CBEMT

I knew that as soon as he came into office and promptly forgot about his campaign promise to separate Fire from EMS.

Because somebody decided that a psych problem is a disease, and diseases require medical treatment. People being transferred for medical treatment go in ambulances, not police cars. Not IFT. Occasionally in the field they'll transport to the ER, or in my town PD transports to their station and the patient has a psych eval there from a local agency- but by state law still needs to be medically cleared at a hospital ER prior to psychiatric admission. Thankfully they call a private for the run to the ER instead of tying up the 911 truck. In the case of the ER, they call a private for the transfer to the psych hospital. Sure, the private could refuse, and risk never getting another discharge or transfer from that ER again. If the crew refuses, they're unemployed. In the field the cops can't ORDER me to transport someone, but if it's clear they are having a psychiatric emergency, aren't I obligated to take them? 99% of all the ER to psych transfers I ever did (and we did a lot) were alert, oriented, and, if not totally cooperative, than at least resigned to the fact that they were going. What right do I have to walk into a patient that has been prepared for hours or sometimes days by the ER staff that they'll be getting "a nice, easy ride" and say "Sorry, even though I know nothing about you or your situation, I'm scared of you, so you're getting in these restraints or I'm drugging you"? That's messed up. If I was a patient and the doctor told me as long as I went willingly everything would be cool, and then some private ambulance jockey tells me I'm getting restrained anyway, guess where my sense of cooperation just went? And that's me right now, completely rational. Imagine what emotionally fragile people feel like. The only people I ever had to restrain PRE-hospital were intoxicated and combative, and plus had head injuries. And technically I needed an order for it since we don't have a protocol, but there wasn't exactly time. Lack of laws and policies in general. Like I said, there's nothing in my protocol or laws pertaining to EMS that says I'm allowed to restrain anyone for anything. But the fact that a psych transfer will usually get paid, under "services not available at this facility," probably doesn't help. If its between that and explaining on the witness stand why I sat there and watched him go, yeah I probably would. If I felt like I couldn't take him/her at the time of initial contact, I'd ask for more personnel in the back, or other measures as appropriate.

Sounds like you've got your answers.

Allegedly, she's a nurse. I can't find the story now though.

That's why we have them, and had them before we got our pump requirement- to prevent overfilling kids during routine IVs. I don't know anyone who's used one though.

I've seen a few of these covered by various media, and as far as I recall in each case there were signs made by the person committing suicide that there was a hazardous substance in the car. Hopefully we won't see anything like this anymore, but if the trend does in fact continue, I hope the trend of warnings continues as well.

Dial-A-Flows were required equipment for ALS ambulances in my state until a few years ago. No one used them. Not because they eyeballed it, but because no one hung drips (that would require a med control order, knowing what the hell you're doing, and a transport time longer than most services have here). During a major protocol update, Dial-A-Flows were banned, and pumps required for all drips. Most services still don't carry them, because drips are considered optional- despite the fact that stable VT has no treatment in our protocols except a drip- as well as the previously mentioned reasons. It affected private services the most, since they were the ones making critical transfers that would be most likely to be running infusions. Most 911 services (90% fire) that had a patient that needed a drip (assuming they could even tell) just drove faster. My service recently got them, and even sprung for the pre-mixed drips. We're one of the few that could actually have time to use and/or need them.

Let's remember where this happened.

3 years later.....?

Lots of fire departments WANT to do EMS because they WANT the run numbers, they WANT the ability to say that they're revenue-generating, and they WANT to justify half-million to million-dollar vehicles whose primary purpose is not, in fact, EMS. Doesn't for one second mean they're going to do it RIGHT. There's a difference between desire and motivation.

.

Can't respond with an actual argument, so just more chest-puffing and self-gratification. Sad. I'd come to expect better from you, at the very least you seemed like a firefighter with a brain and writing ability. You can talk about the paycheck and bennies that your Local managed to scam out of the taxpayers all you want, but it still won't make up for whatever you're so insecure about. Ps- I do have fun, because I don't work there! But your IAFF brothers do, and they could use a few pointers. Maybe you should go tell them how awesome you are.

To be fair, the FFs near where I used to live do something like that all the time- the closest supermarket is outside their district/ie the town line by about a quarter mile, if that. They don't even have to make a turn. The closest firefighters from the town the market is in are actually further away from the market than the out of town guys are, by over a mile I'd say. And they shop there just as often. If I remember from another forum, the store in the Boston incident is 0.9 miles from their station, and less than that from the city line (ie the edge of their district).

I'm sure NAEMT's members are glad to see the progressive, effective professional activism that their dues are paying for.

Nothing left for me to say, considering the pwning my Aussie brothers just delivered.

Fail!

ROFLMAO. How stupid do you think we are?? Still waiting for your demonstration that ALS first response has any scientifically confirmed validity. You really don't have any idea how many Fire-EMS departments do that, do you? I could turn on a scanner right now and count out a half-dozen mutual aid units running back to back calls in a city that isn't even theirs. You'd have thought the home team would be embarrassed into change when a truck 15 minutes outside the city had to come into the Department of Health building for chest pain, but no. Still happens. You haven't seen burnout until you spend a day in my area FDs. Walking chest pain patients down from 3rd floor tenements carrying the portable 02 for themselves. Collaring cspine pain patients inside their cars, then walking them into the truck, laying them on the board, clicking in two stretcher straps, and transporting. No board straps or any thing securing the head. Each transport unit making 5000 calls a year, because the fire side of the IAFF local easily outvotes the EMS side, and the fire side won't consider the mayor's offer to increase ambulances if manpower can be rearranged, and perhaps a few trucks dropped. 10% of the department is doing 90% of the work, and their "brothers" are keeping it that way. 25 or 26 runs in 24 hours (which isn't even the end of their shift) is common. What do you suppose THEIR job satisfaction is? Try firefighters/EMTs being held for 38, having either 10 or 14 off, then back for another 38 (with call volume as mentioned above). Happens around here daily. Meanwhile, agencies like Boston EMS will only schedule you for 8, and kick you out the door after 16, whether you stayed for OT or a swap. So please, spare us the "My deparment is teh aw3some, FD-EMS 4EVA!!!" routine.

That's nice. You still can't prove it changes the patient's outcome one bit (here's a hint, since you didn't get it last time this came up- we like scientific evidence in medicine). Even if (a gigantic assumption) it did somehow miraculously work in YOUR system, guess how many fire based EMS systems completely suck at it? I'll bet it's a lot more than those that are functional. Is there any bounds to your arrogance? You started out intelligent, now you're approaching full-fledged troll status. There's a lot of them at Firehouse.com, you should check it out.

Great job Wake! I'm ashamed to say that in my area, every one of them would have been transported unless a refusal was obtained. Unless the state DMAT team is activated, there's really no provision for getting a doctor to a scene here. We have a hospital-based critical care truck with an MD onboard that will gladly make scene responses, but since our world is run by the fire departments I don't see that happening.

The cost savings comes from eliminating positions and protocols (ALS first response, whether by engine or SUV) that have no basis in fact. "Maintaining the current level of service" is a red herring/smoke screen. There is ZERO medical evidence to show that ALS first response improves patient care or outcome. 37 fire engines, paramedics, monitors, drug bags, tanks of fuel, insurance policies, maintenance, and 111 non-paramedic firefighters (3x37). All dispatched on medical calls to justify their presence for... non-medical calls. Sounds like a great use of taxpayer dollars there, champ. Or, we could follow the actual evidence, and stick with the vehicles that were actually, you know, built for medical calls.

Imagine how much better of a firefighter you could be if you were doing all that full-time instead of spending on EMS calls and EMS training. Imagine what kind of EMS providers could be developed and cultivated if they didn't have to spend time on the dozen-plus firefighter skills you mentioned that need to be maintained (and I know that list was just a sample).

Scenario 2- why are we assuming trauma? Takes about a second and a half to ask bystanders what happened. They'll either tell you, or say nobody saw him go down. It's part of a SAMPLE history, so its not even wrong by the book. Nobody saw him, ok fine, pretend he's got a 1 in a million unstable cervical spine fracture, and try to maintain a jaw thrust while bagging (not going to happen- effectively- with one person) so we can maintain c-spine stabilization. Or they say "He just collapsed." In which case I don't think there's a thing wrong with a head tilt/chin lift. Maybe I didn't answer the question, but I just couldn't let it go. Scenario 3- x1000 to sitting the patient up. You'd be amazed how many problems it solves. KISS.

I've gotta find that 'net video I saw of an Italian EMS physician at the scene of a motorcycle crash.

One piece of advice I was given long ago, "Leave your house early enough to change a flat tire and still get there on time (meaning early)."

Whatever you need to tell yourself to get to sleep at night, "Loo."