Asysin2leads

I don't by the whole keeping up the skills thing as a reason to have less medics on the street. That's like saying having less cops on the street is better for crime rates because the ones who are the street will be able to handcuff faster and shoot straighter. Maybe Boston's EMS system is good, but then again, who the hell wants to be an EMT for 4 years? Christ man, in that time, I could graduate as a PA and not have to put up with an obnoxious partner. Any system that puts unneeded restrictions on getting paramedics to the calls they can be useful on is not a good system. The reason BLS flourishes in urban areas is two fold, one, that there are the higher proportion of BS taxi runs, which sucks up time and energy from units, and two, and if my cynicism is too apparent, I apologize, I think that EMS is very much litigation driven. In other words, members of the lower economic class are less likely to sue when provided with substandard care then those of the a higher economic class. A kid in the ghetto emergency medical treatment is simply not as important as a kid from the suburbs when it comes to the funding of EMS. That's what I truly believe.

Ahhhh, Long Island, making New Jersey's EMS system look "not so bad!"

Whit, listen to me. The BLS wars on this site of been ranging for a long time, and you're new to the battlefield, so I'll be gentle and just give a few points here. 1. Cities like Boston and NYC do not utilize BLS crews because they are more effective. They do it because its cheaper. 2. Your general BLS provider is woefully undereducated and undertrained to be performing assessments and treatments on critically ill or injured people. 3. The notion that ALS can't do anything for trauma is crap. Next time you see a BLS crew doing a scoop and run on a seizing head injury patient, remember, there is no airway, and the lack of ALS intervention is causing brain death. 4. Actually, you have it ass backwards on the creation of EMT and paramedic. Very simply speaking, in the beginning there were paramedics and there were firemen. The paramedics were few and far between, and needed assistance on calls, and the firemen tried to help out best they could, but they really didn't know what they were doing, so a level was created to help the paramedic and also do simple interventions prior to their response. This was the EMT-B level. 5. Once upon a time, I was a trauma victim myself. Lucky for me, I had a very well trained and competent EMT-B crew respond, and I was only about 10 minutes away from a hospital. My injury was in no way life threatening. I didn't need cardioversion, I didn't need airway management, I didn't have any holes in me and I wasn't going to die. However, I was in some of the most excrutiating pain of my life, and the 10 minute hospital ride seemed to go on forever. I can remember every bump, jolt, etc. on the way in, out, and around to the ER. Once I was there they gave me medications that are all commonly carried on ALS ambulances. This is why I am also convinced that ALS has its place even on 'minor' injuries, because with holding medication from people in pain because its cheaper to pay a lower level provider is not good medicine.

Again, Boston highlights a big problem in EMS. Who is going to work for 4 years at a salary of $637.00 a week for the honor and privelege of maybe someday being a medic? Nursing school looks awfully attractive given those odds. Say what you will about the NYC EMS system, but at least anybody with the guts, brains, and drive to be a medic can get a spot without so much friggin' hassle.

EMT-CC, or Came Close, lol And why should we push for the paramedic standard across New York State and the rest of the nation? Read the scenario above several times until it makes sense. Which hero rescue response squad were they from?

ID MAKE ALL THOS MEDICS HAVE TO PRUVE THEMSELVES AS EMTS FIRST AND THEN MAKE SURE NOBODY WORKIN IN THE FIELD IS DOING IT FOR A PAYCHEK BUT FOR THE GOOD OF THE COMUNITY AND SAVIN LIVES

I know why you're getting confused, and its something a lot of people get snagged on. PEA of course stands for "Pulseless Electrical Activity". If we were to use simple logic, electrical activity in the absence of a pulse would be pulseless electrical activity, which could include ventricular fibrillation, a tachydysrhythmia, etc. The thing is, you don't treat those under a PEA protocol. This is why a lot of instructors I have talked too are trying to get what we think of as PEA known by its other name, EMD or Electromechanical dissociation. In other words, the heart somewhat like it should be, but the cardiac muscle is not responding as it should or is unable to respond to the signals. This could be a heart block, severe hypotension, a metabolic disorder, a pneumothorax, or pericardial tamponade, things which are treated under the PEA protocol. Our PEA protocol is called the PEA/EMD protocol. Hope that helps.

I heard in Georgia, most things are kept in the family...

You have a 23 year old 300 lb linebacker who got drunk and fell down a flight of stairs, unresponsive, positive presence of CSF coming out of the ears, with occasional seizure activity. He now resides face down at the bottom of 3 flights of concrete stairs. You have him boarded and collared, and the nice firemen have provided a stokes basket to carry him out in. I would love to see you hold an effective jaw thrust seal with someone else holding adequate cricoid pressure as everyone huffs it up the stairs, out the door, through the yard, and into the ambulance, and then continue to hold it all the way to the hospital. Oh, and screw the combi-tube. Eat, Drink, Intubate and be merry.

In regards to everybody on the Eastbumble Crap Ambulance Corps payroll being someone else's brother, nephew, uncle or nana, I think it sucks. The most qualified person should get the position.

I'm still at a toss up which is worse, Long Island or New Jersey. I was going to write a book, 1001 Long Island Volley jokes, but I had too many. The worse part is they won't stay patching up the Gottis and Joey Buttafuoco out in Suffolk and Nassau County, but feel the need to come into my city so they can have some neato FDNY stuff. Okay, it's settled, Long Island is worse.

Why do the drug times always match the ACLS guidelines? Because otherwise, we get sued and buy some greaseball lawyer another bag of cocaine to do off a $1000 a night hooker's ass. Anymore questions?

When Chuck Norris works the ambulance, telemetry calls HIM. Okay, I'll stop...

Aneurysm of the renal artery. That's probably not right but it sounds good.

That kinda reminds me of those among our ranks who do everything in their power to dress, act, and give the impression of, being law enforcement. If, for some reason, I am anywhere near a scene that involves people with guns who are willing to use them, I want my clothing to be bright Department of Corrections orange, with reflective lettering on the front and back that says "NOT A COP, NOT ARMED, FOR THE LOVE OF GOD DON'T SHOOT", possibly with some flashing neon to go with it, and a full marching band with pipes and drums to announce my presence. However, the people described above are of course useful to send into the scene first. If all else fails, find the dumbest guy on the scene and send him in. Fortunately for me, the FDNY EMS Command provides me with a whole bunch of eager assholes from Long Island with every episode of Third Watch on tape at my disposal to check out questionable scenes for me. Thanks guys!

I say sue. If they retaliating against you for a legitimate complaint and creating an unsafe work environment, they are violating federal law. (Guess who had their annual EEO class today?)

Assessments are a vital skill for any EMS provider. That being said, getting the person to the hospital in a timely manner where people with many more letters after their name can do a much better assessment than us should take priority over playing House M.D. on scene. I mean, after all, there's only one House M.D. and no one else can be him, so don't try. Oh, and if you have one of those young guys who are a little too eager to get to a car wreck so they can strip some young woman of her dignity I mean, er, clothing, kick them in the ass for and give them a 20 spot for a lap dance or something.

You're missing the point though, completely. The town could have the most incredible super wonderful volunteer Fire/EMS response squad in the nation, but if you have the funding and tax base for it, and you're not getting the appropriate care to the appropriate call in a timely manner, your EMS system is broken. If the town is that large, politics aside, its really not excusable in this day and age to not have a paid EMS response with ALS capabilites providing service to the area. See, the thing is, I view EMS as an extension of the hospital, with some public safety aspects thrown in. At one of my local hospitals, as in many places, we have volunteers in the ER. But if I were to suggest we open up an ER staffed primarily by volunteers with the nurses scattered about the city who we call in when we need them, they would escort me to a nice quiet area of the psych ward. But somehow, in that neck of the woods, in the prehospital setting, it makes sense to someone.

I try and take all trash with me, but if I really want to throw something in the trash, I'll ask the patient first. Good manners is a hallmark of good EMS.

Well if feeling like getting charged wth negligent homicide, feel free to use a magnet. I'm not exactly sure about what a magnet will do to an internal defib, but it will rest a pacemaker, which if you don't have proper ALS equipment is basically like playing russian roulette with the patient, which they never find amusing. The answer is get ALS there ASAP.

Yeah, I should qualify, the EMS in Newark, Jersey City, Elizabeth, I'm not talking about them. Those guys are cool, and they go through shit that would turn a lot of us white. And anybody who responds to areas like Camden, parts of Atlantic City, Trenton for that matter, hell, even Asbury Park, hats off to them. I know what 678 is referring to in terms of toning out calls. I speak from experience about this issue because I used to work for a company that did 911 back up for a township in the area. They'd give it to the vollies, then if no one responded, they give it to us. So it was like "Attention available squads, abdominal pain XYZ Avenue..." No response, we'd get it. Then "Attention available squeads, chest pain, QPR Street..." No response, we'd get it. But somehow, magically, When it was "Attention available squads, cool looking motor vehicle accident, QPR and XYZ Street," like squads would fall out of the sky, I swear. Anyway, don't run EMS that way. Peace out.

All right, all right, class, quiet down, quiet down, we've got a lot to cover today. Many people have wondered, how screwed up can an EMS system get? Washington DC's EMS system has taken many well deserved hits, but for sheer lunacy, I really think the shore area of New Jersey can't be beat. The Jersey shore area is a fascinating place to observe how towns must cope with the rapid growth of a population in terms of infrastructure, and as many cynics may note, how to really screw things up. Up until very recently, the Jersey shore area was made up of small rural towns along the seashore, which relied mainly on seasonal tourism and fishing for its revenue. However, starting in the mid 1990's, population growth rapidly expanded due to the rising prices of homes in the New York metro area. The middle class that once occupied Queens and Brooklyn got pushed down the shoreline into a different state. In addition, because apparently wherever there is sand there is old people, retirement communities were built greatly increasing the population, and also of particular note, a population that would have the greatest chances of needing, and also benefiting from, Emergency Medical Services. However, as mentioned before, the infrastructure, particularly relating to EMS, did not adapt to a rapidly growing population. Despite the tax bases and population sizes of many of the townships in New Jersey (not just the shore area), they are still served by in large by volunteer squads. Now, when I say volunteer squad, maybe you think of your local friendly volunteer ambulance guys doing a car wash or a bake sale to raise money for your small town. I can tell you, this is not the case with most of these squads. Granted, some of these towns and he related squads are quite small and do not have much money, but for every tiny town that has a problem getting a volunteer ambulance on the road, their is a volunteer service from the adjoining town that is purchasing a new $500,000 ambulance. When you don't pay your employees, the equipment you can buy with available funds becomes very plentiful. The amount of money many of these volunteer squads pull in from donations is really incredible. Of course, all of these volunteer services do not have anybody higher than an EMT-Basic working on the ambulance. Advanced Life Support on the other hand, is still woefully short staffed due to the monopoly that a handful of Advanced Life Support providers have on the state, which is held in place by a rather asinine piece of legislature known as a "Certificate of Need". Let's say hospital Q wants to run some medics out of its hospital. It has to demonstrate first that its service area is not adequately met by the ALS service already in place. OF course, you have to demonstrate this to a politician, who is usually none to bright and more sympathetic to large corporations eager to keep a hold on its ALS contracts. A recent news piece interviewed the spokesmen for one of these corporations said "The monopoly better serves the public because competiion would drive the costs up." No, he really said that. Another popular reply was "The monopoly is good because otherwise you'd have multiple units fighting over the calls." Now, surely, multiple units fighting over the calls would be a bad thing, but then again, if my loved one was having the big one, I'd rather have multiple ALS units enroute and take whoever got there first rather than waiting for 20 minutes while my loved one succumbs to myocardial ischemia in the $500,000 ambulance. If that wasn't bad enough, we'll look at the area I first mentioned, the shore area. As mentioned before, the population is growing rapidly, so much so that even the volunteer squads can't meet the demand, particularly in the day time. Because of this, several towns have instituted paid BLS crews during the day time, run as part of the police department. Now, unlike medics, local cops in Jersey are paid very well, and they pay the EMT's on par with the police officers. One of the EMT's who work for one of these services I talked with mentioned he makes around $32.00 an hour. That is far more than I make as a medic here in NYC (which doesn't say much, but anyway), but worse than that, its much, much, much, more than a paramedic makes in New Jersey. Before you try moving and getting one these EMT positions, you should know that getting one is harder than getting into Harvard. To get any sort of well paid cushy job in Jersey, you need at least three uncles on the town council and one cousin who is a cop, at least. So where does this really interesting mix of volunteers, monopolies, and really nice EMT positions get us? Basically, if you get in a car wreck in Jersey, you'll have some really cool toys and people dying to use them at your side. Just hope you don't need any type of pain management, advanced airway management or IV therapy, because getting a medic to your side might be a little tricky. I actually know a lot of medics in Jersey and a lot of them are great guys who try and do their best with what they're given, but you can imagine if you're treated like crap and the EMT's make more than you you're not gonna last long. Lastly, if you live in a system like this, pray you don't find yourself in the the unfortunate position of the man who a doctor friend of mine told me about who was brought into the ER while he was attending in New Jersey. The man had an internal defibrillator and a heart condition to go with it. For whatever reason he went into a refractory V-tach/V-fib. The medics took about 20 minutes to get to him, gave him some lidocaine, and he went into a NSR, and was transported without incident. Unfortunately, during those 20 minutes, his internal defibrillator worked very, very well, and delivered electricity to him and the rest of his body no less than 150 times. To most of the general public, an ambulance is an ambulance, its the thing with lights and sirens that takes you to the hospital. This is why New Jersey's system pretty much stays the way it is, because the public would rather have a ride in $500,000 ambulance that looks pretty than in a less cushy ambulance with guys who have slightlly different patches and some more equipment. Then again, to the guy who laid there getting shocked from within 150 times waiting for appropriate care, maybe the difference between BLS and ALS and how exactly his tax money is spent now means something. Class dismissed.

I don't know who came up with that mimic body language crap either. It never sickens me more when some one tries to do baby talk with the kiddies or rap with the teens. You're not fooling anyone. Build confidence and trust by acting your age, knowing what you're talking about, and not bein an asshole.

Good luck Dust, remember, shoot first, ask questions later. Get back in one piece, or people might start calling me the mean one again.

Thats it, we'll expect a full report on the discography of Queen including the overall effecdt of Freddy Mercury on the group by morning. For shame, truly.