Asysin2leads

Well, you can either read the news article here: http://www.nydailynews.com/front/story/443604p-373561c.html Or take my condensed version of events, or read both. Anyway, around about Monday, a young man in an SUV and a young man in on a motorcycle exchanged words as they were both riding up the West Side Highway around about 125th Street. Apparently the man on the motorcycle must have said something to the driver of the SUV who not only was drunk and possibly on drugs, but was also a volunteer firefighter and decided the best course of action was to throw on his blue lights and chase the man down through traffic, colliding with him at 133th street. As a final touch, the driver of the SUV got out and then acted played like a good Samaritan trying to help the injured motorcyclist, it was only because of witnesses that he was arrested. The motorcyclist was pinned under the tires of the SUV and despite the enormous joint effort put in by NYPD ESU, FDNY Rescue, and FDNY EMS, he died two hours later at St. Luke's Roosevelt Hospital. The driver of the SUV's name is Robert Derlan, 23 years old with the Saddle River, NJ, Rescue Squad. While the papers play up the firefighter angle, in New Jersey a rescue squad is the volunteer ambulance, so this guy is probably an EMT as well. The motorcyclists name was Police Officer Eric Concepcion 29, of the 42nd precinct in the Bronx, and the father of two children, ages 1 and 4. As a paramedic, a former firefighter, and a guy who has the police back him up everyday, I can only say the whole story makes me physically ill. May God Bless the family of Officer Concepcion, and help them through this time, and may God have mercy on the soul of Robert Derlan, because I know for a fact the New York County District Attorney's office won't.

I knew there were some sorta good drugs on board, I remember them talking about sedating Richard Reid after his little escapade from the onboard medical kit.

So if this program went into effect and this list got stolen, the terrorists would then do what exactly? Compare the passenger list, which they apparently also obtained for that specific flight, and then cross check it to eliminate the possibility of EMT's performing their duties while the plane is hijacked into their target? "Abdullah, not only will the infidels feel the wrath of our fire, we will eliminate the EMT's first so that no one will be assisted with their albuterol pump during our operation!!! MOOHOOWAHAHAHAHAAH!!!!" Maybe, you say, they will use the list to make fake ID's and infiltrate a secure facility. But, think about it, let's say they have EMT Skippy DeWillard's name, address, and certification number, and then uses it to make a fake ID, rather than just spending the $500 it takes to get his own certification. What is he going to do, go up to a security guard, identify himself as EMT DeWillard, and demand to be let into the secure facility?

And I'm sure the nice people at MONOC et al. pay quite a few bucks each year to make sure the law stays on the books. The fact of the matter is that given the healthcare and tax dollars expendited versus the overall care (meaning response times, level of service, etc.) given, New Jersey comes up very, very short in EMS.

It's not the hospital basis law that makes NJ's system what it is, its the certificate of need coupled with the greed and shortsightedness of the local volunteer squads. I have nothing but respect for the medics in New Jersey, given the low pay and shabby treatment they recieve.

Stupid compuer, I don't know why it keeps double posting

Seriously, my counter-terrorist training consists pretty much of the phrase "Hey, Abdul, your mother eats pork!"

Well, Skippy the Volunteer EMT has long been a metaphor of mine, I suppose he could be Skippy the Paid EMT, but it just doesn't sound right, and besides, the number of volunteer EMT's with "I Save Lives, What do You Do?" bumper stickers to paid members still is at least 10 to 1. I think you have to admit, given the nature of midair emergencies, having a cop (unarmed) around would be more beneficial than having a firefighter around, because a cop's training could be useful, while I'm still not sure where a firefighter's training would come in handy.

Well, Skippy the Volunteer EMT has long been a metaphor of mine, I suppose he could be Skippy the Paid EMT, but it just doesn't sound right, and besides, the number of volunteer EMT's with "I Save Lives, What do You Do?" bumper stickers to paid members still is at least 10 to 1. I think you have to admit, given the nature of midair emergencies, having a cop (unarmed) around would be more beneficial than having a firefighter around, because a cop's training could be useful, while I'm still not sure where a firefighter's training would come in handy.

Great, so now I don't just have to worry about an angry young Islamic man doing something stupid on a plane, I also have to worry about Skippy the volunteer EMT and Billy Raly the hick vollie firefighter sitting behind me itching for their chance to play Rambo? Actually, I read some about this program, and really its just a voluntary database for EMS workers, law enforcement and firefighters to put their names in and then will identify them as such when they fly. I don't think its such a bad idea, though I'm not exactly sure what the firefighters are gonna do in midair, but I hope it doesn't involve ventilation, lol.

I always though giving a healthy does of reality into a CPR class would be a good thing, but who am I to say. Unfortunately, the public's misconception of CPR is extremely skewed, and mass media only makes it worse, take this article from the New York Post for instance: "I'm starting to believe that I'm always in the right place at the right time," said [Margaret Tarulli], who was at the Sheepshead Bay station with a Post photographer, taking pictures for a story about her nomination for a Community Liberty Medal stemming from her heroics last winter. (Basically, a woman fell onto some train tracks, what her condition was, what exactly happened is unknown because the newspaper didn't say, but they did say that...) Two brave men jumped down and lifted the student onto the platform, where Tarulli performed CPR and revived her. "He kept thanking me, a hundred times over," said Tarulli, who has had no formal medical training except for CPR. So, apparently, she must have mighty fine CPR skills going on there, apparently performing a succesful traumatic cardiac arrest save with only lay person training. Wow, huh?

Do you mind sharing a liitle of that "proof" with us Dust? The article you got it from? And does the higher rate correlate with a higher rate of pregnancy, thus skewing the statistics?

Do you mind sharing a liitle of that "proof" with us Dust? The article you got it from? And does the higher rate correlate with a higher rate of pregnancy, thus skewing the statistics?

I've written a couple of pieces on NJ EMS and their related shenanigans. It seems now many towns are starting to get on board with the idea of paid municpal EMS... BLS only now, because of the certifcate of need crap, but who knows, give it a couple of years and New Jersey Townships may actually have paid professional ALS response.

You know, I've had my share of run ins with having to get physical and such, and it does always make me wanna shake my head a little when these threads come up. Someone always mentions O2 therapy, and somehow, that person always thinks they are being very original and funny. In all seriousness, if you hit someone in the head with a D cylinder, you will probably either kill them or give them a serious brain injury, so you'd better be sure before you start swinging. Someone pulls a knife, someone pulls a gun or a big metal pipe, in short run away. Do whatever you have to, and then get your heiney out of there. If a person actually does pull a gun, your best bet actually is to run, because there is the chance he is actually going to shoot, coupled with the chance he'll actually hit you, coupled with the chance he'll hit something vital. Add a little soft body armor on top of that, and you have a good chance of getting the heck out of their if you simply leave quickly. If you do find yourself entangled in a life and death struggle, the key is to fight dirty. Find something soft and squeeze it until it gets softer. Aim for the eyes, the neck, the genitals, and the knees too if you can muster the force. If you see an exposed fleshy part, bite like its a tough piece of steak. Grab a finger and bend it back until you feel a pop, and then keep on bending. This is all what to do simply to extricate yourself, once you are free, RUN AWAY.

That would be "Sommersby", starring Richard Gere and Jodie Foster. No, I didn't watch it, I remember the ad for some reason. God, I'm so ashamed of myself. Okay, how about "I eat breakfast 300 yards from 4000 Cubans who are trained to kill me, so don't think for one second that you can come down here, flash a badge, and make me nervous." That should be easy...

That would be "Sommersby", starring Richard Gere and Jodie Foster. No, I didn't watch it, I remember the ad for some reason. God, I'm so ashamed of myself. Okay, how about "I eat breakfast 300 yards from 4000 Cubans who are trained to kill me, so don't think for one second that you can come down here, flash a badge, and make me nervous." That should be easy...

That would be "Sommersby", starring Richard Gere and Jodie Foster. No, I didn't watch it, I remember the ad for some reason. God, I'm so ashamed of myself. Okay, how about "I eat breakfast 300 yards from 4000 Cubans who are trained to kill me, so don't think for one second that you can come down here, flash a badge, and make me nervous." That should be easy...

his baby's momma's

Sounds like a vasovagal reaction. He may be one of those people who have increased vagal tone, but usually it takes a little more than a little cold water on the wrist to induce it. He was probably was panicking from seeing a relatively deep cut, was breathing fast, which caused vasoconstriction in the capillaries of the brain, and had a high heart rate, which may have dropped from the cold water. Sudden syncope with no underlying medical cause in a normally healthy young person with no cardiac history usually is a vasovagal reaction.

All right, so, I imagine what you are talking about is a sympathetic response to pain, such as increased heart rate, increased respirations, and the associated mechanisms such as increased intercranial pressure and increased myocardial oxygen demand. I can see how that might be a problem, but then again, I still stand by the fact that were not dealing with a patient who has an entire medical history in electronic format and was sure to fast the night before, were dealing with patients we may have little to any information on, including their medications and past history. Maybe you can point me to an article on the negative physiologic effects of percieved pain in a sedated patient, that would be good to look at. I once had a guy who bradyed himself down into the thirties by taking one of his mom's Xanax's on top of his normal daily dose of methadone, so I'm a little wary of the whole opiate/benzo interaction. I guess it is sort of a moral question too, if the patient is in tremendous pain but will not remember the experience, do the same rules of pain management apply? That's a toughy.

Okay, this has been an impressive discussion, my head actually hurts after reading all of the back and forth. But unfortunately, I'm just a bit confused here. Are we arguing about whether to give and opiate (morphine or fentanyl) ON TOP OF a benzodiazapine, or IN PLACE OF the normal sedative like Etomidate or Versed? If its IN PLACE of, while I can respect the easily reversible effects of an opioid, I just don't think that fentanyl or morphine will produce the desired anesthetic and amnesic effect of Versed or Etomidate. I know that fentanyl was originally introduced as an anesthetic, but really I think of it more as an analgesic, that is, you can't feel pain, but you still know what's going on, same as with morphine, and that is not what we want in our RSI patient. An intubatiion performed correctly shouldn't hurt all that much, its just that being unable to move, from a paralytic, breathe from the pathology, and having a tube going down your throat is not something that anyone really wants to remember. If its ON TOP of the Versed or Etomidate, well, I'm just gonna have to say no gracias. I may be a caring person and appreciate a patient's pain, but I'm still a medic first. That means I work in less than ideal circumstances. Perhaps the idea that the effects of an opiate are easily reversible in a patient may make sense in an anesthesiologists mind when considering the benefits vs. risks, but in my world, it just seems like an unnecessary complication. If the person is sedated with an amnesic on board, the lidocaine and the atropine are in and aren't causing any problems, and the person is not moving or fighting the tube, and we are on the way to the hospital, I'm really happy. I mean, really, I don't even get to use RSI, just conscious sedation, and I'll tell you, just getting that onboard in some of the settings I've been in can be a challenge, heck, just getting an IV sometimes can be a major accomplishment. I guess what I'm saying is in your arguements for or against use of anything, be it a tool or a drug, make sure that you take into special considerations that prehospital care faces so often but is so rarely addressed. Even in the back of the ambulance, which is about as a controlled environment as we get, you still have the cops banging on the back door for a copy of the patient's ID, and I gotta try and think of which hospital to go to and give orders to the EMT and keep the screaming family members out, but I don't have to tell you guys, you know. If its one less drug to draw up and one less interaction to consider and and one less possible sharp sticking someone, and one more moment to make sure the patient is being bagged correctly, I'm going to have to say that is the best thing for the patient given the situation. Just wanted to make sure that nobody got too ivory tower with the journal articles and kick us all a good kick back into the gutter in the rain and muck where we belong.

Okay, this has been an impressive discussion, my head actually hurts after reading all of the back and forth. But unfortunately, I'm just a bit confused here. Are we arguing about whether to give and opiate (morphine or fentanyl) ON TOP OF a benzodiazapine, or IN PLACE OF the normal sedative like Etomidate or Versed? If its IN PLACE of, while I can respect the easily reversible effects of an opioid, I just don't think that fentanyl or morphine will produce the desired anesthetic and amnesic effect of Versed or Etomidate. I know that fentanyl was originally introduced as an anesthetic, but really I think of it more as an analgesic, that is, you can't feel pain, but you still know what's going on, same as with morphine, and that is not what we want in our RSI patient. An intubatiion performed correctly shouldn't hurt all that much, its just that being unable to move, from a paralytic, breathe from the pathology, and having a tube going down your throat is not something that anyone really wants to remember. If its ON TOP of the Versed or Etomidate, well, I'm just gonna have to say no gracias. I may be a caring person and appreciate a patient's pain, but I'm still a medic first. That means I work in less than ideal circumstances. Perhaps the idea that the effects of an opiate are easily reversible in a patient may make sense in an anesthesiologists mind when considering the benefits vs. risks, but in my world, it just seems like an unnecessary complication. If the person is sedated with an amnesic on board, the lidocaine and the atropine are in and aren't causing any problems, and the person is not moving or fighting the tube, and we are on the way to the hospital, I'm really happy. I mean, really, I don't even get to use RSI, just conscious sedation, and I'll tell you, just getting that onboard in some of the settings I've been in can be a challenge, heck, just getting an IV sometimes can be a major accomplishment. I guess what I'm saying is in your arguements for or against use of anything, be it a tool or a drug, make sure that you take into special considerations that prehospital care faces so often but is so rarely addressed. Even in the back of the ambulance, which is about as a controlled environment as we get, you still have the cops banging on the back door for a copy of the patient's ID, and I gotta try and think of which hospital to go to and give orders to the EMT and keep the screaming family members out, but I don't have to tell you guys, you know. If its one less drug to draw up and one less interaction to consider and and one less possible sharp sticking someone, and one more moment to make sure the patient is being bagged correctly, I'm going to have to say that is the best thing for the patient given the situation. Just wanted to make sure that nobody got too ivory tower with the journal articles and kick us all a good kick back into the gutter in the rain and muck where we belong.

Okay, this has been an impressive discussion, my head actually hurts after reading all of the back and forth. But unfortunately, I'm just a bit confused here. Are we arguing about whether to give and opiate (morphine or fentanyl) ON TOP OF a benzodiazapine, or IN PLACE OF the normal sedative like Etomidate or Versed? If its IN PLACE of, while I can respect the easily reversible effects of an opioid, I just don't think that fentanyl or morphine will produce the desired anesthetic and amnesic effect of Versed or Etomidate. I know that fentanyl was originally introduced as an anesthetic, but really I think of it more as an analgesic, that is, you can't feel pain, but you still know what's going on, same as with morphine, and that is not what we want in our RSI patient. An intubatiion performed correctly shouldn't hurt all that much, its just that being unable to move, from a paralytic, breathe from the pathology, and having a tube going down your throat is not something that anyone really wants to remember. If its ON TOP of the Versed or Etomidate, well, I'm just gonna have to say no gracias. I may be a caring person and appreciate a patient's pain, but I'm still a medic first. That means I work in less than ideal circumstances. Perhaps the idea that the effects of an opiate are easily reversible in a patient may make sense in an anesthesiologists mind when considering the benefits vs. risks, but in my world, it just seems like an unnecessary complication. If the person is sedated with an amnesic on board, the lidocaine and the atropine are in and aren't causing any problems, and the person is not moving or fighting the tube, and we are on the way to the hospital, I'm really happy. Versed is very good for pain management. I had it while I was in the ER in agonizing pain from a kneecap that wasn't where it was supposed to be, and after they put it into my IV all was well until I woke up with my leg in a brace. Granted, for those of you with an extended transport time, Versed's short duration should be considered, but my opinion is that pain can be managed just fine with only benzodiazipines, if only from personal experience. I mean, really, I don't even get to use RSI, just conscious sedation, and I'll tell you, just getting that onboard in some of the settings I've been in can be a challenge, heck, just getting an IV sometimes can be a major accomplishment. I guess what I'm saying is in your arguements for or against use of anything, be it a tool or a drug, make sure that you take into special considerations that prehospital care faces so often but is so rarely addressed. Even in the back of the ambulance, which is about as a controlled environment as we get, you still have the cops banging on the back door for a copy of the patient's ID, and I gotta try and think of which hospital to go to and give orders to the EMT and keep the screaming family members out, but I don't have to tell you guys, you know. If its one less drug to draw up and one less interaction to consider and and one less possible sharp sticking someone, and one more moment to make sure the patient is being bagged correctly, I'm going to have to say that is the best thing for the patient given the situation. Just wanted to make sure that nobody got too ivory tower with the journal articles and kick us all a good kick back into the gutter in the rain and muck where we belong.

What do I do to put a dirty laryngoscope out? Well, I'm glad you asked. In the field I usually put it in a glove. Then I go back to the station. From there: 1. Retrieve two sets of keys from the lieutenant. 2. Get a biohazard bag, a repair tag, and the repair tag log out from the office. 3. Put the dirty laryngoscope blade into the biohazzard bag. 4. Open up door for equipment room, and then locker with respective key rings. 5. Take out the equipment log book and a new laryngoscope blade. 6. Make appropriate changes to equipment log. 7. Fill out all appropriate lines on repair tag 8. Record repair tag number in equipment log book. 9. Remove first too copies of repair tag, put them in repair tag book 10. Update repair tag book 11. Put remaining copy of repair tag into biohazard bag with dirty blade. 12. Unlock repair locker, put blade, bag, and tag into locker, relock locker. 13. Have lieutenant sign repair book and spare equipment book 14. Return equipment book to equipment locker 15. Relock locker and room 16. Put new blade back into bag. Mix the bureaucracy of municipal government with the bureaucracy of medicine, and it will take you too 17 steps to replace a laryngoscope blade. Don't even ask what I have to do when I give narcotics.