance to practice their assessments and skills with the frequency that is required for mastery or that they personally desire. We could probably talk until our fingers fall off about each of these individually, and maybe even more about what goes on within our own county. But these were the first two that came to mind while i was reading the other responses. That's my limited and likely meaningless two cents on the issue. I do feel that ALS is/should be the standard of care but i also know every call requires solid BLS to be successful.

I really think any radiation that makes it's way to the united states will likely be negligible and far too dilute. The accident at chernobyl was far, far worse than this (at this juncture at least) and actually propelled nuclear fuel and fission products far into the atmosphere....what made it's way here, while detectable, never really amounted to much. As long as the reactor vessels hold up (apparently there may be some leakage or a breach at #2) the melted corium will remain intact and confined to it's respective vessel and pose little risk to the general public. The spent fuel pools are a different story and are a bit more concerning...but again we just don't know all that much. I think everyone is concerned and its good to stay on top of things. But, let's not stir up fears prematurely. There is no reason to go out and get potassium iodine pills and cover ourselves in lead. It's a delicate situation, but not out of the realm of being dealt with. Aside from that, the information available to the public is limited. Flying gives you 5x you're normal daily dose of radiation....radiographs & CT scans give you far more (~months dose or so)...should we stop flying and should MDs stop ordering these tests?

Was just reading through some of the news.....looks like the japanese government has confirmed that there is, at the very least, partial meltdown of reactor cores in reactors 1, 2 & 3. No indications that the molten core has burned through the reactor vessel. Not particularly good news, but as long as the reactor vessels are not breached the radiological fall out should be manageable if not negligible (like they were at 3 mile island). The biggest radiological concerns i have are related to the release or escape of iodoine-131 and Cesium-137. Iodine settles in the thyroid....especially in children and cesium is absorbed and stored in the muscles and bones (primarily muscle tissue) because the body mistakes it for potassium. As a side bar, don't listen to any of the news organizations who try and relate this to the April 1986 incident @ Chernobyl's #4 reactor. the RBMK-1000 reactor was a graphite moderated reactor w/ no containment vessel or building....and allowed the core to burn, fueled by the graphite, openly for weeks.

I was referencing discussion about foreign aid, not domestic spending. So, i'm not quite sure i follow you're question. If you're looking for an opinion, then i would agree that there is an awful lot of frivolous spending with little to no return. Thats why i would support allowing the president to possess line item veto powers.

The problem with foreign aid is that the US government has no mechanism or apparatus to ensure that the billions we dump into our "national interests" overseas actually makes a difference. The money rarely, if ever in the worst cases, gets to the people and programs who need it the most.....it often becomes bolus of cash for corrupt leaders and/or regimes. Sadly NGOs (non-governmental organizations) tend to be far better about putting cash to work and making a difference on the ground. Look @ some of the work the Bill & Melinda Gates foundation has done in terms of AIDS/immunizations/hunger.

Isn't that how it's always been? Obama, Bush, Clinton, etc, etc, etc are all cut from the same cloth. As far as Moore...hes a turd. I remember reading a few years back that he went out of his way to avoid union rates for his productions and he owned stock in major defense contractors.

The regional protocols only allow you to obtain IV/IO access and perform intubation. Besides, i know i wouldn't be comfortable allowing any of that, especially if it involved a pharmacological intervention. We should probably create a new topic to discuss this further.

Not going to disagree with you thats its nice to have a second set of advanced hands. But again - at least here - the "I" scope of practice is limited and courses are not readily available. Likewise, they are operating in a system heavily saturated with paramedics - the opportunities for them to maintain proficiency in IV, IO, Intubation, etc i would persume would be somewhat limited. In areas where paramedics are more of a regional resource (as appose to local one, as we are fortunate to have in westchester) i think they bridge a gap. I work fine alongside EMT-Bs now with no issue, so like i said before...not sure how applicable it is for westchester. In sake of relevance, i also agree that leadership positions should require at least the EMT-B level of certification.

I have a feeling that more than 90% of the time paramedics either beat VACs or are only a few minutes behind them in westchester. I just don't really see the point here, especially when the scope of practice is so limited.

Thats definitely not the case at all. Lights are part of a warning package, if you will. That package includes color schemes and patterns, emergency lighting and audible warning devices. Think about it, why are more and more agencies adopting European style color schemes and pattern and why are chevrons beginning to be mandated for emergency vehicles? Because studies have shown that certain colors, color combinations and patterns increase visibility to the human eye and help direct motorists away from the vehicle.

There isn't a local protocol for emotionally disturbed / excited delirium patients in Westchester, thats the real issue. These are sick people who have a very good chance of becoming far more ill (ie: many go into cardiac arrest from being so acidotic) if their episode is not properly treated. Nasal versed is surely an option for sedation as is Ketamine...im also not sure Haldol is much of an option because of it's tendency to prolong QT interval. Would be nice to have a well written protocol, hopefully its something being worked on

x2 on developing a policy w/ you're medical director. Likewise, PD are the experts on restraining people, let them do it. As far as sedation for the combative or in cases of excited delirium, Westchester does not have an ALS protocol in place for that (probably should?)....i believe NYC does as well as other parts of the tri state area (namely Connecticut)

Do they even have enough people to staff the field com truck at that hour?

I think thats somewhat routine in police related shootings, no?

Glad to hear that they were cleared. Sadly, it sounds like the family is going for blood in the civil circuit...

They aren't going to tell you anything over the phone. The time frame is 6-8 weeks, in my experience it usually ends up being 7-8 weeks. Seeing as you've waited seven, you may very well see you're results this week. Let's not forget that the weather has been very poor and may have delayed the results further. I'm sure you did fine.