STAT213

Nope, sorry. I disagree. Should you have to have a permit to speak freely? To not be stopped and searched illegally? Nope. When the trouncing of your rights begins...where will it stop? Oh, wait, it has begun. What's next? RA

Have you seen some of the "woodchucks" up here? You'd be armed too!! That and all the freaks from south of the border. And, by the way, I am NOT talking about the border that Mr. Bush wants a fence in support of. 636, talked to Palmer lately?

The rules for NH are quite simple. It is a SHALL issue state, meaning unless the PD can find a really good reason to deny you a permit, it is issued to you. You may then carry pretty much anywhere you want in the state, concealed. The fun part is that if you want to "open carry", as in a gun on your belt, that is perfectly legal without any kind of a permit. Same with having a weapon in your house. No permit needed. For those of you who have purchased a handgun in NYS, you know what a mess it is. Here, you walk into store and buy gun. As long as you pass the federal rapid background check, you walk out with the handgun. Now, VT is even more fun. There aren't handgun laws there. None. Zero. Go buy a gun and carry it where you want. Period. Nice, huh? I tend to think so.

The REAL problem is that you guys all live in a state that has trounced your second amendment rights to death. It shouldn't be SCARY to see a handgun in plain view. Now, that's not the best way to carry, but it works. It should also be perfectly legal WITHOUT a permit or shield. Just my $.02 Carry and work safe!! RA

I recently took a ground ladders class from an FDNY guy named Ciampo. GREAT class if you can take it. One of his pet peeves, which I now notice on every fire apparatus pic is the way we rack the ground ladders on our pumps. Why do we put the roof ladder in front? Most of the time, you have to take it off, drop it on the ground and then step over it/on it to then get the extension ladder you need. Its one of those things that we do, just cause we have always done it that way. Turn the whole thing around and nest the roof ladder in the back. Makes life SO much easier, because generally, we need the extension ladder first. Here is an example...and I am NOT picking on YFD...just the first one I found on Seth's site. RA Thanks to DOC22 for pointing out my mistake...fixed!!

WAS asked about the downsides of Etomidate. There really aren't any (well one). Its a fabulous drug. It has little or no cardiac side effects, no effect on blood pressure. It is extremely short acting. Repeat dosing has been shown to have some negative adrenal effects. Thus, its recommended to be given only once. My mentioning of downsides was specifically related to a MAI protocol. While the whole concept of give it, and if you can't secure the airway bag mask ventilate them seems like a good idea, it is a very dangerous five minutes. Especially when you take a breathing patient and make them non breathing and are unable to control their airway. Both RSI and MAI are inherently risky procedures, but its been pretty well proven that MAI is the more dangerous of the two. So. What to do? The really messy ones are facial trauma, trismus, and the like. Do you prohibit use of MAI in those situations.. You see where this is headed, it is the slippery slope, and it is why the med control docs are so nervous about letting us do it. Here in NH we have an RSI protocol, but no MAI protocol. They even go so far as to say those allowed to do RSI can't do MAI. (With the same drugs) Weird, huh? Or is it. MAI is dangerous territory. The medical control doc for the largest service in NH is dead set against his troops using MAI/RSI. Why do you think this is? Its about control and education. Rob

Ok. So, why is it on the outside? Is there a good reason? p.s. Not trying to start any kind of pissing contest here at all. Just a question. Rob

Yeah, this is one of those really sticky political messes. You have a small community with a large tax burden and a good sized standing fire force. You have a mayor looking to make himself look good. The mayor has a good point and what he is saying makes good economic sense...in a world of paper and toy cars. Its just not based on reality at all. But, how can you defend against it without looking like the bad guys. How do you come across to your taxpayers that you aren't a bunch of prima donnas who don't want to do some extra work for the community that is paying you quite well to sit in an air conditioned firehouse with your feet up in a recliner? In my opinion, first thing to do is a education campaign about a day in the life of a FF. Our day is like this. 8AM shift starts. 8-9AM Truck checks. 9-11 Training. 11-1230 PT. 1230-1330 Lunch. 1330-1530 review local buildings and preplans. You get the idea... Its almost like being caught with your hand in the cookie jar. The other thing to do is to hunker down and not give anyone any reason to think you aren't working or training. Stop drinking your coffee on the bumpers of the trucks waiving at joe public as he goes off to his job. Yes, it may seem to look good to be friendly and waving...but what are you really saying? Ha ha look at me, feet up on the pump, enjoying my coffee and you're in traffic headed for your crappy day job. Don't give them a reason to think you are wasting their money.

This is awesome. Anybody who has ANY kind of influence in their towns or hospitals should push for this any chance you get. It cuts down dramatically on times. St. Lukes should be applauded for securing this. Let me tell you, it certainly was a goat rope when I was at STAT to go to St. Lukes. Factor in the ride to the park and you MIGHT be able to just drive to WMC faster. And trust me, it had nothing to do with the Mobile Life Folks. They are/were awesome. It just added almost a half hour to the trip. Now, as for landing at the St. lukes pad to DROP off patients...Has something changed? Never did that particular maneuver.

Oh boy... Etomidate is a great drug. Its a non barbiturate hypnotic with rapid onset and short duration. Here's the kicker...the research is quite clear that using sedatives ALONE to achieve, or attempt to achieve intubation lead to more complications. Either RSI or don't. They passed on the idea of MAI up here. Many places do it. If it ends up in your drug box, please don't view it as the end all and be all. Etomidate is a great drug, when mixed with succinylcholine. Be very careful using it alone.

I went to the "Five Years After Tarver" lecture at FDIC and really had the 'ol eyes opened by what they had to say and by what they are doing out there for RIT/Downed FF. Pretty cool stuff, for sure. They no longer have a RIT assignment, but what they call an "on deck" team. Each working team is backed up with a crew on the outside and rescues are done from the inside out as opposed to the outside in. They practiced this with the ENTIRE department and were able to reduce extrication times of downed and missing FF dramatically. It goes against a lot of what we believe is way to do things with RIT, but they showed how well it worked. That, and they now send 7 engines on the FIRST alarm at commercial structures. If you can read about what they did and are doing out there or catch their show at a conference, I highly recommend it!!

So you guys are doing this all for free? To me, you are being taken advantage of. I bet the fair isn't losing money, and I bet they have to pay for PD coverage. Why should EMS be any different? I would at minimum begin asking for stipends to cover the crews and wear and tear on your rigs. It will begin to wear on your members over time; the first year was probably fun, but it will wear off.

There is a thread following the brother from Oneida's progress at www.signal99.com . He is still in the hospital, and his wife has been posting to the site on a regular basis. According to one of her last posts, he is doing well overall, but was faced with the decision of having his elbow fused or his arm amputated. He underwent the amputation surgery and is doing well, and she states he is in good spirits. Wish him the best.

In terms of what? The evidence in the literature is quite clear that getting the patient to Level One services the quickest is worthwhile. Its like asking if medics make a difference. Anecdotally, sure we do. Can you prove it? Nope. I like to think the things I did on the a/c made a difference, but we are learning new things everyday, especially coming from Iraq. Guess what's coming back - the tourniquet!!! More later...gotta head out. RA

All tx in the a/c are standing orders based on protocol. Lots more drugs, and agressive pain management. Up here in NH, we are doing Chest Tubes, Central lines, surgical airways and giving blood to MS trauma patients. Last I knew, STAT/LifeNet was not that aggressive. They might be doing central lines now, but we were not when I fled.

So, let me pipe in on a few of these things. Standby. This whole concept was started for a number of reasons. Yes, the crew can be anywhere in the hospital so it can take time to assemble at the aircraft. While I was on the STAT Team, we didn't have assignments in the hospital per se, but could be asked to help out in any number of places. ED, IV starts, NICU, etc. There were times in the history of the team when they were assigned to be certain places at certain times. The other reason is so the pilot can check weather. But, if the crew was in quarters as described in Albany's situation it is not as important. Boston Med Flight doesn't do the whole standby thing at all. You either want them or you don't. I can see both sides, but everywhere I have worked in my 9 years of flying, we used the standby concept. Places where the a/c is stored inside, its a big help. What the crew can offer...That depends on the program. Certainly RSI. The IO is another. (Don't you guys have this yet in NY?) As for the whole snakebite thing. I did a few of those in my day at STAT. We had to beg to be able to land @ Jacobi. No one else had the antivenin. As for safety. Someone mentioned that helicopters are dangerous. Why do you think this? Ambulances are spectacularly dangerous in design and practice. Granted when a helicopter crashes, it makes the news. Ever wonder why we don't hear about every ambulance crash? I would argue that its because there are just too many of them. If you want some good stats on crashes, check out www.emsnetwork.org and click on the crash section. I do strongly agree that you should have LifeNet come do their PR/Class I used to teach them, and they are usually a good class.

"Stat, do these times include pre-flight? Does the clock stop when overhead or when you land? What's a realistic turn around time if the patient is waiting at the LZ?" Those are average times for the flight to the scene. Generally add about 5 minutes for weather check and departure. A good on scene time is 10 minutes. By this, I refer to skid to skid times. We do look at these things, and try hard to improve. Like anywhere else, things don't always go the way you like them to. I have had 5 minute skid to skid times. Some were longer. I can tell you as a flight medic, I was always worried about the times and destinations, because we were called to be quick, not to screw around on scene, and not to fly to a hospital someone could have driven to themselves. Its not a perfect world, but its my world and I take a lot of pride in it. Rob

"you should never wait for a helo" Gotta disagree. Put it this way. If you can sit and wait for a helo for fifteen minutes, and they will get to the Level One center in 45 minutes vs. taking them to the local hospital where all they can do is scan them and secure their airway, and all that - including phone calls to the level one to get acceptance - takes 2 hours, sit and wait...its better for the patient. Burns, same thing. Set up camp and wait. On some calls it is better. I promise!!

There are a few exceptions to the whole who should fly thing. Criteria for Air Transport from a scene include: (from the DHART website) Helicopter transport is recommended for the following: * Head injured patients with one of the following: *GCS less than 12 or deteriorating *Focal neuro findings * Penetrating injury or open fracture * Patients with the following chest injuries: *Possible tension pneumothorax *Major chest wall injury *Potential cardiac injury *Penetrating chest wound * Patients with unstable vital signs including hypotension, tachypnea, severe respiratory failure * Burn patients with potential airway involvement * Patients with spine injuries with neurologic involvement and potential airway/breathing compromise 3) Exceptions (patients who may require transport but do not meet the above indications): * Long distance transports of critical patients (more than 2 hours by ground) * Situations where resources at the sending facility are severely limited: o Mass casualty situations o Lack of availability of ground transport o Lack of availability of critical care personnel to accompany patient * Weather conditions that ground transport dangerous (e.g. icy roads but clear skies) There are your exceptions. RA

It sure is a BK 117. In fact its N117NY, the same one serving as Air One right now. It was originally out of NY Cornell hospital, based on the East Side of NYC on one of the helipads. Memory escapes me as to which one. They were doing next to no calls, so moved it up here to WMC in a deal with the old county hospital. It gradually evolved to STAT Flight, and now Life Net. But, it is the original aircraft. She's a 1987 BK 117 A 3. Some of the pilots who are still flying with Air Methods picked her up off the boat from Germany 20 years ago. The lead pilot has been flying it for its entire lifespan. It came up to WMC looking like it did in the photos. The paint scheme is what makes it look like something other than a BK. Hope that helps. Its a great aircraft...Did a lot of fun calls in it.

I say as little as possible. If its BLS, it is literally agency ID then 46 female ankle injury from a fall, awake and alert, see you in 5. ALS, I might give some details if I want them to be ready for something big, but if its a routine workup, I'll just say 46 female, CP workup, had the meds, vitals are good, see you in 5. There really is no reason to say things over the radio that you'll just have to say again to a different person. Up in the syracuse area, all but complicated cases are transmitted to the ED's via computer through the dispatch agency. It works slick, and once the EDs get used to it, they actually love it. No more answering the damn radio every few minutes.

Actually, this has been busted by the ACS and ATLS. I don't have the literature at hand, but here is the simple way to show its is just bad information that we all have been taught. How many of us have taken an upper arm blood pressure to find 50, 60 or 70 palp? I know I have. Applying what we (including me) were taught, this should not be so. Not having a radial pulse, or a femoral for that matter is good indication of severely impacted perfusion, and should be treated appropriately. As for taking BP's on any extremity, I concur with what has been said by others here. You can take it anywhere and frequently on burn patients, you are forced to do just that. However, palpation of carotid pressures is as of this point still discouraged. Something that I remember to this day from paramagic class: 50 % of what I am gonna teach you numbskulls is wrong. I just don't know what 50 % yet. - Dick Cherry

I would be really careful relying on your insurance company. I had a friend who filed a claim for a stolen green light, and when they found out he was running lights on his car, they dumped him. Just make good and sure before you rely on someone else's word about your insurance company.

I was thinking tassels, a basket and some small LED's... Get well soon!!! RA

try this as a starting place.. http://www.phillyfirenews.com/apparatus.aspx