Richard B the EMT

FDNY EMS BLS EMTs are allowed to give Albuterol for asthma, 81 Mg chewable aspirin for chest pain/suspected cardiacs, assist a patient in taking the patient's own nitro pills, but at this time, NO BLS EMT is authorized to use an Epi-Pen in the entire state of New York, not just the FDNY EMS. Again, we're awaiting the NY State DoH to approve a Pilot Program, SOMEWHERE in the state, for EMTs to be allowed Epi-Pens, as per what I have already stated, that we have had the training, but are not allowed to use the training.

Clarification, please: Are you using the term "Westerner" to be European/American geopolitical versus "Asian" (or whatever the currently politically correct wording is now), or someplace depicted in a "John Wayne as cowboy/cavalry officer" movie?

A chicken? Not a duck?

Just as a mention, the union (Local 2507, Uniformed EMTs, Paramedics, and Fire Inspectors of the Fire Department of New York City, District Council 27, American Federation of State County and Municipal Employees) fought hard with the FDNY EMS Command to get soft body armor for the members. But... The last member of the service to be killed, last September, was off duty, and shot at his girlfriend's house, by the woman's ex. While still off duty and not a Line Of Duty Death, I want the guy prosecuted, if it has not already happened, to the fullest extent of the law, up to, and including, the death penalty. The State of New York currently does not have an active death penalty.

Indeed, I do. I used to work in the EMS EMD, for 11 years before the merger into the FDNY, CBEMT. And, as if I have to tell it, just how do these people get to the ERs for the nurses and doctors to review their crap? Why, by an ambulance, of course, MrMeaner. I have seen the attempt to weed out the calls that should have gone by taxi, bus, or even walking, to a low priority treatment clinic, from those who truly would benefit from immediate care by EMS, both at the scene, and on the way to the ED, but the call volume on both sides of that question have increased at the same rate. I honestly don't know how to get away from the ambulance to each request system in current use. I repeat myself here, and probably will do again down the road, that the 9-1-1 systems are, in part, a victim of their own success. "Got a problem? Call 9-1-1, and help is on it's way." Further repeating myself: A commercial showed a 1930s large scale party, quite noisy, with the voice over saying "save 9-1-1 for true emergencies". This is followed by the biplanes circling the Empire State Building, as King Kong is holding onto Fay Wray at the top, and again, the voice over says, "save 9-1-1 for true emergencies" I guess it didn't work.

As a BLS EMT, I have been trained over many refreshers (every 3 years) on how to use an Epi-Pen. Now (and forever, it seems), we are waiting for the NY State DoH to authorize a pilot program, that the EMTs in New York can start using them when needed. As of this time, that I am aware of, the only autoinjectors we in the FDNY EMS Command carry, is the stuff in the WMD packs.

Well, we were warned that this was unrated!

I post the following, including the source (New York State Volunteer Ambulance and Rescue Association) that sent it to me, and invite discussion on the content.

Akflightmedic wrote And tskstorm wrote In response to both of those thoughts, there are local protocols that come into play, and they actually do involve calling OLMC. Usually, after the doctors talk to the patient, the patients decide to go to the hospital, but if they still don't, and I won't spell it out in full here (due to space and time considerations), a LEO/protective custody element is activated. However, if the patient goes unconscious, even if they used their last moment awake arguing against going, it becomes a non issue, as unconscious patients are presumed to want to go to the hospital, and we oblige them.

The Earth's orbit must be in decay, as it revolves around [marq=left:5f4783d3f8] ME![/marq:5f4783d3f8] And just think, I got that poetry out of a 1964 Children's Digest, when I was about 9.75 years old. Besides, I am already referred to as As for getting married on Valentine's day, why not? Is it because you only get valentine's presents and not anniversary presents? Humphrey Bogart always complained that he got cheated out of birthday presents, as he was born on December 25, Christmas Day. As a matter of fact, I'm getting the wrappings for a Valentine's Day wedding anniversary present to go to an old girlfriend and her husband of 2 years. (Those who have been listening to me already know, she is the one I asked to marry me, with just that one small hurdle to get over, standing in our way: She said "No.")

Ventmedic, we agree, that is exactly why this patient has to go. My state and local protocols require, nay, DEMAND this patient be transported for further evaluation and treatment in the Emergency Department.

I'll allow for local and agency protocols allowing for not transporting after treatments are started, but presume to allow for specifics on each call type. As a case in point, EMTs in New York are allowed to give nebulized albuterol to asthma patients, but if treatment is started, in the FDNY EMS Command, that means the patient is going to the hospital by either ALS, or BLS, but the patient is definitely going!

The call referred to, on that link, was in the middle of the night. I was the call taker on the one I referred to, and, as a mention, for a 1400 to 2300 tour, the call came in about 1730 or so. I agree that if an elderly person calls in for what might otherwise be regarded as a BS call, it usually ain't a BS call. Have we all not had calls where the patient was an elderly, and, no matter what was the complaint they had, or what signs and symptoms are presenting, they are apologizing all over the place for troubling us to respond to them? Oh, I also realize there are going to be younger folks who will have the same situation, and folks who we need to direct the "I'm here to save your arse, not kiss it" line. It is just a matter of sifting through the mess to find out which patient is which. And one more thing: even the worst EMS system abuser you always seem to be picking up, can have real problems at any time.

Guys? Gals? Just never let yourselves BECOME the "D Shift!"

You asked if you should mention the Continuing Medical Education class or classes? I'd refer to the fact that you had taken, and are taking, CME classes, without mentioning what specific topics were covered; save those details for the personal interview, if you feel they would help, or are specifically asked for class content.

Different call and situation: While I was working the Dispatch office, a woman calls and states her husband is having a severe toothache. The call taker has a funny feeling about this, and asks if anything else is bothering the patient, or if the patient has any medical history.. The patient has nothing remarkable, per the wife. Under existing policies the call taker enters the call as a "Sick", but due to the patient's age, also under policies, moves the call from the usual "Priority 6" to a "Priority 4". The caller (the wife) then says that she is embarrassed to be making the 9-1-1 call, but then says, "It must be impacted or something, he says the pain is going from his jaw down his left arm. Pain traveling from jaw down Left arm? Upgrade again to "Card" for Cardiac, at "Priority 1"! dual BLS/ALS response. The first arriving crew gets to the patient just as he collapses, and starts CPR, joined seconds later by the other crew. I don't know if it was a good save, or veg-o-matic city, but the patient had spontaneous return of Circulation by the time the 2 crews got to the hospital.

(Anonymous)

Let us not forget that the CPAP machine is also used for the ongoing treatment of Acute Sleep Apnea. I, for one, can not, because that is why I use one! http://www.sleepapnea.org/ for the American Sleep Apnea Association

If you're coming through JFK or LaGuardia in New York City, I might be able to swing some time off to visit with you. Just give me enough notification time.

My Lady J and I were "Mall-Crawling", when she saw me stop and go into the Victoria's Secret. When she rejoined me therein, I pulled my credit card out, and said, "go shop!" She loved the idea, even though she described me afterwards as being quite red in the face!

Is he a military veteran, even if he never saw combat?

OK, then, who volunteers to be the fat lady, singing that it is over?

From an E-mail notification from the New York State Volunteer Ambulance and Rescue Association:

I was about to close down my computer for the night, when I got the LODD notice from the New York State Volunteer Ambulance and Rescue Association. If you want, follow this link to the department he was with. http://www.ti-rescue.org/

This is anecdotal, so is probably not much help, but even when doing a BP of XXX over "Palp", it still is when the sound is auscultated, or pulse palpated, as most of us with experience taking BPs know the needle bounces a lot from pumping up to the sounds being audible. On the other hand, I have had no needle jump at all until after I have first heard the sounds through the stethoscope, on some patients. Just remember that there are actually only 2 things that can and will affect a BP: Anything, and Everything!