Richard B the EMT

Before 9-11, I remember many folks getting departmental permission to do "Ride-Alongs" with us, and even after, some military medical trainees still rode along. I don't recall if they allow anyone doing that anymore, including the military personnel.

I almost forgot: If the patient is violent, I would NOT wait for ALS, Supervisor, or LEOs in the house or apartment, the hallway or sidewalk outside is a safer place for my partner and me. If the patient is in an apartment and damaging things within, screw the equipment if it slows us down, we're going to another floor, and await the LEOs, as the call is now reclassified as a barricaded EDP (Emotionally Disturbed Person), with the LEOs totally in control of what happens to the patient. Related story: On Sunday, September 28, 2008, a nude EDP, standing on a second story level ledge, threatening the NYPD Emergency Services Officers with an 8 foot long florescent light tube in his hands, was shot with a TASER, causing him to lose his balance, fall to the sidewalk, and hit his head, causing fatal head injuries. An ESU truck with an airbag had not yet made the scene. As the NYPD protocols were violated (the TASER was used on someone who potentially could have fallen from high enough to get severely injured, and it isn't supposed to be used in that situation), and the pictures made the internet and newscasts from bystanders' cell phone-cameras, all members of the NYPD ESU were ordered to report to the NYPD training facility at Floyd Bennett Field for a refresher class on proper use of the TASERs. The Lieutenant who ordered the TASER used had been put on "Bow and Arrow" detail, meaning his badge and gun were taken back by the department, and the officer who fired it was now, pending review, "flying a desk". Yesterday (Thursday October 2, 2008), when the first of the ESU officers started arriving, they found the Lieutenant already there, dead from self inflicted gunshot wounds through the inside of the mouth, with a weapon apparently stolen from another LEOs locker. This was the same day the EDP was buried.

I'd first radio for ALS (I'm BLS), for an "ALTMEN" (ALTered MENtal Status) patient. On their interview, would probably contact OLMC, that the patient and Doctor could talk. If the patient refuses to talk, or if deemed needed by the OLMC Doc following the conversation, would request the nearest EMS field supervisor respond. On the supervisor's on scene SitRep (SITuation REPort), the LEOs and a LEO supervisor would then be requested to respond, and put the patient into restraint, and take the responsibility for the patient being transported, against their will, and with at least one LEO in the back of the ambulance with me, to the nearest Psych ER. Time consuming, yes, but several times over, proven to be needed for the best interests of the patient, in my opinion.

As I am aware there is a program for teaching passengers who want that knowledge (perhaps no longer available following 9-11-01), in case the pilot of a small aircraft conks out, the spouse, or regularly flying passenger can take over flying while in mid-flight, until someone can give those talking down instructions. Obviously, they exist, or existed, for something the size of a Beechcraft "Bonanza", not a large commercial 2, 3, or 4 jet engine powered aircraft. Karen Black as a "Stewardess" flying a damaged 747 only exists in fictional movies like the second "Airport" movie (does any military even have a helo capable of the speed of a 747 to winch Charlton Heston down to the damaged aircraft? Even the Airwolf, piloted by Jan Michael Vincent, is only a work of fiction).

I think I have heard of a service, possibly through Social Services, that offers a "Wellness Check" telephone call on a daily basis. If the patient is using 9-1-1 for someone to talk with, perhaps this type service could be arranged to call the person, and then the "Patient" shouldn't be calling 9-1-1. I'll also say, I don't know if this type service is available in my own area, so can anyone tell us if they have it in their area(s)?

Unfortunately, that works only if the partner agrees to do the same, otherwise, the partner might complain against you being stinky. Furthermore, what about any other patients (and their families/friends/bystanders) you might handle during your tour? How are you set for gas masks for all of them?

Thanks for the link. My mother was looking over my shoulder, and posed an unanswered question: What, if any, danger is there for combustion, when Oxygen and Alcohol vapor combined should reach a spark? Alcohol is, after all, a fuel, and the Oxygen supports combustion.

GREAT BALLS OF FIRE! We're back to the "Paragods"? I don't mind a (little) bit of arrogance from those who are trained to a higher level of medical care. My problem is when they don't cooperate with the lesser trained. I've mentioned in the past, some Paragods do a nasty thing called the "Paramedic Push", or "Paramedic Shove". This is illustrated by the tendency to physically push away the EMTs, and sometimes the EMTs do it to the first responders, from the patients. I have heard several reports of EMTs actually knocked onto their keisters by practitioners of this. Politeness should always be protocol, even if not written into the operations guide. The way we should "play together" is, those of higher training should ask the lower trained personnel what they have, what vitals they may have already assessed, as in a basic "SitRep" (Situation Report) and ask them to stay a while until the higher trained personnel can do a further assessment, as they might be needed, even if it's only as equipment pack mules. Have them feel "They are a part of the team!" I usually explain to the first responders that while they already took vitals, I'm going to take my own set, but emphasize that I'm going to compare my readings to theirs, to determine if there has been any significant changes. I do this, even if they just took the BP cuff off the patient, and are still folding it. Look at it this way: There will be times you want them to back you up, which they might not do if they regard you as a "know-it-all idiot who loves being nasty to 'us' (the lower trained personnel) only because we don't know what they know. Why should we help the likes of them?"

I concur. I saw that heading, and was confused that there was no mention of an APGAR score.

Actually, I am unsure if it is a city or state agency. I don't even know if it is part of the dual state agency, the "Port Authority of New York and New Jersey."

You just reminded me that the FDNY EMS is about to place 10 of those "tracked" chairs in 2 ambulances per borough (we have 5 of them, ya know) for "testing, per the salesman of the brand being tested. I met the salesman at the "Pulse Check" convention.

Nothing wrong with that. My outspoken politics are strictly local, to the city council or state assembly/state senate level, so consider me a "Pre-Schooler".

FDNY operates via hydrants, so the pump companies, here known simply as Engine companies, have a 500 gallon tank. We don't use water supply tanker companies. However, the Sanitation department uses large single body tanker trucks for spraying the street clean, kind of like using hi pressure water spray jets under the truck to "sweep" assorted dust, dirt, and light garbage to the side of the road. I don't recall ever seeing one of them up on an MTA bridge, except possibly with a snow blade on the front during snow emergencies.

Can anyone recommend a First Aid book, or a course type for the manager of a local diner? She, and her staff, kind of freaked when a customer had what was described to me as a "Grand Mal" seizure, and, aside from calling 9-1-1, no one on staff knew what to do. I am aware they have F/A classes for baby sitters, but have no clue if there is anything for waiters,waitresses, and kitchen staff, "in case of" any incident(s) at the restaurant. Oh, by New York State law, a poster of how to do the Heimlich Maneuver has to be in public view in restaurants or "fast food" joints, and a "CPR Kit" ("pocket mask" and surgical gloves) must be near the register. For those outside the United States, I use the terminology "Non-Professional" here, simply to indicate that the personnel using the information don't work or volunteer as part of an EMS system, such as my friend the diner manager.

Unless an FDNY EMS crew knows a stretcher can be brought in to a scene, the carry chair is mandatory to be brought in by the crew, along with the Defib and the "first in bag, AKA "Jump kit".

"Hot" or "cold", up until now the vehicles got free passage. Now the MTA is supposed to bill NYC for the vehicles using the facility, presumably even if the emergency is on that facility. All I can tell you is, the Red Light Camera showing vehicles violating the red signal at Beach Channel Drive and Hassock Street, heading into Rockaway from Nassau County, probably has numerous pictures of the butt end of my ambulance travelling "Code 3" (L&S)as I've transported patients from the county line, or from the Redfern Houses Project, to St. John's Episcopal Hospital in Far Rockaway. As for changing the timing, so more people would end up as violators, well, they do earn income for the city. Then, there's the guy got a picture of his car breaking the law by going through the red signal, demanding the fine. He sent a picture of the amount to the authorities. He then got a picture of a set of handcuffs. He got the hint, and sent the check.

:shock: Really? Wow.

Even Father Mulcahy, from TV's "MASH", on numerous times, said Jewish prayers, both with, and over, sick, injured and dying soldiers, as did a priest in a Second World War sequence on the "JAG" show. (Judge Advocate General) From the JEMS.com website and link,,, http://www.jems.com/news_and_articles/news...emt_riders.html Sunday, September 21, 2008 Chaplains turn into EMT riders CARLISLE, Pa. - Chuck Kish was driving near Carlisle a few months ago when he came upon a traffic accident scene. When Kish, pastor of Bethel Assembly of God Church, saw the tarps covering the bodies, he knew it was a fatal crash. "I saw an emergency medical technician walk over to one of the bodies. They lifted the corner of the tarp and he turned away," Kish recalled. "I'll forever remember the look on his face. I thought, 'he needs a chaplain.'" That traumatic moment planted a seed that will bear fruit this month when four volunteer chaplains from his church in South Middleton Township begin riding with crews from Carlisle's Cumberland Goodwill Ambulance company. It might be the first such program in Pennsylvania, and perhaps in the country. The chaplains, including Kish, will be at the elbows of the emergency medical technicians to help those crews, patients and families deal with the physical and emotional pain ambulance workers encounter on a daily basis. "At some point, I think, every person of faith has to take stock of their lives and ask, `Are we giving back enough?'" said Jack Rau, one of the volunteer chaplains. "I can't think of a more perfect place to serve people in need." Janette Kearney, the executive director of the Pennsylvania Emergency Health Services Council, which advises the state Department of Health on ambulance issues, said she knows of no other unit in the state that has chaplains riding with crews. Rau and the other chaplains, Amy Jones and Frank Poley, are commissioned ministers with Bethel. Rau has undergone first-responder training in basic ambulance procedures. Jones is a nurse. Robert Pine, Cumberland Goodwill's EMS chief, said he expects his crews will welcome them. "I don't sense any reluctance," he said. The crews already can seek counseling after stressful calls, but this will be different because the chaplains, in many cases, have been through the same experiences and will be able to relate, Pine said. "There is a benefit in talking to someone who has been there, someone who understands," Pine said. Such understanding is most needed after calls involving children, he said. "When kids are involved, it's always very, very hard," Pine said. "Most of our people have kids of their own. When they come back from one of those calls, you see the looks on their faces and know they need someone to talk to." During the height of a call, the chaplains will mostly stand back. They will be expected to get equipment, Kish said, and to help calm patients, inform and counsel families and pray with them if asked. "There is no expectation that they'll be providing (medical) care," Pine said. Chaplains, who will have special uniforms, will ride with crews in the evenings, which Pine said are among the busiest times for calls. The ambulance effort will mark the second time Kish and Rau have donned uniforms for community service; both are veterans of a police chaplaincy program Kish organized that operates with two local police departments. "It seems that God has put us at all the points of pain in the community," Kish said.

1) Until seen by the surgeons at the hospital that might attempt reattachment, the leg should have accompanied the patient, or been transported ASAP from disentanglement, to determine if it could have been reattached. Only then, if the answer was "No", IF local policies allowed it, should the limb have been possibly used for cadaver dog training. 2) Under traditional Jewish law, a body has to be either intact, or at least all in one place, for burial. It is my understanding, in Israel, they have specialists to painstakingly piece together people killed and blown apart by bombs, even the suicide bombers themselves, for their funerals. 3) There recently was a conviction on several persons who stole body parts from cadavers for transplant purposes. The thefts came to light when at least one of the many recipients got HIV/AIDS from the transplanted part. Did not these people consider the possibility that they were potentially moving a bio-hazard? I think not.

Even in a big type 1, it can get cramped with 2 patients on spinal long boards. I ask a clarification. You mention the stair chair. Don't your minimum equipment lists for your jurisdiction require one? Or, do they allow you to transport a patient in them when the chair is in the ambulance during the transportation? Here in New York State, we used to be allowed to do that, and I remember the catalogs selling restraint devices to "secure" an occupied stair chair to the ambulance floor. 'Tain't the case any more, as it ain't allowed.

I thought I covered that. Good questions. How long has the substance been ingested into her system, are there any samples left to determine what the "aspirin" really was, and who supplied it, as that individual might have planned it as a "date rape". Notify Detectives Olivia Benson and Elliot Stabler of NYPD Manhattan SVU!

BACK ON TOPIC, PEOPLE!!! I am going to mention that this comes as Mayor Mike Bloomberg is demanding that all city agencies must cut their expenditures for the upcoming fiscal year. How? When you have all our city agencies pared already to the bone, what next, cut bone? I also mention that the MTA area that runs the subway trains is going to shelve the plans for the "Second Avenue Subway", needed for the East side of town, as the Lexington Avenue line has been filled to overcapacity from prior to when I rode it to High School in the early 1970s. My mother tells me that the city started to build the Second Avenue Subway at least 4 times from 1935 or so, sold the bonds, and the plans got shelved back then, too. If I have grandchildren, I wonder if they will have that train line in use for them. Anyone good at fortunetelling have a clue?

One of my tests for EMS (May of 1985) was to run up 2 flights of stairs, as in 2 storys up, grab a 175 pound "Heavy Harry" mannikin, and bring it back downstairs, solo, in under a set time limit. Someone who tested with me supposedly "set a course record" in the time he completed this. Oh, then we had to take "Harry" back upstairs for the next dude or dudette. At least returning the mannikin was not timed.

You mean... http://television.aol.com/show/spongebob-s...ants/55365/main

The Verrizano Bridge charges $10.00 to go from Brooklyn to Staten Island, but no charge the other direction. There is a charge, that I forget, from New Jersey to Staten Island, possibly one way only, but it has been a while from when last I traveled that way. The George Washington Bridge charges for going to New York, but no charge to Fort Lee, NJ. Says something for Fort Lee, don't it? However, the bridges and tunnels between New York and New Jersey are, I think, a dual state agency, the "Port Authority of New York and New Jersey". They may either be a part of the MTA, or the MTA is actually a part of them.