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http://www.nydailynews.com/news/2010/01/05/2010-01-05_he_got_the_boots___it_cost_his_career.html

The following are concepts I would look at for a basic chemistry course: 1) Introductory Material -Historical prospectives -Chemistry Defined -Matter Defined -Energy Defined -States of Matter -Basics of physical & chemical properties -Basics of the scientific method +Observation +Law, Theory, Hypothesis +Testing & Validation +Precision & Accuracy -The metric system -Basics of measurement and significant digits -Scientific notation & conversions 2) Basics of Atomic Structure and Elements -Historical and present definition and explanation of the atomic model -Survey of the gross components of an atom (Proton, Neutron, Electron) -Element defined -Periodic table overview and relation to the elements (Atomic number, weight, groups, periods, etc) -Concept of charge and +/- relationship -Concept of isotopes and nuclear decay (alpha, beta, gamma, and positrons) -Concept of the half life -Concepts of the electron "shells," valence electron,s and the concept of the Octet rule 3) Basics of compounds -Ionic bonds -Electronegativity concepts -Covalent bonds -Polar versus non-polar and basic geometry -Polyatomic ionic compounds -Avogadro's Number, the mole, and basic concepts -Basic concepts of molarity -Suspensions, Solutions, Colloids, and calculating molarity & Eq/mEq 4) Survey of organic compounds -Concepts, formal charge, carbon as a backbone -Polar and non-polar/electronegativity revisited -Review of non-covalent interactions and bonds (hydrogen bonding, ion-dipole, London forces, Salt bridges, dipole-dipole) -Overview of hydrocarbons (Alkanes, Alkenes, Alkynes, Aromatics) -Basics of Alcohols, Carboxylic acids, & Esters -Basics of the IUPAC -Basics of isomers and conformation -Basics of lipids, fats, and membranes (Solvent & solute movement principles ie: diffusion, osmosis, facilitated diffusion, active transport) -Basic concept of tonicity: Hyper, hypo, iso -Basics of carbohydrates -Basics of protein +Structure +Peptide binding +Amino acids +Proteins + Structure of protein (primary, secondary, tertiary, quaternary) +Effect of various derangements (PH for example) on non-covalent bonds and conformation 5) States of matter -States redux -Basics of state transition -Basic heat energy formulas -Entropy & Enthalpy -Boyle's Law -Gay Lussac's Law -Charle's Law -Combined Gas Law -Ideal Gas Law -Basic properties and structure of liquids and solids 6) Chemical Equations & Reactions -Basic setup -Balancing -Endothermic versus exothermic -Specifics +Redox +Combustion & Decomposition +Hydrolysis & Hydrogenation -Mole and mass relationship redux -Percent yield, limiting reactant, actual yield, theoretical yield -Reaction rates and basic concepts of enzymes 7) Acid/Base Chemistry -Acids -Bases -Basic formulas -Bronsted, Lewis, and conjugate concepts -Basics of the -Log & PH scale -Le Chatelier's Principle, equilibrium, and titration -Effects of PH changes on bonds *An emphasis of these concepts in a conceptual form and how they apply to the human body throughout the course. Take care, chbare.

Well, the program sees 20 min into the future based on 10 yrs of past data. So if we've had 5 or 6 plane crashes in the same year and same time near the airport (which we've only had 2 or 3 (priavte aircarft, no commercial) in the past 5 yrs), and we're getting sent to the same general area. I'll just make sure to have my extra jump kits ready...... The thought process behind the milage and over usage of vehicles is based on our current stand-by policy. When two trucks which cover a response zone are out running calls, we have to send another truck to that area to cover the zone to maintain response requirements. Based on the new theory or program, if two trucks are out and a zone left uncovered, but according to the program no call will be dropping in the area and it does not reccomend a unit for stand-by, you don't go. Taking that same theory for one truck, apply it to our fleet of 37 trucks and it adds up in a yrs time of numerous cost savings for fuel, wear/tear on our vehicles, and wear/tear on employees. The county in which we live and work in believes in providing the best service possible to the residents and vistors. If that means we're supplied with the lastest in vehicles, equipment, and technology to accomplish the job and be finacially responsible and efficient, then that's what we're given. Our PCR program enables us to collect for this year, 18M out of 25M billed. In which essentially means our service pays for itself, and we're not private! We've been able to keep the priavtes out of our county....

This seems quite interesting... My question of course is how well will this actually work... and what is the data that is used is it just location of calls from the past 4 years or does it take into account weather and other outside information? If this works like they seem to think it will I think we might be looking at a pretty useful tool!

All this animosity stems from "HOSE envy". Sadly its true some people feel woefully under equipped to handle all situations so they choose to canonize the one the have mastered. Its a shame really all they need is a little confidence building and they to will feel adequate in most situations. But one truth still remains some of use can be firemen and emt's some can't. P.S. I love stirring the pot Merry Christmas to all

Ummm he may not have used the term "firemonkey" and such this time, but he's constantly posting comments of that nature. It doesn't matter what the topic is, monkey sees "fire", monkey bashes "fire". That was the ponit of my comment. Our EMS division is fully funded, so I don't see your point. My rig is brand new with 4000 miles and that new "green" technology where the exhaust is retained and superheated, and requires a regeneration if driven at slow speeds too often. Our supplies are fully stocked. Since our personnel are dual role, we don't have problems such as burnout due to mandatory OT, and our firemedics get a break from excessive call volume by rotating to and from the engine. Retention and longevity are easier to achieve when firemedics can work different aspects of the job and not get burnt or feel "stuck" in a certain position. I agree with fire based EMS probably as much if not more than you disagree with it. Don't project the shortcomings and faults of your former dept onto mine.

Just a brief reminder to our American friends, in land are our country is almost the same size as yours. The differene is most of ours in uninhabitable. This streches resources once you are out of metropolitan areas. Is this a failing of the system, not really. Is this a failing of the Paramedics. No. Is this just bad luck? Yep it is. I know of many smaller stations where you can do nothing for days on end then do 5 jobs back to back. Rosters are created to try to cover peak times, but lets face it, EMS doenst have peak times does it?

If you cared to look at a map you'd note these places being mentioned are way the hell out in the sticks and quite rural. Does that mean you should expect a lower standard of care? No, but you have to be realistic, if you live in bum-bum nowhere you have to expect care will take longer. I don't know the exact details around resources in a lot of places, there's only one ambulance and if it's busy well that's just a problem you can't get around.

Full Bill text on link (PDF) http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s1793enr.txt.pdf The Ryan White HIV/AIDS Treatment and Extension Act of 2009 passed the House yesterday by a vote of 408 to 9. The Senate passed the bill earlier this week so the bill now goes to President Obama for his signature into law. There are several new additions to the Ryan White Act which affect emergency care – and specifically emergency responders. It is important to note that the ‘list’ established under Sec. 2695 is very powerful – it essentially determines what infectious diseases should be considered ‘potentially life-threatening’. The list is also used to determine whether or not emergency responders must be notified of an exposure. The entire bill can be found at this link http://bit.ly/2YZs1o Here are the sections affecting emergency care and emergency responders: The bill adds a new section to Ryan White – “Part G Notification of Possible Exposure to Infectious Diseases” Within 180 days after enactment, Section 2695 Requires the Secretary of HHS to complete the development of: * a list of potentially life-threatening infectious diseases, including emerging infectious diseases, to which emergency response employees may be exposed in responding to emergencies (The list developed shall also include a specification of those infectious diseases on the list that are routinely transmitted through airborne or aerosolized means.) * guidelines describing the circumstances in which such employees may be exposed to such diseases, taking into account the conditions under which emergency response is provided; * guidelines describing the manner in which medical facilities should make determinations when an emergency responder is requesting a determination as to whether or not a patient he/she transported had an infectious disease * This list will then be distributed to the public and the states * NOTE: This list is very important because it is relied heavily upon in determining whether or not a responder has been exposed to an infectious disease. The bill also reestablishes some of the notification provisions that were struck during the last Ryan White authorization. This is good news for emergency responders. Specifically, the bill requires Prompt notification – not later than 48 hours after determination is made – to emergency responders when: * A patient is transported and it is determined that the patient has an airborne infectious disease AND WHEN * A patient that is transported by emergency responders dies at or before reaching the medical facility, the medical facility ascertaining the cause of death shall notify the designated officer of the emergency response employees who transported the victim to the initial medical facility of any determination by the medical facility that the victim had an airborne infectious disease. The bill also contains a provision for emergency responders to request a determination as to whether or not a patient had an infectious disease. Basically the provision states that: * The employee must first make a request * The request is then examined, facts are collected by a designated officer * The designated officer then makes a determination – if the designated officer feels that an exposure may have occurred then he/she submits a request to the medical facility * Once the medical facility receives the request, it has 48 hours to respond * The medical facility will make a determination, based on the information possessed by the facility, regarding whether or not the emergency responder was exposed to an infectious disease that appears on the list (created above). * The medical facility can make 3 determinations, Notification of Exposure, Finding of No Exposure, Insufficient information * If a finding of insufficient information is made, the public health officer for the community in which the medical facility is located can also evaluate the request if the designated officer submits the request to him/her.

Thanks for the info.

No. This IS an EMS issue, and "Reasonable" has nothing to do with it. The case here is the FF was off duty, and in many areas because he is a trained responder, this means he is also not covered by the Good Samaritan Law either. Thus, he has no "duty to act" if he is not on the clock or working as a volunteer in the capacity of his job. Moral or ethical reasons whether to render aid or not are another story. Laws on this are vague, they vary from state to state, and they are also not federal. Only a couple states have language that compel an off duty responder to render aid, although as you note, NONE require a person to endanger themselves to do so. Again, in the context of EMS, duty to act is one of several determining factors as to whether or not a provider's actions are protected against a charge of negligence. If we are talking about reporting a crime, that's a different story. I have no idea for certain of the details, but I do know most LEO's are held to a different standard than EMS responders. I believe that in many places, a police officer is essentially always on duty, thus their "duty to act" is probably different than ours.

In the context of EMS, "Duty to act" is only one part of a legal nexus that determines whether a responder can be held liable for negligence/malpractice. I have never heard it applied to situations where the responder is off duty.

More hose envy poor Phil

Let's clarify a few things about what the Ryan White Act actually does. For the large part, the IAFF should have spent their money lobbying at the state level for improved state regulations about testing and seeing their own departments had effective DICOs. In 1990, largely at the insistence of the IAFF, this section was added. Its purpose was to get money to set up some education for employees and a Designated Infection Control Officer in EMS/FDs. Since this was not the primary purpose of the Act, EMS/FDs did establish a DICO but it was usually just a title and not necessarily a working job description. Policies should have been written but often they relied on those from a hospital for exposure on a case by case basis. However, Public Health laws are enforced and if the DICO of any agency taps into them with their policies, the blood and airborne pathogens that are worrisome are covered. In the states that have OSHA, they can also be used for policy making guidelines. Hospital infection control officers will also contact an agency but they can not force the DICO of EMS/FD to do whatever. Public Health notification for certain diseases are there to also assist and enforce certain regulations for that state. The other thing the Ryan White Act does not do is mandate testing without consent for an exposure to a blood borne pathogen. If the state does not allow it, then you again have to rely on your department's policy for prophylactic treatment or to obtain a court order if the exposure is serious enough. OSHA does spell this out and in the states that don't have OSHA, they either a specific state statute or a section in their Public Health laws that addresses this. The DICO should be familiar with his/her policy to get the employee whatever care is necessary. The employee should also make sure they understand their policies. If neither the DICO or the employee take some responsibility, it doesn't matter how many people notify them. Since the Ryan White Act is almost a $3 Billion/year expenditure for People With AIDS/HIV over the next four years and it has been each year for 20 years, EMS/FDs departments would be foolish to rely on those few paragraphs buried inside this Bill. The intent of this Bill was to provide health care and housing to people living with HIV/AIDS. It is a good piece of legislation that is needed and actually $3 Billion in not nearly enough. But, any health care reform could again repeal this Act. It is also sad when most in EMS/FDs only know a couple paragraphs of this Act and believe the Ryan White Act is solely about them. Few even know who Ryan White is. If EMS/FDs fail to establish an effective DICO and have the necessary policies in place to protect their employees there is no assurance that anything from the Ryan White Act will even be followed by that department regardless of the hospitals' part per the Public Health regulations. Most of these regulations are stricter and can be enforced more easily. However, there is no guarantee that the hospitals will test for some diseases if it does not pertain to the immediate illness/injury. Even TB has gone undetected for several ED visits because the symptoms were not all present. So, if you are waiting for an engraved letter from the hospital, you may be waiting a long time if there is no reason to notify you because testing was not done. That doesn't mean you do nothing for a needle stick or when you feel you may have been exposed to something. Again, that is what your DICO is for. He/she should have a relationship with the various hospitals and a policy to see you are covered quickly for whatever exposure. There is also nothing more frustrating than when the ED doctor already knows what he/she is going to diagnose a patient with and asks the EMT(P)s who their DICO is so they can be contacted and prophylactic treatment can be given but all the doctor gets is a blank stare. Sometimes that blank stare is even from the EMS supervisor when approached about a situation. Side note, Florida does have a section in its statutes for testing without consent. California leaves it to the discretion of a doctor and the written informed consent is no longer required. I believe NY still requires consent before blood can be tested for HIV. The same for the Veteran's Administration system which is Federal. The hesitation of some states to have testing without consent is for the protection of the employee and everyone else who enters the health care system. Many states do mandate that if you have HIV or Hep C and are working in health care that you disclose this. However, mandatory testing for health care employees has not yet been legislated and enforced.

At my part-time job information is sent to alpha pagers if you’re on the list. They will include address and complaint, but that’s all. It is a nicety at this job because of the mumbling and/or screaming that goes on during the dispatch, just depends on the type off call. At my full-time job we don't do any of this because of the onboard computers which provide damn near everything you could ever want and more as far as info. This includes run cards, GPS mapping, call back numbers, so on and so forth. It's a good system, and does have some issues, but over all pretty good. somebody please subtract a point for this drivel...........geez!

Many states have adopted a "duty to act" law for its citizens and it can pertain to anything including a crime being committed. The state at least wants you to call 911 and are very careful with including the word "reasonable" in the statute. I believe this all came about with a national headline when a woman was murdered while many people witnessed or heard it. No one acted to even call for help.

I read your posts, and you claimed that these laws do not pertain to EMS. I pointed out where you were incorrect. In every legal opinion and brief I have seen, "reasonable" is not about whether someone should place themselves in danger. Language specifically states that a rescuer- civilian or not- is not expected to put themselves in harms way. It's about what prudent or "reasonable" actions should be taken for a victim- care, treatment, or calling for help, etc.