Croton-on-Hudson opts for full-time EMT

[JJB531 652]

The Medic is not going to transfer care unless there is a crew to transfer to. Before the paid EMT, it only a driver was present the ambulance would not respond unless an EMT filled out the crew. So if OVAC was unavailable, sometimes it could take an absurdly long time to find mutual aid. Today if such situation arises, the paid EMT will respond to scene and the medic will fill out the crew if mutual aid is unavailable in a timely fashion.

Yes, before the paid EMT was introduced to the system, the medic at times would have to ride in a BLS call just for the sake of the wait time for a mutual aid ambulance. Now with the paid EMT in place, I would have no issue transferring care to the EMT, whether there was a driver or not, if it is a BLS level call so I can handle another call rather then commit myself to a BLS call and deprive someone else of ALS level interventions. At times it is a judgement call based on the availability of additional ambulances in surrounding communities, proximity to medical facilities, etc, but if I'm on a sprained ankle and another call for a chest pain, unconscious, difficulty breathing, or any other call that has a high potential to be an ALS level call based on dispatch information (eventhough we know that sometimes dispatch info can be highly inaccurate), I'm triaging care to the EMT and responding to the call where I can do the most good for the patient. If that means that the patient with the sprained ankle has to wait 10 minutes for a mutual aid ambulance to arrive with an EMT on scene, I personally feel that's not on me, that's on the local ambulance agency for not being able to adequately staff their ambulances like the community should expect them to.

The simple fact is that the concept of "well the medic can just ride in the call" is not only an abuse of limited resources that are available in the system, but hinders the whole Tri-Village EMS system just because one agency won't fully commit to addressing and correcting their staffing issues.

[stvrap79 8]

At times it is a judgement call based on the availability of additional ambulances in surrounding communities, proximity to medical facilities, etc, but if I'm on a sprained ankle and another call for a chest pain, unconscious, difficulty breathing, or any other call that has a high potential to be an ALS level call based on dispatch information (eventhough we know that sometimes dispatch info can be highly inaccurate), I'm triaging care to the EMT and responding to the call where I can do the most good for the patient. If that means that the patient with the sprained ankle has to wait 10 minutes for a mutual aid ambulance to arrive with an EMT on scene, I personally feel that's not on me, that's on the local ambulance agency for not being able to adequately staff their ambulances like the community should expect them to.

I couldn't agree more! My observation was based more on the past ways. Now that there is going to be a more than competent EMT on scene, there is no reason why ALS resources should be tied up for "band-aid jobs." I am wondering though, what if you are dispatched ALS to a call in say Croton. On scene is just an EMT alone. What is the protocol for taking another job which may require ALS services more than the current one? Is it solely a judgement call at that point?

[JJB531 652]

I couldn't agree more! My observation was based more on the past ways. Now that there is going to be a more than competent EMT on scene, there is no reason why ALS resources should be tied up for "band-aid jobs." I am wondering though, what if you are dispatched ALS to a call in say Croton. On scene is just an EMT alone. What is the protocol for taking another job which may require ALS services more than the current one? Is it solely a judgement call at that point?

As a paramedic, once you commit to caring for a patient at the ALS level, you are "married" to that patient, meaning once you determine the patient is an ALS patient, and begin ALS interventions, you can't just up and leave the patient with a BLS provider. Patient care has to be transferred to another individual of equal or higher certification (i.e. another paramedic or emergency department staff). In essence, you are abandoning your patient, which can open you up to legal liablities and litigation, and violates Department of Health policies.

In short, if a medic is treating a diabetic, and a chest pain comes in... that medic is already committed to the first ALS call until they can transfer care to an appropriate authority.

[x635 4,066]

Didn't FDNY used to have "Squads" for manpower purposes? Maybe that's what the area needs, a EMT flycar to fill gaps, lol.

[Goose 188]

Is the Village of Croton in the town of ossining or town of cortlandt?

[Guest alsfirefighter]

Is the Village of Croton in the town of ossining or town of cortlandt?

Croton and Buchanan are incorporated villages within the Town of Cortlandt.

Edited December 6, 2011 by alsfirefighter

[JJB531 652]

Croton and Buchanan are incorporated villages within the Town of Cortlandt.

Tommy if you can correct me in the other thread, I was not aware that Croton was a part of Town of Cortlandt, I was only aware that Croton FD/EMS did have part of the Town of Cortlandt within their jurisdictional boundaries.

[Remember585 815]

I, too, agree that the Croton EMS agency did in fact take a nose dive in it's call coverage. What everyone is afraid of speaking up about is why.

It wasn't "a lack of time" by it's members. It was a lack of honest leadership, accountability by the leadership and far too much personal life drama being aired out like a pair of wet socks that made most of the founding and active members (and an Officer or two) resign.

Croton EMS didn't exactly "grab the bull by the horns" to get things "fixed." The village, with the urging of residents and others (you know who you are on here) to do something before someone had to die. There were members of CEMS (some who are still there) that were making noise about how things were sinking and that it might be time to man up and get some help. It fell on the deaf ears of the "leadership" while they all continued playing their immature games that ultimately made a lot of members (this one included) resign.

As a resident, I am glad something has been done. As a founding member of CEMS I am disheartened how things played out, but the writing was on the wall for a long time that the fecal matter was being projected at the proverbial fan, and at a high rate of speed.

I hope the paid staffing helps (I have seen it help during the hours it's there now) but as I said earlier in this thread, if people just listened from day one that we needed to stop crossing our fingers when the pagers went off and went to a dedicated schedule system, then we could have had people stick it out, do their shifts, and only need paid help in the shifts we couldn't cover.

But now that I am a "quitter," I am in no place to speak of their operations now. I know they've got some new people in leadership positions that seem to have a good idea of how things need to be, and I support them on their journey.

And no, don't ask me for an application to join again.

[Remember585 815]

So why not take the berden off ur neighbors and speak with a paid service to supply 1 M/A BLS ambulance. I can think of one where there is always a unit 5min from the village

Kenny,

If you're referring to Care One, I think you may have an exhaust leak into your rig. They're about as dependable as the Giants have been!

I'd rather take my chances of planting "ambulance seeds" in my garden, watering them and waiting for an ambulance to grow!!!!

[ny10570 745]

As a paramedic, once you commit to caring for a patient at the ALS level, you are "married" to that patient, meaning once you determine the patient is an ALS patient, and begin ALS interventions, you can't just up and leave the patient with a BLS provider. Patient care has to be transferred to another individual of equal or higher certification (i.e. another paramedic or emergency department staff). In essence, you are abandoning your patient, which can open you up to legal liablities and litigation, and violates Department of Health policies.

In short, if a medic is treating a diabetic, and a chest pain comes in... that medic is already committed to the first ALS call until they can transfer care to an appropriate authority.

Unless Westchester has something specific I'm unaware of, there is nothing that says ALS units cannot asses and even treat a patient and turn them over to BLS. BLS cannot maintain ALS interventions, but after an ekg or simple glucose administration why not turn it over.

[JJB531 652]

Unless Westchester has something specific I'm unaware of, there is nothing that says ALS units cannot asses and even treat a patient and turn them over to BLS. BLS cannot maintain ALS interventions, but after an ekg or simple glucose administration why not turn it over.

If you perform an EKG and decide your patient is BLS, then you can turn them over. Your statement is exactly what I stated, so I don't see where your going with your post. From your patient assessment if you determine you're going to work up the patient ALS with ALS interventions, you are now "married" to that patient. Once you start with more invasive procedures (advanced airway control, IV access, medication administration), you can't just turn them over. Let me ask, would you give an asthmatic a nebulizer treatment then just turn them over to BLS if they showed signs of improvement because albuterol is a BLS skill?

[ny10570 745]

Absolutely since the BLS are fully capable maintaining that therapy.

[JJB531 652]

Absolutely since the BLS are fully capable maintaining that therapy.

Let us know how that works out for you with the REMAC and medical director. Here is an excerpt from the WREMSCO protocol for nebulized albuterol use by BLS providers, notably the last sentence:

"EMT-Bs working for ALS services may participate in the Nebulized Albuterol Program as long as the BLS providers have undergone the required training and the agency has received REMAC authorization. ALS Services utilizing the program as part of a tiered response must continue to ensure the request for and provision of ALS for patients receiving BLS administration of nebulized albuterol."

[MoFire390 118]

Kenny,

If you're referring to Care One, I think you may have an exhaust leak into your rig. They're about as dependable as the Giants have been!

I'd rather take my chances of planting "ambulance seeds" in my garden, watering them and waiting for an ambulance to grow!!!!

all depends in the time of day...i have been good about getting posted in southern cortlandt. gosh for bid i need to cover a ccvac call while im working, atleast they have someone in the area that knows it and knows 90% of the medics who ride. i dont think it would be a bad idea just an idea that i thought would help out u guys down south. u get a full crew and both are EMT's. heck even if need be some of us are even willing to ride the vacs rig.

[INIT915 1,119]

all depends in the time of day...i have been good about getting posted in southern cortlandt. gosh for bid i need to cover a ccvac call while im working, atleast they have someone in the area that knows it and knows 90% of the medics who ride. i dont think it would be a bad idea just an idea that i thought would help out u guys down south. u get a full crew and both are EMT's. heck even if need be some of us are even willing to ride the vacs rig.

Well, the way some of the Care1 units drive around Cortlandt, they're liable to create more calls then they respond too. And what would Care1's position be if there units (operating generally for-profit) were taken out of service so that the EMT's could ride the call in on a VAC's unit, which, commonsense would dictate they could not bill for?

If I'm an administrator for Care1 (or any commercial service), I don't see how I can approve of that.

[ny10570 745]

Let us know how that works out for you with the REMAC and medical director. Here is an excerpt from the WREMSCO protocol for nebulized albuterol use by BLS providers, notably the last sentence:

Now if you'd please go back to my earlier post where I stated "Unless Westchester has something specific I'm unaware of". This is something Westchester specific that I was previously unaware of. As I am currently certified in NYC I would actually rather enjoy a conversation with a WREMSCO doc if for no other reason than to compare the differences in protocols. In fact I think it would work out quite well for me. Thank you.

[MoFire390 118]

whatever happened to doing the right thing??? if its what some of us believe is the right thing to do then so be it. as long as the call gets covered shouldnt matter what rig shows up!!!!!

[INIT915 1,119]

whatever happened to doing the right thing??? if its what some of us believe is the right thing to do then so be it. as long as the call gets covered shouldnt matter what rig shows up!!!!!

No, I think you misunderstood me. Your intentions are laudable, my question more relates to your company consenting to doing what you alluded to.

[Goose 188]

whatever happened to doing the right thing??? if its what some of us believe is the right thing to do then so be it. as long as the call gets covered shouldnt matter what rig shows up!!!!!

I suppose you're company would have to be cool w/ it as well as the agency. Personally, i always let 60 know if its going to be an ALS or BLS call...at least then if they have a driver they can start out. It's good to have options, but having a good-faith agreement for mutual aid w/ any commercial EMS company is not exactly a reliable solution. Many of us have worked commercial and have seen the silliness that goes on for the almighty dollar...

[MoFire390 118]

I suppose you're company would have to be cool w/ it as well as the agency. Personally, i always let 60 know if its going to be an ALS or BLS call...at least then if they have a driver they can start out. It's good to have options, but having a good-faith agreement for mutual aid w/ any commercial EMS company is not exactly a reliable solution. Many of us have worked commercial and have seen the silliness that goes on for the almighty dollar...

Cortlandt VAC currently has Care1EMS as their primary M/A ambulance...and has come in handy on a few calls already. was just a suggestion. if they are in the area might as well use them...

[JJB531 652]

Now if you'd please go back to my earlier post where I stated "Unless Westchester has something specific I'm unaware of". This is something Westchester specific that I was previously unaware of. As I am currently certified in NYC I would actually rather enjoy a conversation with a WREMSCO doc if for no other reason than to compare the differences in protocols. In fact I think it would work out quite well for me. Thank you.

The first line in the New York State Protocol for Respiratory Distress is to request ALS if available. If you're on scene, you're available. Correct it doesn't say that ALS needs to necessarily intervene, but it appears that it is inferred by this statement.

New York City REMAC Protocol for Asthma for ALS providers states:

"Administer Ipratropium Bromide 0.02% (1unit dose of 2.5mL) by nebulizer, in conjuction with the first 3 doses of Albuterol Sulfate."

Ipratropim Bromide is not in the BLS protocol. As an ALS provider in NYC, if you just decide to administer Albuterol, and withhold the Ipratropium Bromide with the intention of passing off the patient to BLS, are you considered to be withholding treatment and/or violating NYC REMAC protocol?

On the flip side, if you administer Ipratropium, and then pass off to BLS, are you handing off a patient to BLS who is now administering a medication outside the scope of the New York State DOH BLS protocol for nebulized albuterol?

I'm merely playing devils advocate, because although I know we are talking about relatively benign medications when used properly, the potential for a negative outcome for a medic who just passess off an asthmatic is rather high. No one wants to be a "cook book medic", but in the end, a governing body just has to go back to the cook book and see how you changed the recipe.

[ny10570 745]

negative. After administering atrovent, even mag, and steroids I am able to flush the lock, secure it and turn over patient care to BLS. Same applies for diabetics and D50. If the patient were so sick that I went the mag and steroids route there is a serious issue with my clinical judgement that I'm turning over patient care to BLS. Your initial question was a simple neb treatment, and yes I would feel comfortable handing that patient over to BLS. Even the hypoglycemic I've been content to turn over to competent BLS after correcting the condition.

In NYC we recently received a clarification, that with some minor tweaks could be applicable in Westchester. In NYPD and Correctional facilities where delays waiting for an escort to the ER become excessive we are now able return care of these sicker people who may still require ALS interventions at some point to the facility medical staff. In some cases that's a nurse or doctor and others it's an EMT. Its a quick call and has been used for the serious asthmatic after treatment, the stat ep, etc. Why not allow a patient to be left with the EMT on scene while they wait for that bus and free up the medic for the next call? Should the condition worsen the medic can be called back or mutual aid medic can be used.

[INIT915 1,119]

Cortlandt VAC currently has Care1EMS as their primary M/A ambulance...and has come in handy on a few calls already. was just a suggestion. if they are in the area might as well use them...

Does Care1 dedicate an ambulance to Cortlandt? If not, I don't know if you could really call them the "primary M/A ambulance."

[INIT915 1,119]

negative. After administering atrovent, even mag, and steroids I am able to flush the lock, secure it and turn over patient care to BLS. Same applies for diabetics and D50. If the patient were so sick that I went the mag and steroids route there is a serious issue with my clinical judgement that I'm turning over patient care to BLS. Your initial question was a simple neb treatment, and yes I would feel comfortable handing that patient over to BLS. Even the hypoglycemic I've been content to turn over to competent BLS after correcting the condition.

In NYC we recently received a clarification, that with some minor tweaks could be applicable in Westchester. In NYPD and Correctional facilities where delays waiting for an escort to the ER become excessive we are now able return care of these sicker people who may still require ALS interventions at some point to the facility medical staff. In some cases that's a nurse or doctor and others it's an EMT. Its a quick call and has been used for the serious asthmatic after treatment, the stat ep, etc. Why not allow a patient to be left with the EMT on scene while they wait for that bus and free up the medic for the next call? Should the condition worsen the medic can be called back or mutual aid medic can be used.

Wow, even stat ep? I don't think I'd ever feel comfortable with that. Even the "serious" asthmatic. Unless I paid for my own supplemental malpractice insurance and I had no considerable personal assets.

[MoFire390 118]

Does Care1 dedicate an ambulance to Cortlandt? If not, I don't know if you could really call them the "primary M/A ambulance."

yes there is usually at least 2 BLS ambulances in the cortlandt area

[INIT915 1,119]

yes there is usually at least 2 BLS ambulances in the cortlandt area

And those buses are not taking in transports?

[irishfire2491 24]

So, basically, you are taking a Paramedic out of service to ride in a BLS call?

Thats how Putnam County Rolls on the WEST Side! not to get off topic!

[MoFire390 118]

And those buses are not taking in transports?

the condition of the M/A is if Care1 has a rig available then they take the call, the ambulance has to be within 10min of the response area. usually both BLS rigs do transports. considering the 3 of the nursing homes that CCVAC covers are now in an agreement with Care1.

[Goose 188]

negative. After administering atrovent, even mag, and steroids I am able to flush the lock, secure it and turn over patient care to BLS. Same applies for diabetics and D50. If the patient were so sick that I went the mag and steroids route there is a serious issue with my clinical judgement that I'm turning over patient care to BLS. Your initial question was a simple neb treatment, and yes I would feel comfortable handing that patient over to BLS. Even the hypoglycemic I've been content to turn over to competent BLS after correcting the condition.

In NYC we recently received a clarification, that with some minor tweaks could be applicable in Westchester. In NYPD and Correctional facilities where delays waiting for an escort to the ER become excessive we are now able return care of these sicker people who may still require ALS interventions at some point to the facility medical staff. In some cases that's a nurse or doctor and others it's an EMT. Its a quick call and has been used for the serious asthmatic after treatment, the stat ep, etc. Why not allow a patient to be left with the EMT on scene while they wait for that bus and free up the medic for the next call? Should the condition worsen the medic can be called back or mutual aid medic can be used.

Pull any of that in Westchester and you're mac card will be melted down into a PVC ingot in no time at all. That said, I can't help but feel that the this will be changed secondary to a lawsuit in the future. If I'm making a pharmacological intervention (even D50 or combivent) i just don't feel comfortable sending it off with someone other than another medic or higher authority. Even the whole 3 lead and glucose turned over to BLS rubs me the wrong way, but I'm conservative.

[irishfire2491 24]

So why not take the berden off ur neighbors and speak with a paid service to supply 1 M/A BLS ambulance. I can think of one where there is always a unit 5min from the village

LMAO Good Joke

Cortlandt VAC currently has Care1EMS as their primary M/A ambulance...and has come in handy on a few calls already. was just a suggestion. if they are in the area might as well use them...

A Few calls out of how many? Just listening to the radio I hear alot of tones and alot of beeping coming from my FD pager! :angry: