Richard B the EMT

Dusty, could you elaborate on your comment regarding Municipalities running an EMS, an FD, or a combined FD/EMS? My own FDNY and FDNY EMS Command is a municipal department, as in our commissioner has to talk to the City Council, and of course, the Mayor, for funding, or explaining things, good and bad, that happen. Even being in such agency, I don't follow your reasoning, or at least not yet. Thanks in advance.

If I understand the concept of an Alternate Care Facility, it sounds like a free-standing Emergency Room, as in "Walk in, be treated, walk back out again". I have heard of this concept, and have actually used the nickname of "Doc-in-a-box" for it. Normally, I don't like the concept. However, under the "START" concept, this type facility, if used in a disaster, could probably take a bunch of Green tag (walking wounded) patients, taking some of the strain off a hospital connected ER, or even a "MASH" tent, treating all the other color coded categories.

OK, I emailed a Paramedic from my station, and "Marky-mark", as we call him, says:

Well, hot damn, I had forgotten about that song. They don't give it too much airplay here in NYC anymore, even on the "Golden Oldies" station.

I have had a mother of the minor aged patient almost give me and my partner the bum's rush, for not removing our boots before crossing her rug to access her little boy. I also have heard discussion of booties to cover potentially dirty footwear, both in JEMS, and I think I saw some here in the city. However, when I have entered houses where, due to religion, shoes are normally removed, I apologize profusely for having to keep my boots on. I never have gotten any objections from the members of the family, who mostly said, simply, "I understand". As of this point of my 37 year career, while I have gone to churches and synagogues, I have yet to go to a mosque to get a patient. It is my understanding that in the mosque where Malcolm X presided as the imam, if anyone got sick there, the patient would have been brought to the door of the mosque to practically be pushed into the arms of the EMS crew (same thing for "clubhouses" where alleged Mafia members spend idle time, but obviously for different reasons).

I think there was a brief time in the 1970s, when the EMT and Paramedic tests were written by people who in no way were either EMTs, Paramedics, any level of nurse, Physician's Assistant, Medical Doctor, or Doctor of Osteopathy. While the only thing I can do, as a BLS provider, is supplemental O2 for a suspected collapsed lung (diminished lung sounds with tracheal shift), I believe my Paramedics would first attempt a standard IV line before attempting an IO line. I admit I don't know if they are taught to do a chest needle decompression, with or without an OLMC "mother/father may I". On that last, I'll get back to all of you.

Even before the merger into the FDNY, NYC EMS billed for services, dispite being a "Public Service", tax supported agency. BLS and ALS have different charge scales, if O2 used (charge), ALS skills actually utilized (charge), ALS meds (charge), night differential (charge). Mix well, bill the patient, the patient's family, or the patient's Health Maintenance Organization (Blue Cross/Blue shield, Medicaid, or Medicare). Even the volunteer ambulance service providers are now billing for services rendered (have to wonder if mine would still be around if we had gone that route).

I checked on everyone's notes from last week, and if Nancy was suspended, the suspension is apparently over, or she is on probation. 1) Marisa dreaming about Rabbit? Portrayed sexual tensions between characters just went into overdrive and afterburners. 2) Dr Joe's replacement is Dr Daddy? Nancy's father? He even admits he's not a trauma specialist, but he's running the trauma center. Anyone else uncomfortable with this? 3) Perhaps it is a good thing that Nancy, as Paramedic, will act as liaison with the Dr's staffing, she knows something of both sides. 4) Old line of television news has been "If it bleeds, it leads", corrupted, in California fascination style for car chases, to the spoken line, "If it SPEEDS, it leads". 5) A live remote microwave hookup truck (the news van), and these turkeys have the one truck without a brake locking system set by extending the microwave boom tower. This is Television, so suspend reality. 6) The news crew violated a tenet of reporting the news, that of REPORTING the news, not BECOMING the news. Their report, due to the damage to the personnel and the truck, will cause them to be "scooped" by other news crews. Joking! 7) Anyone know if supposedly grounded or isolated electronic gear would explode as done here, when the boom hit the high tension wires? 8) Of all people to ask for advice, following the dream about Rabbit, going to TYLER? O M G! 9) Seems Dr Dad is a stickler, but not allowing a crew to go restock, but insist they finish the call report? If that happened to me, I'd be yelling over radio for my supervisor to respond. I'd have a skimpy report, but information not available when I got to the hospital would be obtained later, not immediately. We have supplemental report forms for that. 10) Tyler is spouting seemingly anti Hindu stuff, but it is a Moslem Mosque. 11) Boone and Tyler are going to wait for the prayer service to end? Also, they wait outside? Even if I was allowed to remain on the scene, I'd be positioned someplace, even if looking through the door, where I could keep a Mark One eyeball on the potential patient. 12) Dr Dad throws Rabbit out for socializing with the Frequent Flyer, Ira. Is that a "While at Work" policy, or a stab at keeping Rabbit out of "His" ER? 13) Oops, Rabbit tells Dr Dad he's seeing Nancy. Someone else posted how could he not know, from their Christmas dinner? 14) OK, I thought the foreshadowing was for an incident with the guy running the power tool, not the one who ended up going over the side. 15) Was that Boone doing religious proselytizing on Tyler, an admitted non religious man? 16) Within Judaism, one may break the Sabbath to save a life. Does not removing footwear, steel toed or otherwise, in a house of worship where it would otherwise be required, violate anything in the Moslem religion? 17) Ira scolded for calling. Then they take him anyway. Sounds like my jurisdiction (NYC). 18) Marisa never should have mentioned the dream to Rabbit. Then she compounds whatever damage with her partner by telling him it was the "Worst lay, real or imagined" she'd ever had? 19) With no special requests for time off being allowed (again, sounds like my jurisdiction), seems Dr Dad's troops are on the verge of a revolution. 20) Glen gives a nice pep talk to Dr Diane. Stand up for yourself when it comes to patient care. 21) Dr Dad's inexperience is showing, telling Rabbit to package the patient in Medical Anti Shock Trousers (MAST), which is now out of protocols in San Fran. (FYI, out of the protocols in NYC, but is still in for the State of NY) 22) Actually nice of Tyler to attempt to tell the ER crew to respect the Moslem woman's religious beliefs. He seems to say one thing, then act another, but it was correct for him to do as he did on arrival at the ER. Might save the hospital a religious discrimination lawsuit. 23) Considering the size of San Francisco, and the expected call volume, it is always a bad sign when the 9-1-1 operators know the frequent flyers by name. "Ira, is that you?" 24) Ira finally got the message not to call, but then starts coughing up blood. The one time he really does need the help, he declines it. 25) Nancy and Diane in agreement on a procedure, even if Diane is to do it, fought by Dr Dad, who ends up freezing in indecision. Finally gives Diane the go-ahead for a procedure he never heard of, versus Diane, who has at minimum, read up on it. 26) Ira the Frequent Flyer, died of Legionnaire's Disease? Everyone is at fault for not determining it, but due to how rare, they'd probably be not held accountable for it. 27) Nancy demands of her dad both professional and personal respect, which despite us here calling her some kind of floozies, she should be getting from her dad. Dad replies, as do so many parents of adult children (I said adult, not adulterous), that he doesn't know if he can, as she'll always be his little girl.

I have NEVER gotten a discount at Dunkin' Donuts, in or out of uniform. I understand some movie theaters, on specific days of the week, offer discounts to emergency responders, but none of the theaters are near me, so I'd lose in fuel ($2.99.9 a gallon yesterday) what I'd save on tickets. The only time I remember getting any discounts was in the week following the 9-11 attack: Rest stops on the New York Thruway had discounted some food items for responders (LEO, FD, EMS), and the military, and french fries were free with another purchase.

While I am not Irish, except, of course, at St Patricks Day Parades, I am going to be 56 in 2 weeks, and spent 37 years on ambulances. Am I old enough?

Here in New York City, and probably the entire state of New York, EMTs, Paramedics, LEOs, teachers, teaching paraprofessionals (Lady J is a "para", and just took a required class on the topic) all levels of nurses, Physician Assistants, Doctors, Fire Fighters, and probably some I accidently left off this list, are required to report suspected child abuse. There will be some duplication, but the more reports, even on the same suspected incident, will prevent another child from falling between the cracks.

Tammy, do you consider yourself a Medium, in the psychic sense? A long time ago, I used to date a Medium. Turned out she was the daughter of a Deneh Navajo "Shaman", but she didn't know that at the time. She seemed to have some precognitive ability, as well as having the occasional visions. How about you? Have you had any "precog" events, or visions? (I, personally, have had one, but will only send it to you on a PM, and only on your request. Suffice to say it involves a storm, an angry crowd, and Kennedy Airport) By the way, a biography of this woman became partial basis for a Hallmark Hall of Fame Tele-movie on the CBS TV network back some 15 years ago, called "The Lost Child".

Take into account that any vehicle handled incorrectly can and will kill somebody, from a bicycle, to a Smart4Two, to a Peterbuilt hauling tandem boxes, to a Chessie system freight train, to the Queen Mary 2, to the USS Enterprise (US Navy, not United Star Ship, although the analogy holds there, too).

I like Annie, she's silly! (so is the person wrote that about MR NORRIS...SIR!)

I doubt that. Both of us would want to be Penn Gillette (spelling?), as we both speak out quite often, and Mr. Teller plays a mute.

I now have given the show a second chance. Character development needs some work. Also, if a trauma center doctor finds a person who doesn't realize they had been shot in the back of the neck, seemingly millimeters from the spine, I feel sure that the doc would NOT be having the patient turn their head, instead, they'd be grabbing a hold to maintain in line c-spine stabilization of their newly discovered patient. As for someone not realizing they had been shot, I recall one of my colleagues at my VAC, who responded to the Eastern Airlines Flight 66 Crash in June of 1975 at JFK, had a piece of aircraft fall on him while he was attempting rescue of patients. He had to be pulled aside and told he had an impaled object sticking out of his back! Figure that someone realizing he's being shot at, even as he sees people falling from the same shooting, or my friend's impaled object, adrenalin can mask pain. Most of us would know this as "Fight or Flight Syndrome".

Considering things overall, I trust that, like me, also a somewhat sarcastic person in my own right, know when to stop that, and be respectful to the patient/family/bystanders, when the LEOs are not there, and the group is hinting nastiness on your person. Sarcasm in that type instance, might prove harmful to your health, unless you, or your partner, are Chuck Norris, Ahhhnold, Sly Stallone, or Jackie Chan. (I know I left out a bunch of someone else's favorites) A note, here: A station mate of mine, in my presence, was deliberately antagonizing an ambulatory frequent flyer. I think he was actually trying to get this local street ETOH Abuser to throw a punch, just so he (the station mate) could beat him (the patient) up with "justification". When I have had that same abuser, I never had any problems with him, because I always show respect.

Hey! That's MY line!

Probably not. He didn't drive with someone riding the outside of his vehicle. However, this does cause me to cut out my bad joke about driving as to not collect humans (or cats, dogs, small critters, and birds) as hood ornaments as I drive.

Overheard on the news: "There is a massive street cave-in in the Bronx, we go now to the news-copter to fill us in".

I can not complain too much, as the search feature must be being used, otherwise, how could we have these entries for a string started 5 years ago?

In the strings on the TV show Trauma, numerous times I have seen folks taking nasty pokes at California protocols. Are they so bad, or disassociated by region? Or is it something I am totally unaware of? I'll use an example of where NY State DoH must be ridiculous, to be compared to California: EMTs are not allowed to apply a "Band-Aid", per NYS DoH, as that is considered a completed procedure, yet we can hand the Band-Aid to the junkie mom to put on her kid's scraped knee.

All I can tell here is a bunch of us don't like California protocols. I'll start a separate string to ask why.

My comments and observations, both medically related, and otherwise, for the "Trauma" episode shown on April 5 are as follows: 1) One cheerleader falls from the pyramid. Per outside sources, I have been led to believe that there are more injuries within the ranks of cheerleaders than the football players they are cheering on. Anyone have documentation either supporting or denying this? 2) Did I misunderstand? I thought Nancy got permission to do the intubation. 3) The seven "P"s? They went too fast for me. What are they, again? 4) Nancy straightened the cheerleader's neck and head out. This is against the protocol of "Splint it as it lays", at least as far as the NY State protocols go. Comments? 5) Tyler plays guitar? Perhaps they'll explore this in some later episode. 6) Tyler takes in Boone for an overnight stay, due to Boone being temporarily evicted due to fumigating of his apartment. Nice partner! 7) Is Asher going to be a fixture, as Tyler's significant other? 8) This cheerleader is definitely not Claire Bennett, of "Heroes", as it is obvious she is hurting (Claire can heal from almost any injury within seconds, for those who don't follow Heroes). 9) Tyler and Asher seem to be too deliberately loud in "getting it on", in Boone's presence. Is it real? 10) Good call on the Sepsis and/or Infection as being Meningitis. 11) Marisa and Rabbit are together in Isolation. What will develop from them being together? 12) The cheerleader is getting worse, to the point of Dr Diane ordering surgery. 13) Either Rabbit was reviewing signs and symptoms of Meningitis for himself, or trying to scare Marisa. If he was trying to scare her, he did a good job of it. 14) Make it official, the cheerleader is paralyzed. Who is going to get sued, Nancy, the SFFD, Doctor Joe, the hospital, or some combination of all of them? 15) Boone was a visitor in Tyler's home. Would that give him any right to complain about Tyler's home activities in Tyler's home in Boone's presence? Something doesn't seem right, here. 16) Patron at strip club hit accidentally by pole dancer's shoe. Patron doesn't want to be known as being a strip club customer, and signs the RMA, then deliberately crashed his car across the street. OK, different address, but it had me thinking the guy might have left the scene and suffered a late developing concussion. Leastwise, he is going to be seen for the MVA, and use it to explain the original head injury. 17) Has Nancy finally been caught for operating outside of her scope of practice as a Paramedic? As argued, she is kind of adrift between Para-Medicine and being a Medical doctor. 18) Nancy's actions seem to be getting between Dr Diane and Glen, they are arguing. 19) Rabbit is not infected, but the question remains if Marisa is or not. Rabbit becomes protective of Marisa, like a good partner should be of whomever their partner should be. 20) Is Nancy suspended? 21) Are Tyler's antics with Asher going to break up the partnership with Boone? 22) I can understand Nancy being interrogated on the "out of scope" practices, but as Rabbit was not on that call, why are they attempting to go after him using her? 23) Neither Rabbit or Marisa has been portrayed as being particularly religious, but it was an interesting touch for her to ask him to pray with her. 24) Nancy's father recuses himself, but instead of leaving, then verbally attacks Dr Joe. What gives? 25) The review panel is attempting blackmail, threatening suspension of Dr. Joe if he doesn't help take Rabbit down. 26) Dr. Joe refuses, and gets the suspension. 27) Dr Diane plays with Marisa's emotions before telling her she doesn't have Meningitis. 28) Asher and Tyler apologize to Boone, their interaction was a bad joke they tried playing on Boone. Asher is just the next door neighbor, and married, to boot! 29) First, Dr. Joe finds out about Glen and Dr Diane, but makes no issue of it, then visits Nancy, and not caring that he's also found out about her and Rabbit, thanks Nancy for turning him in. THIS ain't over.

I think I can understand why the LEOs might feel that causing an accident, even one to prevent a larger one, might be an issue. However, if hailed as a hero, reminds me of a story I was told to describe Chutzpa, the Yiddish word meaning unmitigated gall or nerve: During "Apartheid" in South Africa, a black man went into the water to save a small white boy who was drowning at a "Whites Only" beach. While successful in the attempt, he was arrested for "swimming at a 'Whites Only' beach"!