EMT155

OK... to answer: 1.) Do you transport cardiac arrests? Yes, unless it's obvious death 2.) Do you WANT to transport cardiac arrests? Personally, yes, because I'd rather let the ED deal with the family. Also, I've had a few saves over the years that may not have been if we hadn't kept them viable to the hospital. 3.) What are the benefits gained? Again, personally, not having to deal with the family, it provides psychological first aid for the family to give them time to consider the outcome, CYA factor (thanks Dwayne), It 'looks good' for your service (not sure how better to put that, but it shows a life saving effort for lack of better words) 4.) What are the risks? Really, not that different from any other ALS transport, and a priority response to the ED does not by any means include a balls-to-the-wall approach. You make your best time taking into account road and traffic conditions. 5.) Should any code blues be transported or should they all be called in the field if no return of spontaneous circulation? Yes they should be transported IMHO as cited above. Jim

If you're going to be studying up, a great text that i refer back to a lot still is the Brady book on Arrhythmias. Linkage: http://www.bradybooks.com/store/product.aspx?isbn=0135002389 Great info there. There is also a wealth of info on the net for casual reading and a few places where you can get practice ECG's too. Best of luck!! Jim

Wow..... Lotsa thoughts in all directions here. OK, just to clear up a couple things. not so much that we aren't getting the tickets (worth $10), but more that they were just going to let it go by without bothering to inform us that there was a change. Also, we actually pretty much define the term underfunded. Prime example is our defib. Heartstart 3000. can no longer get it serviced, and it doesn't meet protocols for defib. I've been asking to get it replaced for the last 5 years and it keeps getting skipped over. We spent 2 years begging for uniform shirts for staff that didn't have them (ended up spending our own money for that and just got reimbursed this fall, a year later) . We have a GEM car that usually doesn't work as it gets passed over for maintenance each year, and have not had a marked vehicle even part time for almost 8 years. I know where you're coming from Dwayne, and honestly, I'm seriously considering walking. The reason I don't thus far is because I've put too much blood, sweat and tears into this team. To go into details would sound like bragging, but I have had help, but have carried a large portion of the burden myself. That and I'm really not a quitter. Oh, and the tantrum part, I realize that came off sounding childish, but it's more of a go in and blow a lot of steam around. Over 17 years, the powers that be know that I won't come in steamed unless it's important or justified. Our Exec Dir of EMS is usually the one who plays the politics and i get to be the Bull in the China shop Subtlety is not my specialty. There have been a number of times over the years where we've been promised things only to get them yanked out from under and not told till later. Makes for a bit of bad taste, but we still keep coming back. I guess we're just gluttons for punishment. Jim

By definition, a BBB is a delay of conduction down the left or right bundle branch. Many people have this condition and live totally asymptomatic lives. To the best of my knowledge, we have no protocols dealing with the asymptomatic version here in CNY. This can change by state and region depending on your medical director. Patients with cardiac symptoms should be treated with the appropriate protocols for your region dealing with the symptoms (ie: chest pressure radiating, Systolic over 90, give a baby aspirin and a NTG) If i were to put a patient on the monitor as a precaution with no cardiac complaints and saw it, i would probably question them a little harder along the lines of cardiac history, but other than giving them O2, not much to do other than let the ED staff know. Issues can arise from conduction issues between the SA and AV nodes, or if there is a complete block somewhere along the way as it can and will decrease the effective contractility of the heart as a muscle. Again, refer to local protocols for treatment options. Here is a good explanation of the conduction system of a regular, healthy heart: Linkage Here is a great read on Arrhythmias, including AV blockages: Linkage Also going to attach a pic of the conduction system for you I used to work as a cardiac tech in ICU, and the whole thing just amazes the hell outta me. I'm such a cardaic geek hope this helps you out some. Jim

Hey all!! OK, this is a borderline rant, so you are forewarned. I also wanted to toss this out there for some reactions before I go and throw a patented temper tantrum I have been volunteering for a local BLS first response agency for 17 years now. I am currently the Director of Ops/Recruiting. I preface this so you'll get an idea where i'm coming from. For the past 10 years or so, each year we get a complimentary pass to Lights on the Lake. Mind you, this is the only 'thanks' we actually get as a team. There are no benefits or retirement programs. We are a small 'division' of the county parks system. We don't even get free admission to the parks. This year, we didn't receive them. I spoke with my boss (our Executive Director of EMS) about it as I had received a number of requests as to when they would be going out. He checked into it and found out that the county has sold the whole program to a local communications group. They *did* give the county a number of comp tickets, all of which went 'downtown' to the politicians. I now have a bunch of pissed off EMT's of whom I can guarantee some won't come back next year. Word spreads around here like wildfire when it comes to things like that, meaning I'm going to have to work even harder to convince people to volunteer..... I will be going into the office next month to speak with the commissioner and try to get something for our members as a 'thank you' for giving their time. I know it may sond silly to some, but considering what we go through to get the equipment we need and even something as simple as uniforms, a thank you is something I feel my people deserve. I do work hard to take good care of the people who give their time to us, and feel somewhat slighted that they couldn't even bother to let us know ahead of time that we wouldn't be getting them this year. Thoughts, feelings, opinions? If you vol, does your agency have some sort of compensation, be it a retirement plan, stipend or whatever? Trying to also get ideas for what to ask for when I go in there. Thanks all!! Jim

was trying to think of something that hadn't already been covered here so as not to sound like a broken record, and this crazy week we've had here did the trick while catching up. Dwayne, the one thing I've learned, is that it isn't always the dispatcher's fault either, they have to rely on the info obtained by the call taker, and the call takers have to rely on the caller to give them accurate information. If the caller said there was a man down by a smoking truck, most of us are going to think there was an accident. Obviously not the case here. Remember, your info going in is only as good as the lowest common denominator who called it in. I don't care who called it in, you'll almost never get a complete idea of what's up till you get there. Hope you all had a great week Jim

Am thankful I've never been on the receiving end of that, either from a victim or rescuer standpoint. One more reason why I am glad to be the guy who has to wait till they're out of the car.... Jim

Maz, What about knee replacement? As someone who has all sorts of knee issues due to traumatic injury almost 25 years ago, I have a little bit of idea about issues with knees. My Orthopedic surgeon is already planning the replacement surgery for me and I'm not due for it until I'm 40 (which is another year and a half ish), but other than occasionally taking some Alleve and giving up my skiing about 13 years ago, I haven't slowed down at all. It's true that you should look at other opportunities as well, I personally am taking the civil service exam in March to be a county Dispatcher. My first love is EMS, but gods forbid something took me out, I'll know I have something to back me up. I'm also working on setting up a class for health care providers of all venues on Transgender awareness and how treating a trans individual can differ from someone who was born to their gender identity. Sometimes it just takes looking around at what you do or who you know to figure out how to keep your fingers in the pie if the poo hits the multi bladed oscillating air movement device. The first thing though.... Keep yer chin up kid!! Attitude is everything, and in my case, probably too much But with a positive attitude, you can do almost anything you put your mind to. Best wishes!! Jim

Wow.... Thanks guys (and girl ) for your input. I do try not to let the job influence my home life, but you're right, it doesn't always work that way. Honestly, when I started this, I thought it was going to be better because she used to complain about how much time i spent volunteering...... heheh.. There is a lot more going on around the home than I am up for sharing right now, nothing bad per se, just stressful. And Dwayne.... I can't complain in the intimacy side of things. As to the long engagement part, well, that's ind of on both of us as we're waiting until we can do it he way we want to, not the way we have to. Once she's settled down a bit (and no, sex won't help right this minute) I'm going to try talking to her again (not my strong point admittedly). Although we have found that, as bad as it sounds, email or facebook messages actually work OK for us because there's no shouting or arguing involved. I still welcome comments and thoughts, and once she and I get through today, I am going to start putting together a blog on it..... probably link to this thread at some point too Logging out for family time Jim

Was debating posting this, but figure it can't hurt. Just looking for other's input on this. My Fiance and i have been together for 7 and a half years. It ain't perfect, but then again, what is. She puts up with me and I love her dearly for that. I know I'm not the easiest person in the world to live with. That aside, since I started actually working as an EMT, it seems as though things have gotten rougher. I know I work 60 hours a week at a minimum, but a lot of those hours are overnight, and since we aren't running a dozen calls a night, I generally get my night's sleep in and spend most of the day with her. Her biggest compaint is that my whole attitude on life seems to be changing now and that I don't seem to care any more about much of anything. Yeah, there's a lot more to it I'm sure, and I am not doing this to air my dirty laundry, but asking others out there in the field a simple question: Is your significant other in the business, and does your work affect your relationship? (OK, that's 2 questions, but I think you get my point here). My goal with this topic is twofold. 1- obviously I'm trying to figure out if this is just her adjusting to my schedule still, (I've already talked to a therapist about it, so I am taking active steps) and if it's something that is spread across the business and 2- I'd like to get a general idea and work it into a topic in my blog as well. I'd like to thank any and all who reply to this beforehand. On the vol side, being an officer means I tend to be the one my people come to when they need to talk about something, and I never really thought about this particular topic before, but with the job market where it's at here in the Central NY area, I see more of my people going to full time EMS to earn their paycheck. I know that I'll likely be in this conversation with someone in the not too distant future, and if I can figure it out and smooth my own relationship out, then I can be in a better position to know what they are going through. Thank you again. Jim

I like my GPS, but do not depend on it 24/7. I actually have 2, one that sits in my work bag for distance transports if I'm not 100% where I'm going (and I highly recommend that Magellan RoadMate 2200T) but normally it just sits there with my movements showing. Occasionally, I'll flip it to show direction speed and elevation,etc just to check my speedometer. That being said......... Set it before you drive and DON'T stick it in the middle of the freaking windshield. Mine sits in the lower right corner where it doesn't interfere with my ability to see the road in front of me. It also auto dims with ambient light so as not to be distracting at night (My Ipod is brighter at night than my GPS). Like anything else, there are some common sense things that apply to any type of electronics that, unfortunately, the general populace just can't seem to handle. Anyone remember the Megabus crash in Syracuse a few months back? He missed 17 signs (3 with flashing lights and one of those with white strobes) all because he was allegedly fiddling with his GPS. *shrug* I guess you have to adjust to the lowest common denominator instead of going with self responsibility Jim

Awesome. Absolutely awesome. 2 cousins are FDNY, thankful that bother were off duty and out of the city when that happened. Took us almost 30 hours to find out they were OK. Was just by GZ a couple weeks ago doing a transport to NYC (Ortho pt going home for rehab) and stopped to pay respects. Congrats and proud to know the memories are still alive. Jim

I think this is an interesting concept as far as it goes, however, it's not one I would be comfortable supporting. That being said, I am an organ donor, registered and with family advised of my wishes. Personally, i think that this is going to end up backfiring badly and it's going to be EMS that suffers for it, not the Docs or anyone else. Simply put, we should continue to work a full arrest to the ED and allow them to make the determination and speak with the family. I have yet to see a death in the field that wasn't pulled for autopsy locally. Actually, i believe that any 'unattended' death in Onondaga County is automatically put in for a post mortem. This includes any death that is not... well... expected I guess is the best word. Hospice attended deaths are excluded. If we pronounce on site, it's generally going to be on someone who is not viable for any type of organ harvest. I jsut worry that something is going to happen with this and the family is going to end up having 'buyer's remorse' and blast it out at the EMS because the patient is taken to an ambulance, be it a harvest rig or what have you, and all they are going to see is that ambulance sitting there while it happens. We're the ones who will take the heat on that when it happens. *shrug* Again, this is my personal opinion, not meant to down anyone, I just don't see it working out at least here in the Central NY area. Jim

Great conversation gong here.... On the Vol side, I work as a BLS, non transporting first responder, no ECG or invasive techniques. In that situation, if the CP started prior to the initiation of the ventolin/albuterol Tx, I would be starting ALS on a priority. Continue the Albuterol (just for clarification as it's how our protocols are written) Tx using a NRM attached to the neb. I would also give the pt a chewable baby aspirin and assist taking a NTG as long as the Systolic is greater than 90. At this point, I'm monitoring v/s and updating the ALS awaiting their arrival. We don't have any contraindications for albuterol based on cardiac issues here, so that doesn't play in here. At work, I am the BLS half of the crew, and would assist the ALS provider with starting the albuterol, getting a pulse ox, ECG and then possibly NTG and aspirin as per protocols. Good chance I would also be setting up a line for them to initiate IV access and getting to the ED at a decent pace. HOWEVER....... If I had any suspicion of CHF (ie: lung sounds a little on the 'bubbly' side), I may be more inclined to bypass the albuterol and go straight for O2 via NRM @ 15lpm+ and assist with NTG and advise ALS to expedite. at work.... That's what the paramedics are for Jim

As this story was not true, I can just conjecture away on it. 1- Being as we have a ton of friends who are in the LGBT community and have access to their knowledge base. If a guy has a PA (Prince Albert, or piercing through the glans) it is possible to be stimulated to an ejaculatory state with minimum 'attention' simply because of the location of the nerves and such. 2- The new 'intrusive' pat down is pretty invasive and involves significant body contact. Therefore, it could potentially provide significant stimulation to the passenger to cause an ejaculatory state. 3- The passenger can not be held at fault for having a physical reaction to this contact. It's like saying that if someone wears a cologne that i am allergic to, and I sneeze on them, I assaulted them by sneezing on them. It's all a perfectly normal reaction to an outside stimulation that you have no control over. Besides, the TSA Agent should have been wearing gloves for that exam anyway, and if not, then it's their own fault for making it a 'personal' experience. LOL... I did my best to keep it fairly clean and clinical, but we were just having this conversation the other night with friends of ours and having a great laugh about it. Jim

OK, so it was more a respiratory arrest/pending full arrest. Personally, I feel that any time you bring someone 'back' from a potentially life threatening situation it qualifies as a save. Again, this is my opinion only. I do realize the technical difference between respiratory distress, respiratory arrest and a full (cardiac) arrest. Again, in my personal opinion, anyone who is brought to a healthy outcome after being in one of those preceding situations should be counted as a save. Just clarifying my point of view... Jim

Alex, I have to say, I do like this revision. I think it is more appropriate across the state. I lived in NYC for 2 years on my first college attempt and that is where I took my original basic class way back when. I have spent the vast majority of my EMS career here in Central NY and have worked with agencies across Upstate, Western and Eastern NY over the years through different groups, and I have to say that there is such a HUGE variety of scenarios for care in this state. We have everything from NYC to squads of volunteers that are an hour plus from the local hospitals, even with high speed ground transport. I think that this is the reason why the multiple levels have worked so well in this state. Adding some hours onto the B coursework due to the expanded scope of care is not unreasonable, and I agree that it would be beneficial. Combining the I and CC or even eliminating the I altogether in attempts to match up with the NR is also not unreasonable. Overall, I think that this revised concept is something that the entire state could work with. The key thing to remember when looking at revisions on things like this, is that NY in particular is a very unique state in our variety of settings and situations. There are very few states out there that have this kind of variety. Everything from NYC to places where your neighbor is so far down the road, all you see at night is the stars above. This presents us with unique opportunities to be a leader in the art and science of pre-hospital care in so many different ways (check out the Farm Medic classes that Cornell offers for a great example). The key, and this isn't just for you guys in the city, but for those in the boonies as well, is to remember that we have that variety, and what will work well for one, will be a disaster for another. Thanks for listening to our input, and i wish you well with this and would love to hear the updates as you move forward on this. Jim

Then again, a save's a save either way. Wish we could have more saves. The one thing I always tell the newbies is that you'll loose more than you save and in 20 years, that has borne out. It's different when the patient is a kid, that's for darn sure. When I was a CC here, we had a call for a 2 yr old who seized and stopped breathing. Febrile seizure in June, our response time was under 2 mins as we were right down the street doing a traffic detail for the local high school graduation (FD had a Non Transport ALS Rescue at the time). Turns out when she seized, she partially aspirated a french fry. Suction removed it and I think we all about balled our eyes out when she started screaming. Resp's were 0 on arrival and she was up and crying and all when handed over to the paramedic on the ambulance. We counted that a save and it's one that we'll never forget. Peds saves, for some reason, tend to hit bigger than adult saves. I know the basic psychology as to the why, but still. That's a great way to head into the holiday season there mrsbull!! Happy Holidays to you and yours!! Jim

Not in our protocols at this time in Central NY, but thanks for the topic. I'm reading up on it now and will be asking questions about it considering our weather patterns up here. Jim

Congrats Wendy!!! @ Spenac.... LAMO!! I haven't heard that in forever. Jim

Alex, just as a side note, (I had to check my facts before I posted this) the paramedic program at Herkimer CC is actually an AAS degree upon completion. Just FYI Jim

Thank you all!! @ Richard, no, I unfortunately was not able to make that

Alex, First of all, for the record, I don't disagree with the concept you put forth. That being said, I have been certified for over twenty years, with a year at the Intermediate level and 3 at the CC level. I live and work in Central NY. I have spent almost all two decades as a volunteer EMT and currently am the Director of operations and Recruiting for a volunteer agency. I work full time for a paid ambulance service now as a basic EMT. I only point this all out to let everyone know where I'm coming from. The biggest hurdle you are going to have is that here in Central and Upstate NY, the vast majority of prehospital providers still rely primarily on volunteer members. This is especially true in the more rural areas of Upstate (north of Oswego and Watertown). By requiring more education than we already do, you are taking people away from their families for even more time without any real compensation to them. Eventually, these people are going to get out of the business, and more people will be dissuaded from starting due to the length of schooling. On top of that, it's difficult to find a paramedic level class that is covered by the state. I'm signed up for the closest paramedic class I can locate, and I have to shell the money out of my own pocket, and I don't know of any agencies locally that will reimburse for it. I've been in regular contact with SUNY Upstate and several other local groups that have access to class schedules, and at this time, no one here is offering the class at a state covered level. I'm sure that downstate EMS providers make somewhat more than we do up here, but being a homeowner and parent, having to pay more to keep up my certifications is difficult financially as well as in time. For those of us that get a fiduciary return on our educational investment (and Herkimer community College offers the pilot program, which trades off CME's for recertification, bringing the paramedic level closer to licensure than certification.) While I've rambled about the topic a bit, the point I'm trying to make is that, while ALS providers as the lowest level is good from the patient's perspective, we can never forget that BLS comes first and foremost before ALS, and if we ramp up the requirements too much, we'll end up with less people trying to do more work, leading to more burn out, injury and general loss to attrition. This would not be good for the patient in the long run. While, from a practical point of view, I think we can eliminate/upgrade the I, CC and P levels to provide higher levels of care in the prehospital setting, I think that the basic EMT level as it is, is already where it needs to be to make sure that there is always going to be adequate coverage for the rural areas of the state. The other thing to bear in mind is that in upstate, we have other classes that we take as a compliment to our certification, FarMedic being one of those. I doubt that you would see much in the way of farm accidents and injuries south of Westchester county. Not that it's a bad thing, just a geographical one. This is also why we have multiple regional RMSCO's different areas have different needs, types of calls and transport times. I'm not sure where you deal with the vollies you mentioned, but here in CNY, vollies and paid get along well and work together for the benefit of the patient. In closing, while I agree with your proposal in principle, in practicality, it needs some more latitude to work for the Upstate regions. Best of luck, and hope we can all find something that will benefit the patient without putting undue strain on the people who make it work outside of the city. Jim

Wow. Ugly, I have to tell you, this post really reached out and touched me. Suicide is a topic that's been going around here lately. About a month ago, a friend of ours ended her life by stepping in front of a car. My biggest issue is that now someone else is scarred for the rest of their life because of this. Maybe I'm being insensitive, but I just can't see anything that is so bad that you need to end your life. My finace and i work with gay and transgendered youth, and I've heard stories from some of these kids that would tear your heart out and they still keep on keeping on. As to how it affected you, I think that sometimes we all get to a point where we can't help becoming attached or feeling an attachment to a patient. Especially if it's a young person and we are a parent. I've never been ashamed of that and neither should you. It makes us human and shows that we do what we do because we care, not because it's a paycheck. Expressing yourself is what helps prevent or put off the burnout that is caused by holding it all in. Thank you for sharing, you aren't the only one who feels that way. Jim

Hi there! Obligatory first post introduction. My name's Jim and I'm currently a Basic EMT in NY state working as an EMT for the first time in the 20 years I've been certified. Yes, it took me 20 years to figure out I could get paid for this. I'm also a volunteer with the Onondaga County Parks Emergency Medical Services team and currently serve as the Director of Operations and Recruiting. I've come a long ways over the years from being a know it all newbie to being the 'old guy', entertaining the newbies with stories of calls I've worked. I have opinions that I'm not afraid to share, but have learned from being a part of a county agency, that sometimes discretion is the better part. That all being said, I look forward to being here and spending time chatting with you all. Jim