HERBIE1

LMAO Funny clip, Dwayne. Thanks for the chuckle...

WHen I had my disc problems- L5S1- I went through PT(didn't work), and steroid injections(didn't work). The doc told me that the only other option was fusion. I rejected that, saying that unless I was wheelchair bound, nobody was cutting me. It's simply a matter of how much pain you can tolerate. That was 10 years ago and I'm still working. Bad days- yep, but keep up an excercise routine and work on your core(ABS). As was mentioned, look into dispatch, instructor, tech, or better yet, go back to school. Good luck.

I agree that depending on the situation and the amount of help you may have, a brief report is certainly in order, especially for a "routine" arrest like a 90 year old nursing home patient. I also know that some systems require a detailed report, while other simply want the basics-ie. " We have a 65 year old male cardiac arrest, downtime unknown, ALS protocols established, no response to interventions, CPR continuing, ETA 5 minutes." If they want or need more info than that, they can certainly ask but a concise report like that actually relays a lot of information. Clearly in a busy system, with heavy radio/phone traffic, a lengthy radio report is contraindicated and impractical. There's a sucker born every minute, so SOMEONE will believe this was real, and like you said, someone is looking for their 15 minutes, or simply trying to be an SOB. Right after he died, I recall seeing a video clip of someone in a parking garage jumping out of a white LA County Coroner wagon who "looked like" Michael Jackson, and it fueled the rumor mill that his death was actually staged.

I smell BS here. "It don't look good, we tried to resuscitate him, we've done everything we can"- doesn't sound like anything a practicing provider would say. No mention of medications, PMH, ALS procedures performed. Not to mention these are allegedly LA County medics who are probably used to dealing with high profile cases and I'm sure they have protocols for dealing with these things. I understand that giving a hospital a heads up is imperative to brace for the media. Too many people(fans and paparazzi) with scanners and radios who can listen in on these transmissions, so they would NEVER name someone over the air, not to mention the obvious PHI violations. I think it's a hoax.

In an organizational sense, any new attitude or initiative comes from the top, but at each level of management, the supervisors also need to buy into the new idea or it will fail. The problem with the fire service is there is a long history of established procedures and making changes in such a group is very difficult. It takes strong leadership to promote a radical change, but the reasons why a department may choose to chase after EMS are generally not altruistic, they are self serving. Thus, the fire service may benefit, but not necessarily the public or EMS.

Actually, it can be an issue to buy groceries ahead of time. What if they don't have their full complement of members for that day- short handed, vacations, manpower adjustments, call ins, trades, etc? These things are not always known ahead of time. The cook would need to cover for that missing person out of their own pocket. What if the company had training that day and would not be around for their meals? Shopping ahead is possible, but not always practical. This whistleblower had an ax to grind and was simply trying to stir the pot.

A 400lb er? That's a lightweight. LOL We had 3 of those last day at work. If I got paid by the pound, I'd be able to retire early. Sadly, because one of our patients had fallen in a tiny bathroom, a firefighter who was assisting us slipped in feces he left on the floor and pulled a groin muscle. Turns out the call was aggravating on several levels. The guy was on home O2 24/7 for an unknown lung problem, and had cardiac and diabetic problems as well. He also had horrible cellulitis on his legs, which- besides his size- made it essentially impossible for him to get off the floor on his own. There was no room to maneuver or to have enough help in there. Unfortunately, NOBODY in the house spoke English(some type of slavic language)- all they could tell us was he was a hospice patient but we did not know what his terminal illness was, whether or not he had advanced directives available and what they said, or even the circumstances of his fall. He had no obvious injuries but was in pretty severe respiratory distress, presumably from struggling to get to his feet. We finally extricated him from the bathroom, gave him 100% O2, albuterol and atrovent which helped his distress and improved his sats, noted his glucose was around 300, and transported him to the ER, where the firefighter was also evaluated for his groin pull. Before I was even finished with the report, the nurse informed us that his son arrived, the patient told his son that he didn't want to be seen in the ER, was signing himself out AMA and the ER was already arranging for his transport back home. Grrr...My back is still screaming...

I would think that it depends on where you are touching the patient. If it's a 3 lead, then I doubt that touching the legs would make a difference. I would assume the closer you touch a person to where an electrode is, the larger the impact. I would also suggest that it also depends on the size of the patient- a 90lb nursing home patient vs a 350 pound CHF'er. Next time I have an arrest, I'll need to discreetly check this out.

These studies are always difficult to quantify. Even in this area, there are wide variations in what defines a patient who should be evaluated at a Level 1 Trauma center. Some systems are quite conservative in order to capture as many borderline patients as possible. Other systems are quite "progressive" in their interpretations of which patients qualify as critically injured, or potentially critically injured enough to warrant transport to a Level One center. I do agree that it is difficult to make blanket statements in medicine, but because we operate under the direction of a physician, there does need to be concrete rules(SMO's, SOP's) that are in place in case on line medical control is not available. Because of the variations in the levels of training of providers, the capabilities of each system, as well as the capabilities of the receiving hospitals. That "golden hour" may be completely unreasonable in rural areas, and easily accomplished in a busy urban setting. Good article and food for thought...

I know that in some areas- even in places that DO receive a good deal of snow, encounter killer storms they are simply unable to handle. I know that in many cases the National Guard is mobilized and their 4 wheel and all terrain vehicles are used to get personnel to the scene of emergencies. As was mentioned by several posters now, preparing for a once in a generation disaster by purchasing extra plows or all terrain vehicles is simply cost prohibitive. In a larger city, only a couple plow-fitted or 4X4 vehicles are simply of no use. So what do you do? The best you can- that's what we are best at. What happened in Pittsburgh was unfortunate, but it happens. Even in emergency situations- heat waves, floods, snow storms, hurricanes- the normal calls still come in, in addition to all the emergency related issues. The toe pains, the snotty noses, the drunks- are still coming in. When access is a problem, the system becomes overloaded. It happens, and you do the best you can. Having an emergency plan is essential to mitigate as much of the problem is possible, but as we all know, NO plan can cover everything. We adapt. It's what we do.

46-Honestly I am unclear about the existence and differences of how unions operate in a right to work state. Are you a dues paying member to the IAFF- or some other union? Do you enjoy the same benefits as a member in a union state- ie PAC's, lobbyists, and PR? Do you operate under a collective bargaining agreement? Is your municipality(and the local) not bound by the provisions of that CBA?

Psst- you aren't talking to civilians or some clueless politicians here-many of us DO work in this business. You sound like a PSA bought and paid for by the IAFF. As a matter of fact, I believe that video you linked has been used by the IAFF, but I digress. Listen, I know about the push for manning- nothing new. I also know that in many areas, unless there is a life safety issue, aggressive interior attacks are a thing of the past. Things like master streams and aerial pipes are used now more than ever before- surround and drown. You are absolutely correct about when you need a firefighter, you want 50 guys to show up in less than a minute, with state of the art equipment, have a positive water supply, no frozen hydrants, no lead out problems, all having 20 years experience, hundreds of fires under their belts, and all possessing every certification known to man- from Haz Mat to swift water rescue. Now back to real life... The fire service is used to being the sacred cow- and for good reason. Problem is, times have changed, fires ARE way down, and the fire service has adapted to that by absorbing EMS. Smart for them, not necessarily what's best for the public. The fire service- and IAFF's- number one priority has always been, and will always be fire suppression and rescue. For many areas, 3-4 man companies have always been the norm, and mutual aid agreements supplement their manpower. Ideal- no, but it's reality. In today's economy, an area's police service, EMS, and a dozen other services would suffer if fire received everything they asked for. IAFF is suffering from the same thing that killed Detroit- union arrogance. When times are great, unions negotiate incredible pay and benefits packages. If anyone knows about some of the famous(and often times ridiculous) perks the UAW managed to get for it's members, you know what I mean. Even when a company is losing money, they are required to pay their members. That's fine and great for a member, but a union also needs to be realistic about it's demands and expectations. Unions like the UAW finally agreed to concessions, but it essentially was too little, too late. Big auto needed to be bailed out- their legacy obligations were killing them. I know you cannot put a price tag on public safety, but the sad reality is that it's necessary. I believe in premium pay for risking your life, responding to incidents when everyone else is running away- that's what we do and we should be well compensated for it. Sadly, too many of us are not- especially those in EMS, and just because fire has a longer history, more members, and a stronger lobbying arm, it does not mean it has the right to walk over EMS- especially when it's not providing a better option.

Agreed with all, but it IS about the money. There is only so much money to go around- even in Vegas. If money was no object, all the city employees would be paid 150K, driving a Mercedes,and their company equipment would be state of the art and top of the line. The political reality is that every city agency is being asked to do more with less. When unions are involved it's a sticky issue. Lay offs, pay cuts, unpaid days off, and service cuts are a no-no thanks to collective bargaining agreements. Some areas have negotiated give backs from their unions but the stronger the union(and the more essential the service they provide), the more difficult that will be. The fire service KNOWS they cannot justify their staffing levels based on their call volume, and although insurance regulations require a certain minimum amount of fire protection, these regulations usually say nothing about things like minimum staffing levels. Thus, they expand into EMS, and more specifically transporting, so they can generate revenue to justify maintaining their status quo. Again, this is about what's best for the fire service, NOT necessarily the citizens.

I read your post. I was talking about the snow removal process itself. Even a simple snow plow costs real money when you multiply that by dozens, if not hundreds of vehicles needed to adequately take care of the problem. I'm sure there are also added costs of ensuring the vehicles can handle the added strain of a plow- hydraulics, heavy duty suspension, reinforcing frames- I honestly don't know all the details. Then you have the added wear and tear on a vehicle that may be intended for simple light duty work, which would mean more repairs, and earlier replacement for those vehicles so they could perform their usual functions. The issue of ensuring an ambo fleet can respond in these conditions is a whole different issue, but the same questions and concerns remain. How many cities could afford to buy something like a fleet of HumVee ambos to ensure they can get through a heavy snowfall and difficult streets? Practicality, cost, and political realities need to be considered, especially to prepare for a once in a generation problem. Now if you work in an area that receives 300 inches of snow a year, especially in a rural area, then clearly that added expense is needed.

Agreed. I have no problem with protecting your own interests, but we are also dealing with public safety here, not making widgets in a factory and the owners decide to make their product in China because it's cheaper. It's the owner's prerogative to make money, but that does not mean his product will be any better, just cheaper. The problem is, a 3rd service provider generally does not have the resources to put up a fair fight with the fire service. As big as a private provider may be, it's still no match for the IAFF, their PAC groups and lobbyists, or more importantly, their PR machine aimed at the citizens. John Q Public has no idea what the issues are in this- they simply want someone to show up when they need help. Whether or not they have good service or the providers who respond are competent, is something they may never really know or fully understand- especially if that experience is limited to one or 2 instances. There are quality people on both sides of this, as well as utter morons, so you also don't want to use too broad of a brush to paint this picture.

It's a balancing act. As a city manager you need to play the percentages. If you have x amount of money that could be spent on snow removal equipment, but you live in an area that is not known for big snowfall, a manager would probably use that money for new garbage trucks or improved roadways. In a perfect world you would have all the necessary equipment on stand by with every potential storm. In this economy, it's simply not practical.

No, it's survival of who has the bigger lobbying presence and tradition. Sheer numbers do not make something "better". SO you are OK with pushing something that has nothing to do with making a situation better for the people you are supposedly trying to serve? That's selfish, dude. NOBODY wants to lose their jobs and I would do whatever it takes to take care of my family, but don't pretend this solution is actually what's best for the citizens. There is NO evidence to support that theory and actually more than enough evidence(verifiable and anecdotal) to make a solid contrary argument This is about politics and nothing more. "The change would produce revenue for the city and "hopefully prevent the loss of some of our fire service folks," Fire Chief Al Gillespie said". That was the statement I saw, and his real intentions here.

In a large city, there is no such thing as an easy fix for anything. Think about how much it would cost the city to just retrofit enough vehicles with a simple snowplow just in case a killer snowstorm occurs like this. Who would drive these plows? Where would these drivers be pulled from(other city agencies, private companies, etc?) How much would they be paid? If these drivers were pulled from other city agencies, what would happen to the services they are supposed to provide? Would this be OT? Couple that with the bad economy, city cut backs and lay offs, and it's not such an easy solution. I remember in college I went to a large school in a small town. It rarely saw more than a couple inches of snow at a time. One year they received 6 inches and the entire city and school shut down for a week until they could clear the roads. They simply did not have the assets to deal with that much snow. In most northern cities, 6 inches of snow is a minor storm which would cause minimal issues. Was it foreseeable that the area would receive a larger than average snowfall at some point- sure. Was it likely enough to justify spending hundreds of thousands of dollars on equipment just in case? No. There were much more immediate needs for that money and the tax base simply could not support such expenditures- especially when it may be decades before the problems ever occurred. I have no idea what the average snowfall for Pittsburgh is, but even in a city that is used to dealing with big snowfalls, sometimes it simply comes too hard and too fast to be able to keep up.

I would forgo EMS. If you have the smarts and the ambition and your real desire is to be a doctor, focus on that and do not waste your time with EMS. Working as an EMT- even in an ER setting- could be a great temporary gig to make a few bucks while you are in college, to get your feet wet in medicine, but with your vision issues I think you will find your job opportunities severely limited. Pursuing medical school is a full time job that starts the minute you step foot into college. Besides, you have a long way to go, and unless you are already CERTAIN medical school is your future, I would not limit my choices either. Many people start college with a certain major or field of study in mind and end up changing their minds several times before they finally decide on their careers. Granted, medical school aspirations are slightly different, but don't get tunnel vision. Keep your options open- money, time, realities of school(a pre med curriculum is hard, ultra competitive, and you need to be on top of your game), test scores, the MCAT- these are all hurdles you must overcome, and you may find another career actually better suits your interests. Your first task- ask yourself WHY do you want to be a doctor- or any other career, for that matter. Then speak with a guidance counselor who is actually knowledgeable about the process. In most cases, a high school counselor is NOT the best person to speak to about this subject. Do some leg work on what medical school, being a doctor, and medicine in general is REALLY all about. Talk to your doctor. You may find that your perceptions about the profession and reality are 2 very different things. Most people have no idea what being a doctor- or the process of becoming one- is really like.

Same old story. Vegas FD wants to take only the most critically ill patients and leave the routine stuff for the private providers. Gee- I wonder why they don't want to take over ALL EMS transports for the area? Could it be that they KNOW that the routine, nonemergent types(read BS calls) are either self pay or those on assistance that reimburse pennies on the dollar? So the privates are left with a significant decrease in their revenue stream and are forced out of the area. At least the fire chief was honest- it has nothing to do with providing better care or service to the citizens, it's a self serving ploy to save their own arses.

Mistakes happen. In the heat of an emergency or crisis, people forget their own addresses. Unless you have the capability to verify the address with a phone number, this can happen. Problem is, everyone uses a cell phone now and they aren't necessarily linked to an address, which makes it even harder.

Not defending anyone here but in rural areas, aren't the vehicles more likely to be four wheel drive or have some type of off road capabilities? Most urban fleets are NOT designed for anything but city streets. (Poor ground clearance, no chains, rear wheel drive, etc.) Thus, a deep snow can and have- easily paralyzed a response.

I'm wondering if the antibiotic was prophylactic or if there was an infection going on. I would be leaning towards metabolic issues- ie septic shock, based on the BP. As for ambulating- no way. Cardiac is possible, but it wouldn't be high on my list. Fluids wide, high flow o2 and fly. I'd guess she has a massive course of iV antibiotics in her future. NH patients are tricky.

Well, I don't know how they request additional resources there, or what their call volume was, but I've used a stokes basket to drag people through the snow because a road was impassable, but we also have the luxury of asking for and getting all the help we need. A disaster is defined as more calls than available resources can handle. In this case, it was essentially a disaster situation, and normal rules do not apply. Abdominal pain CAN be a life threatening problem in some cases, but compare it to SOB or chest pain. In this situation you need to prioritize and triage. I did not see what actually killed this guy, but he did die 2 days later. Did the delay even matter? WOuld he have succumbed to his problem anyway, even with immediate transport? I don't know. EMS is not a perfect world. I walked a guy(or more accurately, RAN him) with full blown CHF from his porch to the rig once. Problem is, as we approached his house there was gunfire skipping off the pavement near us, and he was more than willing to run with us. I apologized profusely, but he said he wasn't waiting around for us to carry him. He damn near beat us to the rig too. LOL

What the hell is wrong with people? It was a once in a lifetime storm for that area. Bad things happen. People get stuck, people have MI's shoveling snow, people die. Are they going to sue the weather gods too?