Richard B the EMT

Speaking both flippantly, and off the top of my head, EMT-Bs transport patients, FRs don't.

The FDNY EMS KDTs are kind of a radio/computer "telemetry" system used as a part of the Computer Assisted Dispatch system, and operate in the 800 MHz band. As a part of getting Volunteer Ambulance Services "integrated" into the 9-1-1 system, in the Mutual Aid Radio System (MARS), the FDNY is asking the VAS/VAC/VFDs to pay for the installation into their ambulances, at a cost of something like $2,000.00 per vehicle. No mention has been in made, per the volunteer EMS circles I travel in, of anything for the dispatch offices of the volunteer services, just for the vehicles. Prior to the EMS/FDNY merger, NYC EMS issued "dial-up" type radios to the Volunteer EMS/VFDs, and either installed them, per the agency's request, in the vehicles, or the dispatch offices. These radios primarily operated on 155.34 MHz. Later, portable radios operating in a "Trunked" 800 MHz system were issued. I'll post other information on the FDNY EMS/Districts 4 and 18 New York State Volunteer Ambulance and Rescue Association "discussions" as I relocate them in my memory sticks, or get them from District 4, in regards to the MARS.

A visitor to New York for the 1990 Tennis "Open" was stabbed in the chest, while attempting to protect his family from a mugging. Under protocols then in use, the responding crews placed him into a MAST, inflated the 3 compartments, and proceeded to transport. He exanguenated through the chest stab wound. In the ensuing firestorm of critisizm in the local, state and national medias, protocols were changed to not use MAST for penetrating chest trauma, and in following years, statewide training included MAST, but the equipment was removed from the NYC EMS (pre FDNY merger) ambulances. Find the article about the attack, but not mentioning the MAST, and NYS DoH policies, below. http://www.queenstribune.com/anniversary20...rianwatkins.htm http://www.health.state.ny.us/nysdoh/ems/policy/s97-04.htm <H1 id=pagetitle>Medical Anti-Shock Trousers</H1> Advisory No. <A name=S97-04>97-04 Date Approved: August 7, 1997 New York State Department of Health Bureau of Emergency Medical Services Note: This advisory guideline announces important changes in the Statewide Basic Life Support Adult and Pediatric Treatment Protocols. Revised copies of each of the protocols affected by these changes are attached. Revised copies of each of the protocols affected by these changes are also being sent to all emergency medical services agencies statewide. Regional Emergency Medical Advisory Committees, and regional, system, and service medical directors are directed to facilitate use of the revised protocols at the local level, and are further advised to modify local protocols, policies, and procedures accordingly. Current Statewide Basic Life Support Adult and Pediatric Treatment Protocols stipulate that Medical Anti-Shock Trousers (MAST), also known as the Pneumatic Anti-Shock Garment (PASG), should be inflated if the systolic blood pressure is below 90 mm Hg in adults or below 70 mm Hg in children and signs of inadequate perfusion are present, if MAST (PASG) are available. The State Emergency Medical Advisory Committee has reviewed these protocols, and concludes, on the basis of recent scientific evidence, that prehospital MAST (PASG) use in New York State should be considered only in adult major blunt trauma with severe hypotension (systolic blood pressure < 50 mm Hg) and hypotension (systolic blood pressure < 90 mm Hg) associated with unstable pelvic fracture. In 1989, Mattox et al, in a prospective randomized study of 911 adult trauma patients, mostly with penetrating injuries, found that MAST (PASG) use was associated with longer scene times, and worsened the survival of adult patients with systolic hypotension (BP < 90 mm Hg) as well as those with primary thoracic injuries who presented in traumatic cardiac arrest. In 1992, Cooper et al, in a retrospective study of the efficacy of MAST (PASG) use in 436 pediatric trauma patients, mostly with blunt injuries, from the National Pediatric Trauma Registry who presented in hypotensive shock, found similar results. In 1993, Cayten et al reported the results of a retrospective study of MAST (PASG) use in 629 hypotensive adult trauma patients which concurred with Mattox's findings, although they were able to demonstrate a small but statistically significant survival advantage in severe hypotension (BP < 50 mm Hg). While there have been no prospective studies and no published trauma registry data in support of MAST (PASG) use for hypotension associated with unstable pelvic fractures, retrospective reviews and cases reports consistently support MAST (PASG) use in such circumstances. In 1997, O'Connor et al performed a collective review of the scientific literature as an evaluation of MAST (PASG) in various clinical settings. On the basis of this review, Domeier et al developed a position paper on use of MAST (PASG) for the National Association of EMS Physicians, the Summary Recommendations from which, as they pertain to trauma, are summarized below. MAST (PASG) are "usually indicated, useful, and effective" (Class I evidence) for: None. MAST (PASG) are "acceptable, of uncertain efficacy, [although the] weight of evidence favors usefulness and efficacy" (Class IIa evidence) for: "Hypotension due to suspected pelvic fracture; Severe traumatic hypotension (palpable pulse, blood pressure not obtainable). *" MAST (PASG) are "acceptable, of uncertain efficacy, may be helpful, probably not harmful" (Class IIb evidence) for: "Penetrating abdominal injury; Lower extremity hemorrhage (otherwise uncontrolled); * Pelvic fracture without hypotension; * Spinal shock. *" MAST (PASG) are "inappropriate, not indicated, may be harmful" (Class III evidence) for: "Adjunct to CPR; Diaphragmatic rupture; Penetrating thoracic injury; Pulmonary edema; To splint fractures of the lower extremities; Extremity trauma; Abdominal evisceration; Acute myocardial infarction; Cardiac tamponade; Cardiogenic shock; Gravid uterus." * Data from controlled trials not available. Recommendation based on other evidence. The literature cited supports the conclusion that the role of MAST (PASG) in the prehospital emergency medical care of adult and pediatric patients is extremely limited. The State Emergency Medical Advisory committee agrees with the National Association of EMS Physicians that the weight of the evidence favors the usefulness and efficacy of MAST (PASG) only for adult major blunt trauma with severe hypotension (systolic blood pressure < 50 mm Hg) and hypotension (systolic blood pressure < 90 mm Hg) associated with unstable pelvic fracture, a position which is consistent with the 1997 Edition of the Advanced Trauma Life Support Course of the American College of Surgeons. The State Emergency Medical Advisory Committee (SEMAC) therefore recommends their use under these circumstances, although Regional Emergency Medical Advisory Committees (REMAC) may prescribe their use under other circumstances to address specific local conditions. The Statewide Basic Life Support Adult and Pediatric Treatment Protocols are being modified to reflect this change, and Regional Emergency Medical Advisory Committees, and regional, system, and service medical directors are advised to modify local protocols, policies, and procedures accordingly. Selected References Mattox KL, Bickell W, Pepe PE, et al: Prospective MAST study in 911 patients. J Trauma 1989;29:1104-1112. Cooper A, Barlow B, DiScala C, et al: Efficacy of MAST use in children who present in hypotensive shock. J Trauma 1992;33:151. Cayten CG, Berendt BM, Byrne DW, et al: A study of pneumatic antishock garments in severely hypotensive trauma patients. J Trauma 1993;34:728-735. Flint L, Babikian G, Anders M, et al: Definitive control of hemorrhage from severe pelvic fracture. Ann Surg 1990;221:703-707. O'Connor RE, Domeier RM: Collective review: An evaluation of the pneumatic anti-shock garment (PASG) in various clinical settings. Prehosp Emerg Care 1997;1:36-44. Domeier RM, O'Connor RE, Delbridge TR, et al: Position paper: National Association of EMS Physicians: Use of the pneumatic anti-shock garment (PASG). Prehosp Emerg Care 1997;1:32-35. Issued by: Mark C. Henry, M.D. Chairman, State Emergency Medical Advisory Committee Authorized by: Barbara A. DeBuono, M.D. Commissioner, Department of Health Revised: June 1998

There is a "policy" in our overall EMS community, that of responding "L&S" to calls, and on determining the condition(s) of the patient(s) will assist in the decision to go "L&S" to hospital, on the philosophy that when the crew arrives at the scene of the call, technically, the emergency is over. I do not state if I hold to that, but do state many do, or their local protocols mandate that philosophy.

For Jellyfish stings (not the Portuguese Man-O-War variety at least, as those can be first time exposure fatal), Vodka might not be ON the injury to cause easing of the pain, but IN the patient, so they temporarily don't care. While I am in a coastal beachfront area that usually gets the so-called "Lion's Mane" variety Jellyfish (local name, I don't know if that is the Marine Biologist's name for them), I keep hearing of putting (brand name specific) Adolph's Meat Tenderizer on the exposed areas of skin. While I have had the stings myself, I never had the meat tenderizer treatment done to me. I'll keep the tenderizer for my steaks and burgers. While on the subject of stuff used for other than original intended purpose, Avon brand "Skin So Soft" lotion is supposedly also used as a preventative to mosquito stings. For the tenderizer or lotion, anyone have any success stories to relate?

Earlier, I said I neglected to mention that they are all operating in a beachfront area.

You have me with the fact that we're talking mountains. HOWEVER... I have knowledge of 6 4x4 Pumper companies and 3, possibly 4, 4x4 ambulances, operated by the Roxbury VFD/EMS, the Rockaway Point VFD/EMS, and the Point Breeze VFD. All are within 5 miles of me, and all are within the confines of the greater city of New York.

They were originally known as "Military", as they had some background in Fighter Jet Jockey flight suits, to prevent them from passing out when "pulling 'G's".

Going back to the butter on burns... First, there is the issue of the pain the patient is going to endure, removing the butter from the burn, in addition to the pain from the burn in the first place. Second, why would anyone want to sautee a burn?

However it is going to be done, it is going to be a lot more complicated than the trick of getting a cat out of a tree. For the cat, take a charged deuce and a half line, a bunch of others standing "downstream", aim carefully for the cat, and administer a short burst from the nozzle to dislodge the cat, with the bunch of the others ready to catch a falling cat. Yeah, I know, not helpful in the case at hand, but mine sounds like fun, anyway.

THAT line takes me back to around 1974, when an instructor told me that an ER doctor couldn't understand that an ambulance crew IN THE FIELD was unable to put a burned extremity into an ice bath, even after being told, both by the instructor and numerous students, that ambulances don't carry ice making machines. Everyone at that class agreed, however, if such was available, that it was the best course of action.

Connecticut? I thought that was where an anti aircraft missile, minus any warhead, fell off the delivery truck! Again, supposedly on the I-95.

That job on the I-95: was it somewhere in NYC? I think I remember hearing about it, not through EMS/FD/PD comm channels, but the WINS 1010 AM News Radio traffic report.

Yes, I know I am reopening a 4 year old string, but I reread this while looking up something else. 1) The bodies could have been removed to someplace less "in public view," to await the "mortuary police", if applying the standards of my location (NYC). As also stated, that may not be the policies used in that beach area in Italy. 2) I would have gone to a more somber tone, and moved my partying a distance away out of respect to any friends and family of the deceased still in close proximity to where they were covered on that beach. 3) How many people, due to some kind of identifying with celebrities like Dale Earnhardt, or the recent passing of Michael Jackson, forgot, and are forgetting, that the world kept turning before these individuals were born, and now that they are gone, the world will continue turning. As mentioned in that 1950s song about the couple breaking up,

Lone Star has it so right on that one. The lawyers love seeing that on a call report in negligence trials

Who is Momma J? Momma B is the female parental unit, Lady J is the girlfriend.

Knowing that both EMTs and Paramedics practice the ABCs, in this instance meaning "Ambulate Before Carrying", I hope no one here EVER tries that with chest pain patients. (I'll not get into the massive list of other patient conditions that shouldn't move under their own steam at this time)

Why, THANK YOU, Lone Star!

Under the current mayor of NYC, the Board of Education became the Department of Education. I am, all these years later, still having trouble hearing that my girlfriend, Lady J, works for the DOE, and think, momentarily, I am hearing Department Of Energy, which we both laugh about.

Does anyone deliberately NOT stop at a red traffic signal or stop sign in their POV? Then why, when you don't know if the cross street has any traffic coming, would you just rush out? The old story goes that I was riding with a friend, when we came to a red traffic light. My friend just breezed through without slowing down. "Why did you do that?" "That's how my brother taught me to drive." We came to another red traffic signal, and again, he jetted through. On seeing my concerned look, he again stated "It's all right, I told you that is how my brother taught me to drive". Then we came to a green traffic light. My friend jammed on the brakes, and skidded to a halt! "NOW what?" "My brother might be on the road!" Personal experience: Traveling in the center lane of the three in my direction of travel, on the famously infamous "World's longest and narrowest parking lot", the Long Island Expressway, at L&S status, when a driver ahead of me realized there was a vehicle with red lights and siren behind him, just jammed on his brakes. My partner panic stopped, and there were a lot of screeching brakes and tires from easily 50 or more other vehicles, as we somehow all avoided a chain reaction crash, or running off the road, or into the divider, including numerous "18 wheeler" tractor/box combination trucks. All jokes aside, when driving any emergency vehicle, drive like you are expecting the unexpected, as you usually will not be disappointed.

In a joint statement, the offices of the United States, New York, and New Jersey Attorney Generals announced that yesterday, at the John F. Kennedy International Airport, an individual, later discovered to be a Public School teacher, was arrested while trying to board a flight to Washington DC, while in possession of a ruler, a protractor, a set square, and a calculator. The Attorney Generals offices expressed the belief that the man is a member of the notorious Al-Gebra movement, and is being charged with carrying weapons of math instruction. Al-Gebra is a fearsome cult, that desires average solutions by means and extremes, and sometimes goes off on a tangent in a search of absolute value. They consist of shadowy figures, with names like “X” or “Y”, and, although they are referred to as “unknowns”, we know they really belong to a common denominator, and are part of the axis of medieval with coordinates in every country. As the great Greek philanderer, Isoseles, used to say, there are three sides to every angle, and if God had wanted us to have better weapons of math instruction, he would have given us more fingers and toes. I am grateful our government has given us a cosine of intent on protracting us from these math-dogs, who are willing to disintegrate us with calculus disregard. These statistic bastards love to inflict plane on every sphere of influence. Under the circumference, it is time we differentiated their root, made our point, and drew the line. These weapons of math instruction have the potential to decimal everything in their math on a scalene never before seen, unless we become exponents of a higher power, and begin to factor in random facts of vertex. As the first President George Bush used to say, “Read my ellipse”. Here is one principal he is uncertainty of – Although they continue to multiply, their days are numbered, and the hypotenuse will tighten around their necks!

There is currently a pilot program underway in New York City for hypothermic treatment of post cardiac arrest patients. Sorry, but I just don't recall specifics at this time.

Dibs are a chocolate shell coated ice cream "niblett" confection, which I indulge in every now and again. It also makes sense as Difficulty In Breathing, which I had not previously heard locally. As for SOB? The story goes that the High tension buisinessman complained to his doctor while at the hospital for treatment. "Doctor, how dare you write that in my chart? I'm now thinking of suing you!" "Mr. Jones, first of all, you are not supposed to be looking at your charts. Secondly, S O B stands for 'Shortness Of Breath'"!

In February, 1977, I got broad sided by the one vehicle traveling in the left hand lane going westbound, on a major east/west thoroughfare, that didn't see that all other east/west traffic had stopped for my southbound ambulance that was turning east. My partner had lights and siren on, and cannot blame the sun in the Eldorado driver's eyes, as it was roughly 10 PM, on a clear night. No, the L&S are not automatic clear right of way, but a clamoring for right of way to be yielded by the other drivers to you. Crossing against the traffic signal should be by eye contact with the drivers in each lane, one at a time. Someone said, "Don't come to a complete stop, but keep moving forward so they don't think you're parked". Wrong, Wrong, WRONG! It will end up badly, with you having the forward corners of both the emergency vehicle and the other vehicle connecting. The impact will spin out one or both of the involved vehicles, and smash into other vehicles, possibly causing multiple spin-outs and collisions. I wish that on no emergency vehicle, or civilian vehicle. As already indicated, crossing against the traffic signal should be by eye contact with the drivers in each lane, one at a time. If it is 3 lanes in each direction, let it mean 6 individual stops to make the crossing safely.

As one who was a part of the original poster's Q&A on a term I was unfamiliar with, there have been many times I have asked the same thing of the gang here. We can always do what I just quoted, also. Many times we hear the sound of a hand palm smacking a forehead, when a simple term is explained. I've done it, and will, most likely, do it again.