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If its all the same to you, I'm going to go ahead and pity the people who died in this horrible tragedy, and pity their families as well. Fire and EMS is not about doing things at all costs. Its about getting your job done and going home at the end of the night.

I'll throw this kid in the middle of a meconium aspiration or breech birth sometime and see how well he does then. I'm sure every high risk obstetrician in the world threw something at the TV set when they watched this kid, especially now that their malpractice rates are approaching the six figure range.

So long as you can be in charge of a couple of million depending on whether or not the rest of the squad votes you treasurer, and so long as the "captain" of the squad can send the ambulance out for a $500 transmission tune up billed to the township to his brother the auto mechanic whenever he pleases, and so long as the towns want pretty ambulances with pretty lights and remain the dark about EMS, and so long as the local politicians benefit from it, the Volunteers will exist, the First Aid Council will exist, and people in New Jersey will die needlessly. To fix the the EMS system in NJ you'd first have to fix the corruption in NJ, and well, I think my plan to empty Lake Superior with my trusty pail will have more success.

You know, of the Police Department EMS services I know, they run so much better than Fire based EMS. Why do you think that is? Is it because like EMS, cops can actually show up for their job, go home at the end of the night and be done with it?

Unfortunately, Upton, I've run into the same people. Here's a tip: The youngest you could have been on 9/11 is 21, so if you run into anyone under the age of 28 making the same claims you know they are full of shit. Lucky for me I never needed a patch on my arm to get laid.

Cuz we got teh kewl uniformz.

And both myself and Ayatollah Khomeni take a piss in the morning after we wake up. What's your point?

My advice is this: First, know what the procedure for treating a sexual assault victim. If your service or company does not have clear, written instructions and procedures for handling cases like this, be sure to inform them of the necessity of it and strive to make changes. This should include input from your local ER and law enforcement agencies. As sad as it is, not only are you handling a patient and a victim, you are also handling evidence in one of the most serious crimes we have on the books. Act accordingly. Personally I think the only way to handle this is a careful mixture of compassion and professionalism. I think professionalism is extremely important not only because of the legal aspects, but because it reminds everyone that what has happened is a crime. Its not someone getting hurt, its not someone's feelings being injured and in need of a shoulder to cry on, it is a violent crime. I don't think there is anything I, or anyone can really say that will even come close to taking away the pain and suffering of a sexual assault victim, and I think its the height of arrogance and hero mentality that any of us could swoop in and say some magic words. All we can do is our best to make the person feel safe, secure, and cared for. That and keep our own emotions involving hunting down the bastard and shooting him in the genitals at bay.

I beg to differ on the "NJ Volunteers aren't any worse". They are worse, in the same sense that Long Island volunteers take whackerdom and egos to a level not easily imaginable. In several posts I have mentioned that truly, some communities do not have the tax base to support a paid ALS service, yet most volunteer services spring up in the more affluent of towns. This is the story of most towns in New Jersey. Almost all of the communities in NJ meet or far exceed the money needed to provide paid fire and EMS, yet none of them do. You should see some of these volunteer services sometime. They are not holding bake sales to buy a new ambulance. The amount of money that flows through some of them exceeds the budget for some small town's emergency rooms. It is a racket, pure and simple, and the worse thing is that it is a racket wrapped up in the cloak of heroism and altruism, which just makes it worse. These people are costing other's lives, and they are doing it by lining their pockets and pretending like they are helping others. I sure hope they all spend a lot of time in confessional on Sunday.

From talking to a few fairly reputable sources, or as reputable sources as I am going to get, the clusterf*ck started out as thus: To deal with the high call volume in Manhattan, an ambulance from Staten Island was redeployed to Manhattan. While enroute, they were called for a job in Brooklyn and ended up at Kings County hospital. After they became available for that job, the dispatcher assigned them to their new 'atom', or dispatch area, in Manhattan, probably under orders from dispatch supervisors so they could get to Manhattan without coming up recommended for more jobs in Brooklyn. Now they come up for the job in Manhattan. They inform dispatch they are highly extended. Through various machinations, this does not translate as "I'm in Brooklyn and I'm not getting there anytime soon." Whether or not people in lieutenant's and captain's costumes were threatening the unit with being placed off service if they didn't respond are true or not is unknown to me, but I wouldn't be surprised if it happened. Like I said, the system, between the dispatch and the ignorance of supervision and leadership, is just plain broken.

ERDoc, I don't know whether to be proud or ashamed that I actually know that reference you just made.

I concur. New Jersey, between the corruption and bureaucracy, is utterly unfixable in all aspects. Unfortunately, NJ is so far gone that corruption is pretty much day to day business. I read the papers all the time from Jersey and it is fairly common occurence, judges, legislators, and administrators being hauled off to the pokey for fairly petty bribes and graft, $500 here, a new car there, which tells me that taking bribes and handouts is just part of the way of doing things. Ain't no way you're going to shut down a vollie squad that rakes in a couple of million dollars a year in "donations" when money is changing hands like that. Just not going to happen.

Heh, EMS, I liked your comments about the line officers. Too high jack this thread just a little I think the biggest issue that is driving me out of this profession is the arrogance and political bullshit of it. The ratio of people who act like they know all about prehospital care versus the amount of people who can even get through the simplest of tasks properly in the field is extremely low. If its not dealing with the officer's bullshit, its dealing with my partner's bullshit, and if its not my partner's bullshit, its the EMT's bullshit, and if its not the EMT's bullshit, its the firefighter's bullshit, who's bullshit supercedes all other bullshit, but that's another story. I ask, whatever happened to just doing your job? Doing my job is the only goal I have at work. Even if the call is bogus, I still try to get it done well. Why can't people just focus on what needs to be done to get the calls done, and then do it, and go the hell home? Now I'm really ranting, but you know what? I have met a lot of people in my life, people who know things and will do things that I will never even come close too. Neurosurgeons, astrophysicists, professional musicians, Navy SeALs, I've known these people and they do not have the same fucking egos I run into doing this line of work. Maybe some of them do, but not the ones I've met. So, for the love of God, everybody get the fuck over themselves already! THAT GOES FOR YOU TOO, FIREMEN!!! Okay, I'm done. I need a cigarette.

My favorite piece of advice about needle decompression comes from an ex-partner of mine who had done many a year in Brooklyn during the good old days. He said, "The definitive diagnosis of a tension pneumothorax is that the patient is willing to allow you to jab them in the chest with a needle if it will help them breathe."

P3, you're killing me, lol. The short answer is I have no real clue. Mind you, this woman wasn't at the South Ferry terminal and geographically close to Staten Island, she was at 55th street, about a third of the way up Manhattan. Units from Queens or Brooklyn should have come up first recommended. I don't think we'll ever know if this was really a "glitch" in the system, such as a flaw in the GPS software, or if really the system is just plain breaking down. In some ways I hope it was a glitch, because otherwise, it would have meant that every single BLS unit in Harlem, Midtown, Downtown, Queens West, and Brooklyn were on an assignment at that given moment in the day. At every single juncture I have voiced my concerns about our dispatch system. I have always stated that over triaging calls and simply sending an ambulance anytime someone needs their prescription filled might fill the city's coffers with Medicare and Medicaid money, but not only is it wrong it is also doomed to fail, and several people, including our union president Pat Bahnken, thinks the system is now approaching or at critical mass. But the real problem is that you can't tell the FDNY anything. Its like a bad Monty Python sketch sometimes, the FDNY assuring that they carefully coordinate its resources, as ALS units go flying to the stuffy nose and 88 year old women are allowed to sizzle on the sidewalk at 55th street. If what 1aCe3 is saying is correct, then it simply lays bare how bad the system really is. I can see the lieutenant or captain on the air threatening to put them off service. Did the Lt. or Captain talk to the unit? Did they say "Okay, we know you're extended, but you're the only ones, do your best"? Or did they offer solutions? No. They sat in their command car handing down threats over the radio when the system was clearly screwed up. I've had a captain threaten to put me off service if I didn't go back available when a police officer was directing me to a person under a train. I thought the captain was on scene, and at a different location with the patient, but it turns out he was three miles away with no clue what was going on. Unfortunately, the FDNY promotes asshole butt kissers into its ranks as management, so its like trying to do your job while middle school hall monitors look over your shoulder. Anyway, the system is plain and simple BROKEN at many levels and its not going to get better anytime soon. I only hope and pray that the EMT's and Paramedics of the FDNY EMS system do their best and try desperately to get to the patients and the hospital despite the FDNY's continued multiple levels off gross incompetence.

Somehow I thought my post was pretty self explanatory, but I'll clarify it a little more. Yesterday was 93 degrees in the shade, with high humidity. I felt fine coming in to work. I had my liter bottle of water with me while I worked. While working, on one call, I lost enough fluid to become symptomatic. If you can't understand how someone can not realize the symptoms of then only mild dehydration while working in an emotionally charged environment, then not feel symptoms while sitting in an air conditioned ambulance, and then only feel the effects of hypovolemia when he stands in one place in the ER, I suggest you review the effects of the sympathetic nervous system, and orthostatic hypotension and its manifestations. Or perhaps I could just send you my undershirt and uniform shirt so you can see how much fluid I actually lose on one call. I'll even put it in a biohazard bag for you.

Buff, like bus, and skell, is a New York term that people in the system usually forget no one else uses. To buff is to respond to a job that the dispatcher didn't assign you. This usually occurs when the triple shooting at the MVA during the structure fire occurs and a crew is really bored or they want to make the morning paper. Since EMS jobs in the FDNY EMS system come in through PD before it is relayed to EMS, the truly savvy buff (which is also a noun, meaning someone who is a little too excited about the job, akin to a whacker in other parts) will be monitoring PD frequencies to get the jump on that call. A buff is also someone who poses in their yellow pants next to a suppression vehicle. Sorry, I had to say it.

Ever notice the posts that say "volunteer" are the ones with the glaring grammatical and spelling errors? I wonder why that is. Today I had a near syncopal episode in the middle of the emergency room due to hypovolemia secondary to dehydration from running around in our current heat wave. And when I say near syncopal episode, I don't mean, oh, I felt a little faint, I mean the color started to drain from the room, sparkles started to creep in to my peripheral vision but because I recognized what was about to happen, I sat down on the floor rather than than passing out. My blood pressure was 80/40. They did a 12 lead to make sure I wasn't having a heart attack I was so pale. I got 2 liters of fluid and the rest of the day off. Maybe my passion is lacking. But I think my dedication trumps any vollie any day of the week.

Actually I'm all in favor of the increased scrutiny of Fire and EMS, especially Fire. Yeah, you guys. I'm not even going to get into the amount of waste that happened post-9/11, and while it is blasphemy to some, it was still waste. And I mean waste, I don't mean, oh someone got a new engine or ambulance when the old one would do, I mean, millions upon millions of dollars, spent on crap if not just put into somebody's pocket. Fire and EMS departments over the past couple of years have basically opened their arms for every single cent federal 'Homeland Security' grants and donations have thrown at them, and now, with the rising cost of fuel and healthcare costs, OMG, play time is over and you actually have to start spending the money wisely instead of paying for the walnut, brass, and stained glass artwork in the kitchen. Not to say that all cost cutting measures are warranted, for instance, New York City's cost cutting measures was to remove our "Gator" units from the beaches this summer. They were little six wheeled tractors manned with overtime EMT's that didn't use a lot of gas and were really good on the sand. Now a line unit, big, hulking, diesel ambulance is going to be the one driving across the beach. And they tell me Bloomberg used to be a businessman.

Does anyone know the criteria for a Level I trauma center? I don't, and its a rhetorical question, but it includes things like having whole plasma on stand by and in-house neurosurgeons. They are very picky about this stuff. If someone like JCAHO was to ask "Exactly why did the trauma patient succumb?" The answer really should not be "Well, EMS didn't call in a notification."

I'm glad everyone is okay. Which is why folks, only call the helicopter if absolutely necessary. Yes, they are loud and impressive but they also have a tendency to crash and explode terribly. I hate helicopters.

TJZ, you have my deepest sympathies. I serious suggest taking some time away from EMS for a little bit. I know you have been working hard and don't want to let anyone down, this is really a personal tragedy for you and you should really think about taking some time off at this point. This is my suggestion based on experiences I've had with other people in similar situations, you don't want to start equating working EMS with losing people you know.

Our notification system is very brief, including usually only patient's age, vitals, mechanism of injury, and care given (Sometimes simply saying ALS established) with an ETA. Sometimes they get through, sometimes the dispatcher is too busy. Honestly, a properly equipped Level I should be ready to throw down whether they get a note or not. Personally I think its goes a little smoother when we call ahead, but nothing stunning. First of all, an EMT's assessment skills, in the grand scheme of things, are very limited. Secondly, they'll redo everything once you get to the ER, with lots of people and bright lights to work under. That's probably what the desk jockey was getting at. Relax a little.

Yeah, it was choking, but the fact that the pathology is an airway obstruction may not be readily apparent. I'm just pointing out that this is a case where the current emphasis on "load and go" was not the right thing to do. Just as there are cases where providers taking too long to secure an airway led to adverse patient outcomes, I believe there are many cases where provider uneasiness or unwillingness to perform aggressive maneuvers led to poor outcomes.

They're not dead. This was my call. She's still alive as of this writing, and this was back in March. If a 91 year old can survive it, so can you. [web:107f3b44ea]http://abclocal.go.com/wabc/story?section=news/local&id=6018245[/web:107f3b44ea]