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In NYC EMS, this is known as a "10-96 prior to our arrival". I don't chase overdoses. The only overdose I can even treat effectively is an opiate overdose, and they don't run anywhere. Secondly, if he's running, he's breathing, which means EMS is pretty much useless to him. This is a psychiatric call, and its what we pay the police for. If the guy gets hit by a car, its better than us getting in a wreck chasing him. Plus we could use it as an anti-drug campaign, too. NEXT QUESTION.

Yep. New Jersey EMS at its finest. What exactly have you vollie squads done lately to your medics that they are now telling you "Eh, no one's gonna get better in the back of the ambulance anyway..." Actually I think you're right. I'm 86'ing the monitor and med bag. Screw it.

Congratulations. Just one more test and you can call yourself my colleague. Ain't it exciting???

I suggest we all review "Dirtbikes, tattoos, and bumperstickers: Correlation or causation?" by Dr. Philip K. Weinereimer, Ph.D

The type of humor being described is known as "gallows humor" or "dark humor" and is a real, documented psychological phenomenon that occurs when people are faced with situations that are imminently life threatening to themselves or others, although true gallows humor relates only to when someone themselves are faced with imminent death, such during the Falklands war of the 1980's when a group of British sailors on a sinking warship started singing "Always look on the bright side of life" from "The Life of Brian" while waiting to be rescued. Otherwise, the humor is known as "dark humor", but is of the same nature; when we laugh, it releases certain hormones which cause us to relax. It has nothing to do with finding others in pain funny or amusing, but rather our mind has to do something so that we can still function. But just because we understand gallows humor and black humor from our own experiences doesn't mean that others always will. So keep your joking to yourself.

It is the patient's choice, and so long as you are transporting IN to a state from another state it is well within guidelines to do so. Tell your boss he was wrong, and tell the officer to go back to writing parking tickets and leave you guys alone.

You know, some people see being able to move on with your life after retirement as a healthy thing. People get all misty eyed over things like that, but you have to ask yourself, why would someone with a nice, stable lretired life be spending his time at firehouses?

First: Yes you can bag a conscious patient. Its called assist breathing. You coach the patient and tell them to inhale when you tell them, the rate is the same as regular ventilation, 12/min, or 1 every 5 seconds. Hyperventilation is one every 2 to 3 seconds, which gives you a figure of around 28-30, bpm, where 40 came from I have no clue. Second: Transport time is 4 minutes. However, you shouldn't figure transport time, you should figure time to intervention, be it meds or intubation, and even though the ER is 4 minutes away, between loading, unloading, giving report, and the ER getting set up, you could easily be looking at a 15-20 minute time to intervention. If the medics are 6 minutes out, bag 'em and wait.

AS A MATTER OF FACT I DO STICKER MY RIDE... HERE'S A PIC :evil: YEAH! HOW DO YOU LIKE THAT?

It depends, freedome. Most places, particularly municipal agencies, do background checks which ask you to disclose certain information about yourself, including medical and psychiatric history. While having a certain diagnosis or certain condition or taking a certain med may not positively bar your from employment, it can certainly be an obstacle. Its better to disclose it up front then let them find out, in any event.

No, its okay, were bringing Anthony in to mediate. "PEOPLE! PLEASE! COME ON! WE ALL HAVE THE RIGHT TO SPEAK! HEY! EXCUSE ME! EXCUSE ME! THAT IS NOT RESPECTING EACH OTHER'S BOUNDARIES, OKAY? AND...HEY! WHO THREW THAT?"

Yep, you're definitely from L.A. Maybe we'll all sit down and try to understand each other's feelings utilizing a talking stick, some aroma therapy and some chai tea in the process.

Maybe, but currently, compared to our Governor playing hide the veto stamp with high price hookers, we kind of pale in comparison for newsworthiness.

Top O' the mahrnin' to ya, Okay folks, first off, thanks for all of the replies to the previous thread about the decision to prevent the FDNY EMS Pipes & Drums band from marching in the St. Patrick'sDay parade. Especially WelshMedic, your reply really cracked me upSo here's what happened. Our band manager and various other people related to it and our union met with Chief Cassano, the head of the Emerald Society, Billy Nolan, and apparently whoever else had a few minutes to kill this afternoon. Apparently the band is really banned. As in the parade organizers have been told to block them if they attempt to play. Billy Nolan's reply to our band's leader was: "To The Members of the FDNY EMS Pipes and Drums Band; I am reaching out to you directly to try to eliminate any miscommunications with regards to the New York City St. Patrick's Day Parade. As I am sure you are aware, there has been considerable controversy in the past between the FDNY Emerald Society and The St. Patrick's Day Parade Committee. Last year's parade saw the Emerald Society moved from our traditional place in the parade as punishment for an unwelcome contingent marching within our ranks and carrying a banner in 2006. Our efforts to prevent this punishment was not successful. Through an ongoing dialogue with The St. Patrick's Day Parade Committee, we were able to have our society returned to our proper place in the line of march this year. This came with conditions that were mandated by the committee to prevent another violation of their rules. Among those conditions are a provision that we would not allow any other units to join us as well as following the parade committee's rule of only one banner per marching unit. I understand that the parade committee has denied your request to march this year and I am disappointed for you and your members, however, if we allow your contingent to join us we will definitely suffer the consequences. This has been made crystal clear to us. We are under the "microscope" of the parade committee and we do not want to give them any reason to retaliate against us. I believe that if your unit insists on marching without affiliation papers from the parade committee, you will negatively impact any opportunity your members will have in obtaining your own place in the future parades. Members of the FDNY EMS divisions have a place in the line of march within our ranks just as all of the divisions of the Fire Department have. I hope that your members can appreciate the delicate position we are in and respect our request that your band do not march as their own unit. Yours Fraternally, Billy Nolan, President" 'nuther words, since our so-called heros have acted so reprehensibly in the past, falling down drunk on the parade route, making out with anything with a pair of boobs along the way, and generally moving along like a herd of cattle in a pasture along the parade route, you guys don't get to play, because you're part of us but not really cuz you don't get it the brotherhood, man. All I can say is that not since Ted Kennedy have I been so ashamed to be of Irish heritage. If any body on here will actually be at the St. Patrick's Day parade in NYC, PM me, because we are going to need a lot of support. Sometimes you do have to show them exactly what's under your kilt.

Mailman, in industry terms, we say this guy is full of Spitzer. There is no way you can be a practicing paramedic and not know lifting fentanyl is a big no no. In fact, another industry term that can be applied is "junkie lies". This means not only is someone telling a lie, but they are so desperate, due to the power of addiction, that they will say anything except the truth. Junkies, generally speaking, will not tell the truth. They will say ANYTHING except "I was using drugs to get high because I am addicted." Example: I responded once for a woman passed out on the floor with pinpoint pupils, a syringe in one hand, and a lighter and spoon in the other. After some Narcan she came around. She then proceeded to tell me she didn't do drugs. After I stated I had some doubts about her story, she said, okay, she does do drugs, but only snorts it here and there. I then stated I had doubts about that as well. She then stated she was napping. You see, once someone is in the grip of addiction, they will do whatever it takes to rationalize their behavior, and unfortunately, if you are in love with an addict, you will do whatever it takes to enable their behavior, particularly if you have a bit of a hero complex and want to stop your loved one's suffering... from jonesing, I mean, not from pain. It is one of the most tragic situations imaginable.

I assume you're talking about the first part of my post, and not the second. Let me tell you this, because I mean it. My system probably has the record for the next 500 years for sheer amount of bullshit we do on a given day. A good bulk of my time is spent treating...er... not really treating.... dealing with people who not only don't have a life threatening emergency but really don't even need to see a physician in the first place, or even a nurse, or hell, even a paramedic. Also, I will go out on a limb and say I do some of the most walking of any paramedic in any system. Five flights up, down, and through the not-quite-up-to-date-in-the-fire-code-narrow-hallway is really pretty much routine for me, everyday. But guess what? Every single call, no matter what, oxygen, med/tech bag, monitor, and stair chair, or stretcher if we are really lucky. I don't drag 40 lbs. of equipment down to the lowest level of Grand Central Station to wake up a drunk for my health, and few will ever accuse me of being textbook, and I have the command disciplines to prove it.

I'm not going to comment on the choices the paramedics you rode with made because I am not fully aware of the situation. Your post to me seemed to be two seperate questions. The first is, should medics (and EMTs for that matter) always bring their equipment in on every call, and the second is, is it okay to initiate ALS treatment in the ambulance? The first question is, yes, absolutely, medics should bring all equipment, O2, monitor, med/tech bag, and carrying device in on every call. Every one. No matter how tired, overworked, or underpaid a crew is, there is no excuse to not bring in all the necessary equipment, every time. If you can't lug 30-40 lbs. of equipment around for the duration of your shift, up and down stairs, in and out of narrow corridors, its time to find another job. Now, the second part of your post I think gets at a different point, and the answer is, yes, it is perfectly acceptable to safely remove a patient to the ambulance or to a better area depending on necessity. Unless the patient is critical, there is no reason I have to start an IV while in someone's dimly lit apartment, with loud music, and barking dogs going on. I am fully capable of doing so, if necessary, but unless the situation warrants, it is better in terms of patient care and provider safety to initiate ALS procedures in the ambulance. Now, if the person is in cardiac arrest, of course, we pretty much work 'em where they are.

medictx, you do have some valid points, but I still think you're missing the big picture. You are right to say protocols are doctor's orders and should be followed pretty much as written, and if your medical director, by way of protocol or not states "Only use 0.9% NS @ KVO for IV access, don't use saline locks" then yes, we should be only hanging bags, and using a saline lock, even if there is no difference, would be improper and unprofessional. If our medical director gives us something to do, we should do it, its his (or her) license, that means he (or she) gets to make the rules. The thing I think you're missing is that do to the nature of the human body in all its glory with all its different variables, no protocol is going to cover every single patient 100% of the time. Its just plain impossible. I can give you three different asthma patients, presenting with the same vitals, the same EKG, and even pretty much the same history, and one of them will need a nebulizer, one will need some mag sulfate and some epi, and one will need to be intubated. That is why the educational component of paramedic class is so much greater than the skills component. I wish we could just follow protocol. It would be so much easier. I wouldn't even have to put down the PSP to treat a patient. Unfortunately, that just isn't the way it is. I gave a good example of how strictly following protocol is not always what is best for the patient. I had an elderly male, with a BP of 80/P, and an EKG showing rapid atrial fibrillation. I felt the hypotension was due to dehydration, which could be corrected with a fluid bolus, and the rhythm treated with amiodarone. Whoever the newly minted protocol monkey on the other end of the telemetry line, however, stated that since his BP was below 90mm hg, he was an unstable patient and needed to be cardioverted. This was a patient who fell into certain criteria, but still managed to slip through the cracks of the protocols, and when that happens, we have to do what is right for the patient, which is our guiding principal.

Another reason that educational standards and training are key to a successful EMS system. When some of us get on the EMT-B program and medic mills, what a lot of people don't realize is that it isn't so much more the patient's sake, but for the provider's sake. Maybe I'm getting old, bitter, and cynical, but lately, I care a lot more about the people wearing the uniform than the patient, and currently, many of the programs that leave you wearing a patch of some sort do nothing more than set you up, and this situation is a prime example of it. I don't fault the responders so much as I fault the system. Obviously, the two responders with the Fire/Rescue jackets somewhere along the line got it into their heads that they were fully prepared to handle 911 emergencies. It is readily apparent that they are not, and now they are the laughing stock on national TV. It is not fair to send well meaning people half cocked out into the world into situations where police officers, psychiatrists, and ER physicians would shudder at the thought of. From my experiences with all three, the intoxicated, uncooperative patient who may or may not be a patient is one of the big litigation nightmares, and if you are dealing with it, you had better be crystal clear on what to do. IMHO, there are no perfect answers to this. If you let her pass out you can get charged with nonfeasance, if you do intervene, you can be charged with violating their rights. If you have to make a decision, its better to err on the side of being charged with violating someone's rights, rather than standing around waiting for someone to pass out. A court is more likely to be sympathetic if you violated someone's rights but were genuinely acting in their best interests, rather than standing around in your Fire/Rescue jacket while she passes out.

Fire doesn't like us and we don't like them. We were forced to co-exist in 1996 thanks to the dread Giuliani, and its been a struggle ever since. The Emerald society will all drink poisoned potchkin before letting us anywhere near them. Yes, this is what people come up with during the hours sitting around at the firehouse.

I try to materialize out of nowhere and say "Please state the nature of the medical emergency."

My vote is paramedic student who just learned venipuncture. When it comes to a lock or line, there are for more important things to debate when it comes to patient care. However, if you want to get technical about it, even our protocols here in NYC state "0.9% saline at KVO or saline lock". A bag is a nuisance. It gets tangled and increases the risk of accidently ripping out the IV. On the other hand, even in a needless system, repeatedly having to draw up flushes and use them increases the risk of injury. I guess you have to just use like, judgement and stuff in each situation. (BTW, its specific. Pacific is an ocean).

Sorry, here's the link. Here's the site, for real.

Friends, Romans, Countrymen, EMTs, lend me your ears. The FDNY is up to doing what it does best, being a bunch of disrespectful f---heads. Two years ago, in response the FDNY Emerald Society's Pipes and Drums band consistently refusing to play or participate in events that include FDNY EMS members (their line is DAHHHH THEYZ NOT OUR BROTHERS F--K THEM), a group of EMTs and paramedics in the FDNY EMS Command formed the EMS Pipes and Drums group. Their website can be found here. Last St. Patrick's day they debuted, performing exceptionally and instilling FDNY EMS members with what they have been sincerely lacking ever since the FDNY took them over in 1996; dignity, pride, and morale. This year, Chief Salvatore Cassano, again bowing to political pressures, requested that the FDNY EMS Pipes and Drums band not perform, despite the dedication, practice, and determination of its members. It is a sad day when a department that is supposed to be a symbol of bravery and integrity displays such cowardice and disregard for its members, but unfortunately for the members of EMS, it is all too common a practice. The leader of the band, Don Riley, has requested that people refrain from e-mailing Chief Cassano or the president of the FDNY Emerald Society in protest, and I will honor his request. However, anything anyone can do to show their support would be much appreciated, and remember what type of behavior you are really supporting when you purchase and FDNY baseball cap. Happy St. Patrick's day to all.

As a proud member of the NYC AA Minor league baseball team, I would also recommend either Springfield or Northeastern. I've also precepted many of their students and I have found pretty much without exception them to be knowledgeable, prepared, and with the proper attitude to work 911 ALS response. It does suck none of them are accredited. I thought Northeastern was, at least. Shows what I know.