STAT213

I agree that we should not be carrying any sort of weapons as EMS folks. While there are a lot of mutts out there, there are people who respect that we are not cops. Now, some of us may look like cops with our uniforms - that is a whole different issue - but once word gets out on the street that we are carrying weapons, and word will get out, we lose something. I think ALSFirefighter said it best...use your brain. Know when things are gonna go bad and have an out.

I think valuable information would be # of FF per capita in other major US cities. How does Philly compare? How many houses per capita? How many calls are those engines going to? etc, etc. I think you need information such as that before you can make a full decision. 60 staffed engines sounds like a lot, but we only have 4.

Huh? Closest MOST Appropriate facility, right? Did I miss something. The WREMSCO protocol defines it as nearest appropriate. So, where is the problem. Take the patient where they need to go? Who will question this or attack your decision? I am curious why people don't expand the protocol to its limit. Where is the apprehension?

Someone above here mentioned... " I learned long ago." There are a lot things that we learned long ago that were wrong. Very wrong. That CPR works and we should do it until we get to the hospital is one of them. It is 1) generally futile and 2) essentially ineffective in the back of an ambulance. My paramedic instructor taught me that 50 % of what he would teach us would be wrong. He just didn't know what 50 % yet. He was right. I learned about Epi in cardiac arrest, massive fluid resus, MAST Pants and CPR for more than 20 minutes. There are some golden rules out there. Just once, though, try pronouncing someone in the field (granted of course, you have the protocols for it..) and see how it works. You'll be surprised. A lot of the family's anxiety comes from the way we barrel into their house, pounce on their loved ones and fly out. Slow it down, take a breath and see how it works. You'll be amazed. RA

A few responses to some of the things on this thread. I live and work in NH now, and have WAY better protocols than anywhere in NY. That is why after 20 minutes of CPR, an arrest can be terminated. BFD EMT-B, I appreciate your sentiments about the save you had. I can tell you that after 15 minutes of asystole and 3-5 minutes of down, all you are saving is a heart. The person they knew is dead. DEAD. Maybe not today, maybe not tomorrow and in all likelyhood, you just made the family's decision 10 times harder because they are now faced with decisions like withdrawl, life support, etc. As for the worthy good bye, I would argue that one until I am blue in the face. A week of lingering or fighting in the ICU is not healthy (for the family). The person will die, or will be brain dead. Performing CPR in the hope of a miracle is not worth it. You will cause way more anguish that you solve. (over those 100 arrests.) The worthy good bye is the one that you arrange in their living room with a calm demeanor and explanation. I have done this many times and it works really well. You calmly explain to the family that their loved one is dead. You explain what you are doing to try and bring them back to life. You bring them into the room where you are working them and let them hold their family members hand. This takes an incredible amount of professionalism and a calm demeanor, but it is very rewarding. Once you end the efforts, you now have a NEW set of patients to deal with: the family. Assist them in getting the PD and the funeral home there. Help them through what is a horrible day. Now, this has to be done with everyone's agreement, and its not just a rush in, work 'em tell 'em he's dead and leave kinda thing. Its a compassionate, calm effort.

why? how is this any different from what an ED doctor would do? we are following the same protocols, written by the same people. you don't get sued for following any other protocols, do you? oh, and it is OK to stop CPR once you have started. You don't have to continue just because some well intentioned soul started working a corpse. Even in NY, you can do this. Its that box on the PCR that is "obvious death." Be not afraid.

All I can say is...its about time. Dead is dead. I was calling codes back in the 90's upstate, then moved downstate and was told we don't do that here. Thankfully, my current protocols allow me to terminate after 20 minutes of BCLS and or ACLS. So, if we don't get 'em back after 20 minutes, its over. OVER. You bring the family in and explain the situation, and then TERMINATE. Dead is dead folks. Ain't no amount of CPR and drugs that'll fix it.

Two things I would like to add. Those who were in favor of this insane practice did get quiet fast. Why? Did you realize your inane way of thinking has no place in the fire service, or did you just get scared off? Its funny, I actually enjoy these threads, and they are the most read... Second, 585 mentioned something about not going to LODD funerals for people that did something stupid. This touches a nerve in me as a flight paramedic, and I have had this thought more than once. (One of the more high profile accidents lately in the airmedical industry was because the crew was being STUPID. Period. Avoidable deaths.) Its a great idea. But, where do we take it? Do we not goto the funeral of a brother/sister who was the overweight smoker? Hmm. Would be interesting. If you are not fit for duty, and you die, no benefits, no funeral. Ultimately, its a choice you made and we should not suffer for it. This is a pretty strong posture, I agree, but what if...

Arrrgghh...I can't figure it out. You are not a cop, why do you want a "shield?" Step back for a minute, all of those who are arguing that you should be able to carry and display one. WHY? Again, WHY? It is not needed. Is it to make you feel better about yourself? I guess its like the parades, I just don't get it. Maybe that's why I left New York State completely. I just don't get it...

This issue is slightly near to my existance, so I will offer a few comments on it. As for safety, though there have been a large number of crashes recently with medevac helicopters, it is still safer in the back of my helicopter than in the back of my ambulance. I would so much rather be flown to a real trauma center than be taken to some little hospital any day. Should you be flown 5 miles in Westchester County. Doubtful, very doubtful. Helicopters have their place. Landing in Millwood to take a conscious patient to WMC isn't one of them. All that being said, the debate is important and should be continued. Just don't believe everything you read because someone with MD after their name said it.

You have been told that you can't wear or display your badge in NYC. The PD says they do not want people in their AO with non NYPD issued shields. Ok, that tells me not to bring one to NYC. Your badge is not recognized there, even if it was issued to you by your department. You have no need to carry a badge in NYC. Where is the issue? Why do you need to carry a shield in NYC? Can someone give me a good reason as to why you would need (need now gang, not want) to carry a shield in NYC?

All I have to add to this whole dialogue is that I am SO glad I don't have to put up with this kind of doo-doo anymore. It is just not tolerated in a professional firehouse. You speak up out of place and you are put down and shut up. Quick. New guys get it the worst, but even the old timers get their share. I have run into the type of snot nosed twits people are referring to on here. Thankfully, just not in my firehouse. Munson is right, there is lots to learn and I can learn from everyone out there. But, I will agree that some little twit flapping his gums is not the guy I listen too hard to.

I feel old now. Thanks guys... Though it has been a while, I have used them more times that I can count...

How does the government let it happen? What exactly do you mean by this? It's not the government's fault that these hospitals can't manage their finances properly. Now, it may be the government's problem in that they only pay 80% of 80% for medicare bills, but there are plenty of hospitals out there that do just fine even with this limitation.

Just realized that the original poster asked about NYC. Nope, no dedicated EMS a/c. There is no where to land in the city. Once in a blue moon, you can convince the PD supervisor to let you land @ Jacobi. Otherwise, you cannot land at a hospital. The Pan Am rooftop crash and Mayor Guiliani ended anybody landing on a rooftop pad in the city. For example, if you are bringing a patient to Columbia Pres by air, you have to land @ West 30th and go for a drive, a LONG drive in the back of somebody's ambulance. Rob

whoops. my bad. i had the "nor" right... thanks for pointing that out!! Rob

Somebody above me stated its NFPA/OSHA rules to be geared up while driving/riding. Can you cite the specific NFPA Standard? Now, while working, heck yea. I highly doubt you have all the info. I work for a NFPA savvy department, and have never heard this. In fact, knowing what little I know about the NFPA I doubt they would mandate something that would hinder you. In, addition if this is the case, how do you reconcile the wearing of NFPA recommended headsets. Aint no helmet worn with those. As for putting on your gloves on the way to a call, nope. That is just plain silly. I would really check your source of info. Might be one of those myths that are out there...

Ok, here is the lineup. LifeNet (a division of Airmethods Corp.) runs four aircraft in the state. Life Net 7-1 Aka Albany One an EC 135 out of Albany Med Life Net 7-2 out of Glen NY. Either an AS 350 B2 or a BO-105 Life Net 7-3 aka STAT Flight Air One BK-117 A3 out of WMC Life Net 7-4 aka STAT Flight Air Two BK-117 A4 out of Kobelt Airport. WMC USED key word here folks USED to run the a/c. The defaulted on payment to their vendor and it is now privatized. Joy. Also in New York, located out of Stewart Int'l Airport is the NYSP Aviation Division. They have 2 A/C. Lifeguard 17 a Bell 430 Lifeguard 18 a Bell 407 They are staffed by Mobile Life Support Services and have one paramedic on the a/c. Yup one. Not a nurse and a paramedic, but one paramedic. Oh, and they operate in violation of a number of federal statutes. But, who is counting? In Jersey, you used to have just 2 a/c, both run by the Jersey State Police. There are now 4 One NJSP S-76 B is based out of an airport in Northern Jersey @ Somerset County Airport. The other is based out of Trenton; they also run a spare. PHI runs 2 aircraft in Jersey, in partnership with Atlantic City Medical Center and with Monoc. Both are EC-135s. Connecticut has the two a/c run by Hartford Hospital as mentioned above. Both are currently BK117s (not sure if A3 or A4) One is based at Hartford Hospital and the other is Based at Backus Hospital in Norwalk, CT. For those wanting pictures of EMS helicopters, here is a link to pretty much the best site around for them. Its run by a 10 year old kid. http://alecbuck.com/airambulance/mediagallery/index.php Want to know more. PM me, I'll fill you in on the rest. Rob

I think I can offer some insight on this one... A resource for anyone wanting to play on helicopters: www.flightweb.com If you want to be hired on as a flight medic, get ALL of your certs, and instructor ones help more. Have 3 or more years of good experience in in a BUSY 911 system. Have some experience doing ALS transfers. Get your CCEMT-P and be prepared to take the FP-C. As for the comment about nurses...there are no nurse/nurse programs left in the Northeast. STAT used to fly with one a/c as nurse/nurse for the neonate calls, but those days are over. LifeStar still flies with a Nurse and an RT. So, don't apply for a job in CT. If you really want to do it, do some ride alongs. See if you like it. Its not like any other medic job out there, and is really a mix of nursing and paramedicine. If you have any questions, PM me. I've been doing it for a while now.

My LT asked me once, as we were going to the cat in the tree call... "Rob, have you ever seen a cat skeleton in a tree??" I 'bout fell out of my seat(belt), but the cat owner didn't quite see it as funny. We are a service organization, and the call of last resort for many people. Go there, offer suggestions and do what you can. Remember, that person calling may be the one vote you need to get that new fire engine/house/gear/STAFFING... I think those before me have covered the options pretty well. R

One thing my department added to the puzzle was a separate pocket just above the ankle for a section of bailout line/webbing. Works pretty well and is easy to reach as you are crawling around on your belly.

I'll always remember something a very seasoned (and good) paramedic told me when I started in this profession... "The amount of gear carried on the belt (or person) is inversely related to their knowledge and ability." I liked what he had to teach me, and began to believe what I saw. My gear goes in my bags, and my hands in my pockets. To this day, when I am doing EMS, you won't find a thing on my belt, and nothing other than a pair o gloves and one medication cheat sheet in my back pocket. Now, there are a few more tricks unto the flight suit, mind you... And, of course the bunkers are a whole nuther topic... Be safe, Rob

Ok, all you smooth bore fanatics... I agree fully that the smooth bore has its place, and is a great nozzle. How 'bout foam? Can't do it with a smooth bore, right? What do you feel are the advantages to having a smooth bore vs. the ability to flow foam? From what I have been taught, (I am talking about Class A foam here) adding foam to your water gives a huge advantage. So, add that to the discussion...

Doubt things have changed, but when I worked there (3 years ago), RPS (www.rocklandparamedics.org) staffed a number of medic units. Medic 1 was a RMC/Regional truck in Haverstraw. Medic 3 was in New City at New City Vac. Medic 3-1 was in Tuxedo (Orange County) Single Medic. Medic 2-1 was in Orangeburg in their own station. Medic 2-3 was in Ramapo at RVAC. Medic 2-5 was in Spring Valley @ SHVAC. Medic 5 in Nyack at their own station (shared Building with one of the Nyack FD companies) All but medic 3-1 staffed with two medics, two sets of gear. Again, my info may be a little out of date, but I still talk to some of the folks there.

Chief, Is this for your new ladder, cause we have already had this discussion!!! Seriously though...I have found some great answers, info and resources at www.isoslayer.com. From what I have seen on their website, they have their ducks in a row when it comes to ISO questions. Good luck, RA