FormerEMSLT297

Facinating idea, I've never seen it in NY, NJ, MD, DC, or VA, but it's a GREAT Idea.... sounds a little cost prohibitive when a charge nurse can just say "ohh, medic XXX, go to room 3... " I don't see the real benefit of it.. Please explain what you think it would acomplish, as well as the cost benefit. LOL thanks Former

(edited for content) As I began reading this post, I though the exact same thing..... The minute a Psych. facility REFUSES to accept, or release a patient to you,, heads will roll, and management will be involved. Why spend money on BADGES when you can spend the money on BEER, and or wild women,,,, (LOL) The point is you don't need it, and it could get you killed. Ex. you are in a bank that gets robbed, they begin looking thru your wallets, they see your badge, (don't or can't read) and think you're a COP. Bang you're DEAD. Or even worse, you are working and in uniform, you stop at a local 7-11 (a.k.a. STOP and ROB) you walk in with your shiny badge on. Robber turns, sees badge out of the corner of his eye, and BANG you're DEAD. Look what happened to those 2 brave well meaning Auxiliary cops, looks like cops, has badge,, but NO GUN, DEAD. I never bought a badge on my own, and the minute the agency I was working for said it was optional to wear, as a MEDIC, I stopped wearing it. Now only wear it when I', on duty in police uniform, wearing a vest, and ARMED. To do anything more than that is inviting disaster. My thouhgts are my own and do not represent my agency or dept. Former NYC-EMS (FDNY) Lieutenant,, now Police officer, flight medic, VFF

Same side groin injury and I believe that they taught same side for everything when i first took KED 1985... I will say that the KED is probably the MOST underutilized device on the ambulance.... it always amazes me that it was a 20, 30 or 40 minute extrication with multiple hurst tools and they did a great job chocking the car, cutting the car, covering the patient, but even with 44,5, r more EMT's medics, etc. no one thought "Hmm,, while they are cutting, I/we should get him in a KED so he is ready to be removed from the car. IMHO, if the patient doesn't require rapid extrication, for decomp shock, or airway issues, and ESPECIALLY while the patient is trapped and you have plenty of time to put it in place then WHY NOT USE the K.E.D. Just my 2 cents

To answer the question YES,,,, some of the "Rescue Paramedic" and "Haz Tach" Ambulances do have scott paks on their buses... HAZ-TACH" Lieutenants.. formally EMS SOD. once again for those not familiar with NYC PRESS PASSES they say in part " MAY CROSS POLICE AND FIRE LINES WHEREEVER FORMED"... they are signed by fire and police comm.. Free press thats what made/makes this country GREAT. just my 2 cents.

See that,,, the NAVY and USMC don't even have "medics" they have combat Corpsman MOS 8404. CORPSMAN Up... LOL But i understand what you are asking the answer is a little tougher seeing how so many different military medicine people are capable and allowed to do so mant differnet skills

Eng542,, you didnt answer my question about having dedicated bls units to ride with you ? Would that change your mind about ALS SUV's ? I just think that if properly supported with the correct number of BLS units the system could work well... I understand NJ has it's own problems,, not to mention that stupid law about ALS being only hospital based...

22 + years in EMS,,, worked in NYC and several other counties around nyc,, now in MD,,, had hundreds of codes, had several true saves,, by which i mean survive to Discharge from hospital... I had one save where the patient was V-fib,, shcoked a bunch of times and by the time we were wheeling into the ER, the patient was trying to pull out her E.T. tube. (THATS what I call a save) Unfortunatly my agency defined a "save" as return of pulses,,,,, which often meant the patient was in the CCU on a vent and unconcsious... ( I really dont consider that a "save") I think I can stated with a reasonable degree of certainty that if you dont get a return of pulses pre-hospitally you aint goin' to get it. Except for those hypothermic patients and some other rare exceptions..

I don't know whether i think that you are qualified to give an opinion since you have only been a medic for 1 month. I noted your reasons and deleted them for brevities sake..... But let me ask you this... I know NJ has its own problems with volly F.A. Squads and such, but..... if you had a dedicated paid BLS unit that could show if the F.A. Squad didnt get out in say 10 minutes ... would that change your mind about being in a fly car.??????... What about being able to clear 1 call and turn the patient over to the bls and then go assist another BLS unit that had a critical patient ?????... instead of being tied up transporting a broken arm to the hospital ???????? Just curious.

NYC-EMS (pre-merger) used them fairly extensively in the late 1980's- early 90's and they had mixed results for the following reason/s: At the station I worked at the ran 3 medic units ..... 2 24 hours and 1 16 hours in addition to multiple BLS units. The medic units were originally transport units Radio designations 13X, 13V, 10Z (V-Z designate ALS transportt units) Then came the vehicle shortages,,, so they gave the Ambluances to BLS units, and put the medics in fly cars. 13X became 12U (U being ALS non-transport) 13V became 13U 10Z became 10U So what that basically did was that you just REMOVED 3 transport units from your system. It was good and bad, because Medics were going on priority jobs, but if the pt was BLS they could clear and stay in service, that was the good part. The bad part was that a lot of calls were mis dispatched as high priority calls,, Unconcsious, Cardiac and Difficulty Breathing. So if no BLS unit was available the medics went alone and when they got there, they were stuck waiting for a transport. And when call volume got really bad, the disp. would send the medics on injury calls, just to clear the disp. screen. I know of several instances where the medics were tied up at scenes with broken legs and arms, for 1 even 2 hours before a transport became available, now that was extreme, but it did happen. I also know that in some places like southern MD, NJ, and Long Island NY, it works well. If you plan to implement it, you need to make sure there are enough transport units so that the medics don't get stranded. NYC-EMS, now FDNY-EMS, is planning to revamp the PRU system and allow supervisors to provide ALS with a BLS partner. The problem in NYC is still that Medics get misdispatched to calls where they are not needed, and sometimes, medics are not available for the patients that truely need them. As far as types of vehicles ,,, I like www.odyessyauto.com or www.plcustom.com for the vehicles like tahoes or suburbans.

I can say that in 22+ years of providing BLS and ALS level care( Volunteer, career 3rd service, Fire Dept.etc) I have never been sucessfully sued. Had some depositions taken, but never sued. I don't have professional insurance,, I dont think we need it, especially not as a vollyEMT-B.....My take is that the insurance companies just want your MONEY. Think State Farm after Katrina,,,, all those people who were insured and got F#$@#D. I say no. Now, if I hit the Power Bal and continued to work as a medic, that might be different. But if your just joe shmo EMT, Save your money. Just my 2 cents,,,,

In NYC this was referred to as "hot shotting a vein",,, and along with all the previous complications in doing this, one of the other problems was that after you give the med, what if you need to give another or more..? keep hotshotting, till you run out of vein??????????? I heard of old time medics, who used to hot shot narcan to heroin O.D.'s and then let them go their merry way,, now other than the fact that the narcan wears off a lot faster than the narcotic, and then the patient crashes (again) The reasons this was done seems to be for pure laziness..... ( I never did it, none of my partners never did it,, but It was taught in medic basic school as a GREAT BIG NO NO.) Between the introduction of adult I.O, and the use of all arm, leg and if necessary E-J lines, I would have to estimate that you can only truely not start a line in a very small percentage of patients..... I just don't think it is worth the risk..... now some meds can be given I.M. and that may be a stop gap until you can get a line, or if you can't, but it just doesn't sound like good medicine to me.... Former

I have not been able to watch the video yet, as the server is blocked by the company i work for, (no you tube for me). Having said that you must understand, from LEGAL perspective, no citizen has a right or "expectation of privacy" on or in any public place. city street, park etc. The news people have every right to stand as close as possible and film you, as long as you stay in the public venue, they can not however follow you into a private house, hospital, clinic, or the back of your ambulance (without permission of the owner). So if you don't like the press hawking your patient, cover them up, put them in the back of your unit and close the doors, we occasionally used to cover the windows with sheets or have other providers block the windows with their bodies. And as for a cop taking a press camera,, that in NYPD as well as any other dept in the GREAT USA, is tantamount to political and career suicide. A cop in DC took someone's camera, after yelling at him that he doesn't give permission to be video taped, and then locked the "citizen" up for like dis con or some BS. The "citizen" won a 100 or 150 K dollar civil rights law suit .... It may be in poor taste, it may seem cold and callous, but the news people are protected, and their NYC press passes say in part "...may cross fire and police lines wherever formed..." ,, they are also signed by both the Fire and Police Commissioner. In my many years of working in NYC i kind of learned to just ignore them, and pretend like they weren't even there,,, and that seemed to work the best.... My suggestion to the young person from Mass. who was soo upset about this is, get used to it, and figure out a way to cope, because now more than ever if you are in this field, you are in the public eye.... live and in person.. Stay safe... Former NYC-EMS, LT, Paramedic, Dispatcher, EMT, Paramedic preceptor, etc.

New York City 9-1-1 units can refuse transports, the procedure is as follows: The NYC-EMS system (Pre-merger) had a procedure (still in place with the great fire monkeys) called a 10-95 (triaged out thru medical control). After a unit BLS or ALS arrives at the scene and completes a full patient assessment (2 sets of V/S) and determines in the crews mind that the patient does not need transport, they can call a medical control physician, and present their case, if the MD agrees he will speak with the patient on a taped phone line and basically tell the patient "you're not going" and then we give the patient a copy of the PCR and leave. In 10 years full time I saw the need for it to be done 3 times.... and all 3 times it was successful. One patient that stands out is as follows: 30 something male found at the MTS Police station, prisoner, complaining of non traumatic back pain, onset 8 hours ago. He claims the cause of his pain was "sleeping all night on this hard jail cell bench. No evidence of trauma, v/s WNL, put him on the phone with the doc, he repeated that his back only started hurting after trying to sleep on the jail cell bench.,,, denies trauma, no fight during arrest, no medical Hx. etc. After speaking with the MD he was REFUSED. Talked to the cops later in the week, he made it to court and was released on bail. his "back pain " never came up again after we refused him. Now this is just one of the 3 examples i have,, all are basically the same,,,, This protocol is still in place,, I think it specifies, that under 5 or over 70 you can't refuse,, etc. But in this case it is good. I have heard of some systems doing similar stuff, like after assessment if you just need a ride to the hospital because you have a clinic appointment or like a minor laceration needing a few stitches, but can wait, they give you a taxi voucher, bus ticket, or in some cases send an ambulette or van to run around and pickup all the minor cases within like an hour or 2 and the 9-1-1 unit goes in service.... Anyone do stuff like that it would be interesting to hear about. Stay safe Former

:roll: UMMMMMM,,, errrrrrrr, ahhhhhhhh,,,,????????

tying the ankle hitch for the traction splint with a triangular bandage, (before they had the commercially made one) And remembering the percentages for Nasal O2. Yeah I think that was all.

I used the Brady Essentials of Paramedic Practice for my original NR, which I took 3 years ago. I found the workbook and the text very useful for studying. I've been NY State certified for almost 21 years (but never needed NR). I found the books to be helpful and passsed the registry written and practical on the first shot. I also loaned the books to a friend, long time medic trying to get NR and he also passed on the first shot. So, I reccommend the Brady Essentials of Paramedic Practice WORK BOOK (has lots of pre tests in it) And if you can get the Brady TEXT also it would help you out(not as much), but I managed to study almost entirely from the workbook. God luck let us know how it goes. Former

I concur H I S T A M I N E......

All of the answers are CLASSIC signs of a tension pneumothorax EXCEPT Wheezes,,,, JVD because of increased intrathroasic pressure, Trachael Deviation (a late sign) because of the mediastinal shift, Respiratory distress because how would you like a puntured lung,,, So the answer is Wheeezes.

Let me just say that IMHO the KED is one of the most UNDERutilized piece of equipment me carry. Having said that, was it indicated in this case.?????? In many states, the KED is indicated unless the patient is critical or unstable and s/he meets the criteria for what is called rapid extrication. And based on what you said, I can't tell if this patient met the "rapid extrication" criteria. Some of the rapid extrication signs might be unsecured airway, unconcsious/unresponsive, severe hypotension, etc. The thing I also try to think about is this. If it's going to take 10 minutes to cut the patient out and you can safely place a KED, why not do it, if the patient is having neck, back etc, pain. Now if the patient is critical, and you have to "yank" them out quickly so to speak to secure the airway, then do a rapid extrication, and forgo placing the KED, just do it as safely as possible while limiting movement of the back and C- spine. Former

I worked in an ER years ago in N.Y.,,, the bottom line was you could do basically what your hospital allowed you to do. Remember that is some hospitals certain RN's are not allowed to do I.V.'s, others are. As far as our "scope of practice" (as EMT-P's in ER's) we did I.V.'s, Foley caths, IM, SQ, SL meds, we triaged, wrapped sprains and strains and gave discharge directions in how to use crutches, etc. (however each skill we wered allowed to do had to be signed off on, and we had to have a letter in our employee file. All the medics were also part of the in house code team, so we would go on all the codes and do the ACLS thing with the house resident. In some places I know that medic did central lines, after being certified by the Doc's.

Hmm,,, lets see, Earthquakes, mudslides, firestorms, your occasional race riot, global warming, Socialist republic gun ban state, ... combined with one of the highest cost of living in the country, naaa I'm not interested in CA. Ohh and I think that $180,000 is a STRETCH.

A couple of reasons why this is a good idea. 1. Smaller truck (as stated) keeps operating costs down. 2. Many Fire dept's keep their engines for 5, 10 even 15 years or more. This program greatly reduces the wear and tear on the engines, and trucks, which in turn keeps maintenance costs down, fuel costs, down, etc. 3. a lot of times as stated you don't need 4 or 5 FF at the scene. 4. The smaller trucks 4x4's suburbans, tahoes, whatever are more maneuverable and can get thru traffic faster, better and safer. 4. And one of the BEST reasons, keep the engines in service to fight fires.

I also would not leave the U.S.A. Sorry,, I'm already a Medic My course was 1200+ hours of education in addition to an AS college (56 credits i think),, I'm making close to 100K a year now, I have a good retirement system, I LOVE my job, and am looking at a 10K increase in the near future, and like i said about boston ,, why go back to BLS on the maybe you'll get an ALS job. No socialized medicine, No to large pools of applicants for a small number of jobs, however, Now if I hooked up with a playboy playmate, and she lived in ontario, and said i had to move up there for our relationship to continue,, I MIGHT, consider it. and thats just MIGHT.

Free CEU's and aVolunteer training fund does not pay for FUEL.. Having said that there are many many issues. My NY volunteer FD began billing about 10 years ago. As a true combination paid and volunteer service many volunteers were against it. They felt they shouldn't be charging for their services. But when we began we notified the communtity about the reasons, like fuel, equipment, training costs etc. The comm. was very supportive. And we bill medicare, medicaid, and pvt insurance, and if we dont collect we dont agressively collect. Over ten years later, the results are very positive. When we go to the town council to ask for a new ambulance or truck, they whine about how much it will cost, and we remind them about the ambulance billing money we bring in and then they usually relent. I dont know the specific laws in NJ and what you would lose as far as training money or good sam protection, but we researched it in depth and found the negaitves were out weighed by the monies we would receive. The only negative in NY that I could remember was that the ambulance had to be NYS certified, instead of just registered, which mean the NYS inspectors could come in and shut us down. We were initially nervous but had an overall good experience with NYS DOH. I hope this helps. Good luck. Former

That was my point on one of the other posts.. N.J. needs to drop the only hospital based ALS provider stuff and allow any FD, Third Service, or qualified dept to run ALS units..... be it Police agenices, Fire Depts, third service, or whatever. One of the biggest problems with NJ ems is that BY LAW all ALS MUST be hospital based. And when the hospitals lose money, they close and leave large areas without ALS coverage. I say the FD's and municipal agencies should get a medical director, get a lobbying group together, and change that law. IMHO