Medic2588

There are some of us who are trying to change things for the better. I would say thanks to the Task Force EMS is much better prepared for potential specific events (terrorism on the Port Authority trains, maritime emergencies, etc). But even then we meet with resistence from several organizations in the state (I'll be politically correct and leave names out). Its frustrating, but I'm convinced every state has their problems. Jersey just seems to be more vocal about it. Devin

I remain respectful of a patient's religion and religious practices but I will not pray with them. Personally I do not like to become emotionally involved on any level with my patients, which helps me immensely in dealing with death. I empathize with a patient, but not sympathize, and the emotional dettachment enables me to watch a patient die without being bothered. However, I do try to learn as much about the religious and cultural values of the communities in my response area. I find it very interesting and it helps me remain respectful of their wishes at the time of death. I'm actually writing a paper for my Emergency Management masters on how cross cultural mourning and funeral practices are impacted by mass fatality investigations. Devin

Um, let's see... Valium, Ativan, Morphine.. ooops, did I say that outloud? Actually, I do help myself to nitrile gloves as well. I from time to time utilize their linen and pillows (but only my base hospital). Every hospital however is far game for my Drug Rep Pen addiction. No pen with a medication name on the side of it is safe from me. Devin

Mediccjh, Just one correction on what I consider an otherwise perfect Manifesto: They do hold EMTs and Paramedics accountable for actions and the State does investigate complaints. HOWEVER: you REALLY have to screw up and kill someone in an impressive way (do we remember the Trenton incident with the head injury patient?). There just needs to be a much better way to follow up on complaints, such as more staffing in DHSS. Otherwise, preach on brother! Devin

Not at all SSG, that's what this site is for. The only stupid questions are those that aren't asked. Of course, we can always come up with stupid answers 8) Devin

Cushing's Triad is a group of signs that might indicate increased intracranial pressure. 1. Increased BP - to improve oxygenation to the brain to compensate for the increased pressure 2. Decreased Pulse - triggered by the pressure on the baroreceptors in the brain 3. Altered patterns of breathing - I forgot how you explain this one Beck's Triad is a group of signs that might indicate a pericardial tamponade 1. Decreased systolic BP with a narrowing of the difference between the systolic and diastolic values 2. Muffled heart tones 3. Jugular vein distention Devin

The shut down caused a huge panic, but it wasn't a complete shut down. Its funny where our priorities lie. Everyone remembers the casinos shut down but forget about the State Police having to go to work. :shock: Devin

True in theory. However there is a max on how much you can write off, and its never even close to what you paid out. Sadly I found that out the hard way in the quest to finish my masters. And tax deductions are not as good as free training. Devin

Not that I'm defending MONOC, but part of the reason we tend to villify them is that they treat EMS as a business. That seems almost counter-intuitive to what we see EMS as. For the provider, our bottom line is our patient. However, for a business to succeed it has to be run like a business. MONOC has been able to provide care to many in NJ who would have never received it relying on the failing local volunteer agencies. However, I think MONOC got too big too fast and outgrew its billing parameters. Now its forced to shut down units because it can't bill in the same many other agencies are allowed. I'm very interested to see what the EMS Focus Group comes up with in respect to changes within NJ. Although, I'm really not convinced you'll see a deregulation of ALS service. Especially since there is such a problem regulating BLS units in NJ, it would be difficult to ensure compliance and quality if everyone started running ALS. I have nothing against any particular BLS unit in NJ (ok, that may not be 100% accurate) but we can all agree we know several EMTs who cannot be trusted with sharp instruments Devin

Scrat, UMDNJ stayed open during the shut down as it was considered an Essential Service (as the State Police didn't shut down). Parts of OEMS remained in service during the shut down. The entire department was not shut down. However, as much of what OEMS does is reviewing complaints and regulations, would EMS as we know it grind to a halt if they closed up shop for a few days? No, which is why they many of the staff were off during that period. Medic2891, As for the First Aid council, it wields power only in few places in New Jersey. Bergen County is one, some south Jersey areas as well. However, the vast majority of NJ squads have signed out of the FAC or stay only as a means of getting an invitation to their annual party. They do have some influence only because they know how to whine. However, with the right pressure you can get them to acquiesse (any Garden Staters remember the turmoil with the creation of the EMS Task Force?). And trust me, working loosely with the DHSS I can say you'll NEVER see OEMS become separate in your lifetime. The way to solve that problem is to get quality people in there and have the state actually fund it properly. You have some really good people working there now, but why would you work hard or stay if you're getting paid S**T? For all the bashing NJ gets, I honestly think it works ok. Could it be better? Sure, but I'm positive every state has their particular problems. My advice to help you avoid an early ulcer is to not expect much from anyone. Don't expect to have quality BLS and you won't be disappointed, only pleasantly surprised when they turn out to be competent. And don't expect quality ALS partners either, that educational process seems to be tanking in several programs (many non-Jersey programs). Devin

Yea because no one dies unnecessarily anywhere else. We just do it in fantastic ways that make the news. :roll: Devin

In NJ, projects for the most part utilize these fly cars for paramedic units. They are usually SUVs or utility body vehicles that do not transport. They are staffed with 2 paramedics. We intercept with the BLS and provide care in their ambulance en route to the hospital. As a paramedic I love it. Occasionally it can be a redundent use of manpower, but that is how the protocols in our area are set up. Other systems in NJ utilize ambulances for their paramedics. These often do not transport unless there is no BLS ambulance available. The usually a culture thing (ALS/BLS tuff wars). Devin

What I find helpful, when physically possible, is to pull the patient to the head of the stretcher so his/her head is dangling off the edge. Then I elevate the stretcher to about a 45 degree angle. This puts the body in near perfect alignment. It then becomes very easy to move the jaw out of the way to see the airway. Grants, this is not possible if the patient is a trauma patient or a retracted elderly patient. Devin

The International Atomic Energency Association has adopted a new symbol for radiation. Apparently, people around the world seem less likely to recognize the classic trefoil. To read more about the new change, check out: http://www.iaea.org/NewsCenter/PressReleas.../prn200703.html Unfortunately, its not a joke. Devin

How many points do we deduct as this is the 3rd time this thread was posted? Devin

Here we have one in the region capable of using hyperbaric oxygen for treating CO poisonings (not all chambers are created equally). So we transport all patients to local hospitals and then ship them out if they need hyperbaric O2. CO poisonings rarely produce large amounts of patients requiring hyperbaric therapy. But I guess it all comes down to local protocols. Devin

I'm still not convinced. More than just a carboxyhemoglobin level is needed to determine hyperbaric oxygen, and triage for multiple patients should be standard regardless of the cause of the MCI. A standardized system like START or SMART should be used and hyperbaric therapy decided upon by the emergency room after the blood levels are checked. Devin

As an Advanced Hazmat Life Support instructor and Hazmat Tech, I'm curious to see why this piece of equipment would be of any value to anyone in the prehospital setting. If you suspect the person has inhaled Carbon Monoxide, the only course of treatment you have is Oxygen. I'm not sure what other decisions you would need to make for a CO poisoning. As a myriad of factors can influence the way a Pulse Ox reads, I'm sure the SpCO detector can be equally influenced. Therefore, the only way to truly know how much CO a person has been exposed to would be to draw blood and measure the carboxyhemoglobin levels. Devin

NJ's EMS Task Force operates 3 Gators for special events and all terrain access. We have access through our member agencies to 5 more Gators and a Mule. Devin

Contrary to what MONOC would have you believe, not all ALS projects in NJ lose money. MONOC is a unique entity because under Medicare A billing rules, they are considered a "hospital group" and not a "Hospital." Therefore, they are not allowed to bill for Medicare Part A. Which, for a service that serves a large percentage of senior citizens, this could be a problem. However, the rest of the hospitals don't have this problem. Devin

Civil, Not sure the exact brand we have since its not in my possession in the office at the moment, but I don't believe it cost more than $250 a pager. And these were recommended by the Nuclear Medicine/Safety people at one of our cancer treatment centers so I'm pretty confident they'll pick up radiation. Devin

Civil - no need to apologize. I know what you're getting at and don't think you have any alterior motives. But we don't anyone saying anything about preparedness here that could be used against them. We have Rad pagers for the EMS Task Force. Some of the ambulances in the state also have the radiation detectors in the ambulances. The problem with these is that they get set off by patients who recently had radiation stress tests. Ruff - quite the contrary. We are probably best prepared to respond to a radiation incident because of all the preparedness that went on during the Cold War. Responders being very very sick or very very dying is a misconception. You need Chernobyl type radiation levels to kill responders like that. That being said, there is still a problem with responder exposure. There really is no PPE to protect you from radiation, although SCBA will protect you from inhaling radioactive particles. The good news is, this is probably the easiest exposure level to measure, track, and predict medical effects. The detection equipment is extremely easy to use, with the right training and right practice - Which I think is what Civil is getting at. Most places have created plans to respond to radiologicla incidents. Its up to everyone to make sure they are familiar with these plans. If you're reading this, encourage co-workers to review you plans and become more familiar with them. And if you find you don't have plans for it, feel free to PM me and I'll set you on the right path for planning. Devin

CivilDefense, A lot of your questions may be construed as information that should not be made this public. However, I will say in general for NJ: 1. Radiological detection equipment is available on several EMS units (note several, not 100%). Is it calibrated? Can't say with any degree of certainty, but I know mine is 2. Is the state active in the Maintence program? Not sure if it is active with the same program of which you speak, but our State Police Hazmat Response Unit will assist with maintenance and calibration... or so I'm told. 3. Does your state make training available? Yes, at least twice a year we have training through Bechtel, NV at the Middlesex County Fire Academy. Who goes? Not sure, but I know several EMS persons who have. 4. Do police and EMS involve themselve in Rad/Nuke prep? On the whole yes, especially now that we have the NJ EMS Task Force to be involved in most emergency planning. 5. Plans/protocols for contaminated patients... on the whole yes, but has it filtered through to everyone? Can't be sure. Most every hospital is equipped to decon radiation patients and our state Burn Center can coordinate evacuations to other specialty care centers through the NDMS network. Devin

Sewage Worker... um, not too far off for an urban medic Devin

Um, this depends... is it per incident? :oops: $875 although I thought I'd be much more. Devin