Richard B the EMT

This is one time I am GLAD to know the FDNY's policy of nobody but the chauffeur in the vehicles as they leave the station, everyone else stopping traffic until the vehicle clears the bays, and someone hits the button to bring the bay door down. Then, everyone stops holding traffic, jumps in, and they respond to whatever the call. Not always successful, as one time as they were doing that, a driver cut them off as they were all on board. I was not working that day, and caught up with the driver at the traffic signal. When I yelled at her, she told me, as they were "just standing there", even with all the E-Lights and siren running, she "thought they were parked!"

There was a company that I used to work for, emphasis USED to work for, that tried sending units out on the road, missing state required equipment. They got nailed by the State DoH for attempting to pass the equipment from an inspected ambulance to the next going in for their inspection. The DoH ordered them to shut down for a day, so all the ambulances could be in the building at the same time, and not sent to the streets until checked out. They nailed a bunch of the ambulances for non-compliance, and a few were condemned as unsafe for use, and needed to be replaced (age, rotted floors, other stuff). As the crews forced to either work or be laid off for using the unequipped trucks also got fined, I was so glad I wasn't there anymore (No, I was not the one dropped the dime to the DoH, but I should have been!)

From the information presented, I can only hope that the attempt to pass was an innocent oversight, and not deliberate. Either way, the potential to Fire, EMS, and the civilian vehicle for anything from 1 minor injury,to numerous fatalities was there. Everyone was lucky.

A catch phrase I kept hearing over the years was, if they walk away, we (EMS) are not paid to chase them. I don't know if I hold to that. However, as a call report must be generated, we make an official entry of these being an "RMA by Walk-Away" (RMA=Refused Medical Assistance). We never use such wording on the Call Reports, and either tell dispatch that the "Patient" left prior to EMS arrival, or declined any and all EMS assistance, including signing the RMA.

I just reread this one. It best illustrates the T-Shirt saying,

1) When I got paged out both times on the final MASH episode, I could either run and do the call, or take the time to set up the VCR and be late for the call, which would have gotten me into trouble. 2) I don't think TIVO was yet invented. 3) It took me 4 years later, but I finally saw the entire show, on a regularly scheduled day off, so nobody was going to page me. I took the phone off the hook, too!

Raffmedic106 Richard B the EMT (asked, and answered, although we seem to have a disagreement as to which shoulder it is to be worn on. Military folks to settle for us, please?)

As noted in other strings, I am originally from a volunteer ambulance corps. I vollied, and worked private, and later municipal ambulances concurrently. While in the vollies, and the privates (mostly inter-facility transfers), I paid my own way for training, and re certification training as an EMT. When I started municipal (again, while still concurrently at the vollies), I was paid to sit in the municipal EMS academy's classrooms for training/re certification as an EMT. I am about to go to the Pulse Check Convention, Educational Conference, and Trade Show, of the New York State Volunteer Ambulance and Rescue Association, for the 15th time (event at the Holiday Inn Turf, 205 Wolf Road, Albany NY, October 1-October 4, 2009). I'll explain the issue in a moment. The New York State Department of Health has, in recent years, started issuing 5 year EMT-B certifications, with Continuing Medical Education (CME) training of a specified number of classroom and skills hours, while still keeping the older 3 year certs as a full refresher class. If you are not in a "Patient Contact" area of an EMS provider, you are supposedly "restricted" to the 3 year certs. Obviously, this is causing confusion, as they (NYS DoH) attempts to fine tune this issue. As it sits now, FDNY EMS EMD personnel who receive the calls through the 9-1-1 system, as they provide "first aid" instructions to the callers, are considered to be in patient contact, but the dispatchers, whop talk with the ambulance crews, and relay "Standby" and "Notification" contacts to the ERs, are NOT considered as being in patient contact. Call takers are allowed the 5 year cert, the dispatchers are only afforded the 3 year cert. As for my convention? While some of the seminar speakers are actually the same people I'd be sitting in front of, at the FDNY EMS Academy, the FDNY will not accept any of my credit hours for attending. At the same time, the state DoH will accept them. Confusing? Oh, yeah! I'm paying for my attending the convention out of pocket, but can, and will again, claim it on my income tax, as a "Cost Of Doing Business" expense, and holding on to all documentation of classes attended, if FDNY reverses their stand. By the way, even my instructors at the FDNY EMS Academy are telling me to hold on to that documentation, as even they do not know if or when, the documentation will be accepted by the department.

If that means carrying a flag, I see no reason why not.

While I am aware that "Police Dogs" and "Police Horses" are technically LEOs, and "Service animals" (read: guide dogs for the visually impaired, hearing impaired assistants, others) are to be transported with their owner/handlers (NYS DoH ruling, number on research via Google-help yourself!), my priorities will always be human first, and if could be considered a kind of psych first aid for the human, animal second. While writing this, I am kind of having a flashback to 1965, when I saw my dog actually being hit by a car (She was seen and treated in an animal hospital, survived, and lived until age 14 in human years), so I can kind of commiserate. Not mentioned in the string was, did either of the paramedics contact the DVM via the OLMC, or did one of them have the number of their own pet's DVM on their cellphone? While I don't know if it would help any, if a letter of commendation from the LEO agency the man and dog worked for might ease any problems the Paramedics might face, as how can you punish someone in the agency, who is being congratulated for doing whatever the deed by another agency (IMHO)? A mention: Years ago, my VAC was called for an injury call, no further information. On arrival, found the patient was a dog. No policy on how to handle. The agency's chief was at the base, responded in his POV, and transported the dog in the POV to an animal hospital, where another member of the VAC was employed, and took over care. Dog owner was grateful, but story never covered in local press. FYI, I was driving the ambulance that tour.

Many notations here, red flags due to ETOH involvement, the suggestion in dispatch info of the aspirin, and suicide. Definite need of On Line Medical Control, and perhaps the LEOs. Local protocols, rules, regs, and laws will dictate, as mine are OLMC, supervisor and LEO involvement. I'd be thinking transport for further evaluation by higher medical authority, with the above mentioned involved.

When you figure that the first organized Fire Department was founded in Philadelphia, Pennsylvania, by United States "Founding Father" Ben Franklin, fire departments have been around from probably earlier than 1776. Police departments were originally fire "rattle watches" patrolling even earlier. EMS AS EMS has only been around from roughly 1970. Everyone else has an established Public Relations area, as most know the FD "puts the wet stuff on the red stuff", and the cops shoot at the bad guys, to stop the bad guys from hurting the good guys. In the eyes of the public, we might still be viewed as the teams of guys (and now gals) carrying an old style 2 pole stretcher. However, if being a publicity hound is all you want, instead of the publicity as the occasional pat on the back, as stated numerous times on the site, as well as just this string, you're in the wrong job.

The notice and guidance below was issued by the Suffolk County Department Health and contains information about the recently issued mandate from the NYS DOH requiring certain health care providers get seasonal and H1N1 flu shots. Notes from the September NYS EMS Council meeting indicate compliance is required by 11/30/09 but this window may move based on H1N1 vaccine availability. Some EMS providers are covered by the mandate and others are not. Members of independent volunteer squads across the state do not appear to be covered by the mandate unless they are in EMT (B, I , CC or P) courses that requires hospital time. Nevertheless, vaccination is strongly encouraged. Squads should check with their local Health Departments for availability of flu shots in their area. Some hospitals may be offering shots free to squads in their catchment area. Notice was sent out last week of North Shore-Manhasset’s offer and schedule of shots available to members of Queens squads. Blue Cross-Blue Shield says it will cover H1N1 flu shots for its policy-holders this year and in 2010. BC-BS is the most popular plan with federal workers and retirees. NY Governor David A. Paterson announced on 9/10/09 that insurers must cover seasonal flu and novel H1N1 vaccinations for children who are aged 19 and younger and enrolled in comprehensive health plans. There is an exemption in the mandate where the shot is medically contraindicated. There may also have to be an accommodation to religious beliefs. In some individual hospitals elsewhere in the country that have mandated flu shots those personnel that have refused for whatever reason were required to wear surgical masks at all times. No other state or city agency in America has a requirement for mandatory flu shots although it is almost universally recommended for health care personnel. News reports indicate a coalition of New York health care workers unions are considering filing a lawsuit to block the mandate. Additional information about required vaccinations is on the NYS DOH web site at http://www.health.state.ny.us/diseases/communicable/influenza/seasonal/providers/health_care_personnel_influenza_immunization_requirements.htm Jim Downey Coeditor, BLANKET newsletter, NYSVA&RA Editor, PULSE newsletter, District 4, NYC Region, NYSVA&RA To be removed from the NYSVA&RA e-mail list please send a message to jamesbdown@aol.com PULSE CHECK 2009, October 1 to 4. Full information at www.nysvara.org Click on the PULSE CHECK logo. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx SEPTEMBER 18, 2009 Reminder to all EMS agencies and providers that the seasonal influenza season, has officially started this month. Suffolk County continues using the Severe Respiratory Illness EMD Protocol, and continues to add the "FC" designation to the call determinant code. This designation is an indication that you may encounter a potentially infectious patient with influenza-like illness (ILI). Continue to employ our past recommendations for the use of PPE and early notification to hospitals. Regular and on-going communication within the county - between our Health Commissioner, our Division of Public Health, the Division of EMS, hospitals and FRES, and outside the county - with other key state and local officials continue, so that we can all keep abreast of on-going developments and recommendations to ensure a consistent message and approach to managing the situation. The issue of vaccines has caused some confusion, based on some media reports and interpretations throughout the system, based on what some folks are hearing or being told. As of today-here is the current factual situation: Seasonal influenza vaccine became available in Suffolk County recently and our department and many private physicians began administering seasonal influenza vaccine last week, and will continue to do so, throughout the flu season. The Health Department's POD clinics will continue through November, 2009 and the location of these sites will be listed on the Health Department's website www.suffolkcountyny.gov/health Consistent with previous flu season guidance - EMS providers and other first responders such as firefighters and law enforcement personnel providing emergency medical response are at risk and are strongly encouraged to get seasonal influenza vaccine from their private physicians, from their agency physicians, or by visiting a local pharmacy, or a SCDHS Influenza Immunization POD Clinic. The "mandate" that you have heard about comes from a recent change in the Section 405 of the NY State Health Code Regulations that govern Article 28 facilities, such as hospitals, skilled nursing facilities, diagnostic & treatment centers, licensed home health care agencies, health centers, and hospice programs. The modified regulation, in effect now, "requires that all persons employed or affiliated with an Article 28 facility, whether paid or unpaid, including but not limited to employees, members of the medical staff, contract staff, students, and volunteers, who either have direct contact with patients or whose activities are such that if they were infected with influenza, they could potentially expose patients, or others who have direct contact with patients, to influenza” receive the seasonal influenza vaccine, (now) and the H1N1 vaccine (if/when available). The only exemption included in the regulation is in cases where the vaccine is medically contraindicated and that exemption will have to be certified by a physician or nurse practitioner. This regulatory change DOES affect EMS providers directly employed by an Article 28 facility, or those EMS providers working with an ambulance service under contract to an Article 28 facility, by definition. As of this writing….the rules change DOES NOT apply to volunteer or career EMS providers with ambulance services operating in the Suffolk County EMS System, as governed by Article 30. Given the impact that local ambulances have on daily emergency department volume, the State DOH has asked the Department of Legal Affairs (DLA) for an opinion as to whether or not this regulation extends to every EMS provider. We will keep you posted on any changes. There is one cross over issue and that is limited to volunteer EMS or career EMS students enrolled in EMT-B or EMT-CC Original Courses as those courses have hospital clinical rotations associated with them. By definition, transient students doing clinical time in hospitals are indeed part of the "hospital community" and thus, must have the flu vaccine now, and H1N1 vaccine if /when available, along with other longstanding required vaccines required by the 405 Regulations ( Rubella, Rubeola, Hepatitis B, Tetanus, Diphtheria, and PPD) to be eligible for clinical rotations. Regarding the H1N1 vaccine - It's too soon to for public discussion about the H1N1 vaccine policy as the Federal Government - to - NY State - to - Suffolk County distribution and supply methods are still under development and we don't yet know how we will address first responders as priority target audience. What we do know is that "first responders with direct patient contact" are in tier 1 (first to get) in both scenarios - plenty of vaccine; and limited supply of vaccine. EMS agency leaders are strongly encouraged to: ·Facilitate programs where EMS providers and their families get the seasonal flu vaccine; ·Review their agency specific Respiratory Protection Plans to ensure that they have the necessary equipment, plans and preparations to protect their providers in cases of respiratory illness, fever and cough, especially when doing "aerosol increasing" procedures such as nebulized meds, BVM, suctioning, or intubation. The current recommendation is a fit-tested N95 mask in accordance with State EMS Policy Statements on infectious disease and respiratory protection; ·Review their agency specific Continuity of Operations Plans (COOP) to ensure uninterrupted response in cases of high absenteeism due to member / family illness; and ·Review infection control practices to ensure that EMS providers reduce the risk of infection and cross contamination by frequent hand washing, and by cleaning ambulance surfaces, including steering wheel, radio mics, stretcher, shelves, and durable medical equipment after every call.

Amen, brother! One private service I was with paged us out for calls. I got paged out during the final episode of MASH. A few months later, they reran the episode. Damn if I didn't get paged out again at exactly the same point!

We did, exclusively, but started phasing them out in the late 1970s in favor of the type one modulars. The last one was converted to a mobile command post called the Field Com, retired in 1986. Thing was so used/abused, it could only go 25 miles per hour, downhill, with the wind pushing it, with a long running start. Maybe.

Notable exception to that last: Iran.

OK, when I was at the vollies, we held station IN the station between calls, sometimes drilled, mostly watched TV. Privates, we sat at whatever location dispatch told us to hang out at until a call came in. I'm Fire Service based, but we have an assigned street corner we're to hang out at between calls, or be relatively close to between calls. If we were at the station, we were restocking ot cleaning the ambulance, glomming down a meal bought on the way to the station, or using the latrine (the "head", the "can", you get the idea). Presume each provider to be different with what they do, or allow their crews to do, between assignments. As stated, research them, ask the folks currently working for them.

Regional EMS COuncil of New York City www.nycremsco.org New York State Department of Health WWW.Health.State.NY.US Fire Department of New York (City) http://www.nyc.gov/html/fdny/html/home2.shtml NY State Volunteer Ambulance and Rescue Association, Inc. (877) NYS-VARA http://www.nysvara.org/index.html New York State Physician Profile http://www.nydoctorprofile.com/welcome.jsp New York State Emergency Management Office http://www.semo.state.ny.us/index.cfm

The tale I told is supposed to have been possibly 16th century. They didn't have motorized anything yet, to need fixing.

Ultra-devout Jewish is also not supposed to have a non married man taking care of a woman, or a man be handled by a woman. Also, they are not supposed to ride in a vehicle between sundown on Fridays and sundown on Saturdays. In my own religious training, attributed to a Rabbi Hillel, a Jewish and non Jewish man are walking on the Sabbath, discussing the affairs of the world, when they heard the voice of a child calling for help from a semi-demolished abandoned house. The non Jew offers to run and get help, but, instead, the Jewish man joins with the other man, and the 2 of them rescued the child. A religious council in the town charges the Jewish man with "breaking the Sabbath" to effect the rescue, and threatened to stone him, but the town's Jewish leader, after consideration for a while, told the charged man that no stoning would take place. He pronounced that "to save a life, one may break the Sabbath. Like, tolerate, or hate them, that is why you'll still see Hatzoloh Chevra ambulances responding to calls, even on the Sabbath. Also, I have had calls where I realize I am in either a Moslem or Hindu household. On those times, I apologize for not removing my boots, explaining that I want to take care of the patient that they called me to, not waist the patient's time to remove and then replace the boots. The fact that I am aware of this seems to make a good impression on the people in these households. However, the woman who wanted my partner and I to take off our boots because she didn't want us tracking in rain water onto her carpet, instead of taking care of her sick 3 year old, was told off, not by my partner or myself, but the NYPD LEOs who responded with us.

http://www.nyc.gov/h...ideshow23.shtml

Um-GA-Wa!

It just dawned on me: They buried the stereo speaker instead of the dog? Some stereo systems midrange speakers, going towards the bass side of the audio spectrum, are called "Woofers"! If it had been canaries or other pet birds, they would have buried the "Tweeters"!

On a different string a while back, I first heard of the alcohol tampon. Coincidently, a few weeks later, it was mentioned in one of the CSI shows.

Part One: Part 2 Part 3