Richard B the EMT

I have not yet viewed the video, probably will do so tomorrow. However, in my experiences, if one has to analyze if something is fun, or funny, it no longer is fun, or funny.

On a case where the husband attempted to stage his wife's "suicide", between when I was told to go to the District Attorney's office, and when I got there the next day, the wife dropped the charges. Go figure. Good luck in court, with whichever side you've been asked to testify for.

If the fire spreads from the dumpster to the house while the dispatcher is trying to determine which of the 3 type responses should be utilized, it is potentially a lousy system. Then, again, no matter how good a system is, there will always be room for some improvement later on.

I have had a similar patient. She lived in an apartment building, and when she'd call 9-1-1, and the ambulance would respond, she would ask to be taken to a hospital 2 counties, and perhaps an hour's travel time, away. Neither of the local hospitals in the isolated section of the county where she lived, carried the pain med she "needed". I suspect she had run out of her prescription, or was using too much. Point: I remind everyone that this is in a city of multiple counties, where almost all calls handled are within 15 minutes travel time of AN emergency room, and closest Trauma Centers to the call in question are roughly a half hour. Point: Any call where travel time, other than "specialty" centers like Trauma or Burn, would be more than 10 minutes past the actual nearest hospitals, provided the patient is "stable", has to be approved by the on line medical control doctors. If unstable, a patient would have to go local. Different doctors at the OLMC would grant, or deny, going past that "10 minute rule". One team got into trouble for taking her without asking permission. She wouldn't say no to the local Emergency rooms, if the OLMC declined her going to the hospital 2 counties over. When she moved to a skilled facility, which was so close to one of the 2 hospitals, you could sneeze at the facility, and someone at the ER would say "gesundheit", we still got her, but, of course, she wanted to go to the further away ER, which did, and does not, require OLMC contact. However, when we started getting calls on her floor for her, and the nursing staff was confused why we were there, but she'd stroll up and say, "Here I am, let's go", as she had called from the pay phone for 9-1-1, she became the facility's "administrative problem", and she was soon transferred to somewhere outside of my station's usual response area. We've lost touch, but I am not looking for her. I hope she gets the help for the pain med addiction, if indeed that is what it is.

As a reminder, any of the medical alert devices are supposed to give information to the rescuers about the victim/patient, when the victim/patient is unable to do so for themselves. I'll use as an example, an unconscious head injury patient, while the doctors are attempting to find out what is going on, is supposed to be given a CT scan, with contrasting elements. The contrasting elements are iodine based. The patient has a severe allergy to shellfish, which contains iodine. Is this patient about to have a reaction to the iodine? If the medical alert device is utilized, the doctors, presumably, will at least know about the iodine allergy, and cut orders for a contrasting element NOT containing iodine.

When Hurricane Donna hit, I was at home. I also was 6 years old. When Gloria hit, I was at higher elevation, at the EMS headquarters.

I am posting this at about 8 PM. The 5 PM TV news reports said that 6 people, medical staffers and Health and Hospitals Corporation Police, have been fired. How the hospital cops forgot they had video surveillance, I have no clue.

You might all want to contact the Medic Alert foundation, out of Turlock, California. They pioneered the Medic Alert devices, which indicate a member ID number, and the international toll free number to call for information on record for that number. I wear one, which has listing of my meds, cardiac condition, sleep apnea, home address and phone, even the name and contact number for my Primary Care Physician. The newest device is a memory stick. I don't approve of this idea just yet, as not all ambulances have the USB socket for it to be plugged in to, or even have a computer in the first place. http://www.medicalert.com/home/Homegradient.aspx

Not for nothing, but there's an Orange County in New York, and probably other states, too. Back to the discussion.

The idea of a demonstration being "controlled" with "Super-Soaker" water guns throws my alleged mind back to the early to mid 1960s. You might want to remember the name "Chief Bull Conner". Per the Wikipedia, at link http://en.wikipedia.org/wiki/Bull_Connor (Bold face type is my commentary) Then, again, if I get squirted by a super-soaker, I might get one, and squirt back. On the other hand, I might respond to a water gun with a real one. "Obvious" logic does not apply in war zones, due to, minimally, local attitudes versus foreigners thinking the "locals" think the same way they do. My easiest example of that is, the holding up of a hand in the "Talk to the hand" position. In American and UK thinking, this means stop or halt. It has no such meaning in Iraq or Afghanistan, where a different hand positioning and motion means stop or halt. If I heard correctly, the US/UK "Stop/Halt" gesture is simply a kind of "hello" wave. Here in New York City, we have had kids who used a super-soaker to squirt passing cars assaulted by the drivers. It is presumed they all speak the same language, so, again, logic might not apply.

If the bridges under the control of the Metropolitan Transportation Authority- Bridges and Tunnels, and/or the bridges under the control of the Port Authority of New York and New Jersey were to close when wind gusts went over 40 MPH, it would effect the entire upper East Coast/Atlantic Seaboard. They only post signs reducing the speed limit. If the bridges are double deckers, they'd close the lower levels, due to either a wind tunnel or venturi effect between the lower and upper roadways. As a matter for discussion, the only 2 times, other than for roadway repair, that I recall any MTA-B&T bridges being closed, was not weather, but the September 11, 2001 Attack on America, at the World Trade Center, and then again because of the crash of American Airlines Flight 587 in my home community of Belle Harbor, NY, on November 12, 2001.

I am unsure on this, but I think I read the "Reader's Digest" version of that professor's book. On the scene of one incident, he tried reason, and, due to a perceived attitude from the suspect, nearly hit the "alleged perpetrator", before he regained his composure. Only thing I remember from the condensation, other than it's being out there, somewhere.

Then we agree that one per DECADE is still one too many? As stated, I'll wait for the NTSB report, and hope that whatever lessons from the investigation are learned, that it will prevent another similar one in the future, if at all avoidable.

Unfortunately, there are going to be fools who think themselves better than someone else because they are are, or are in (choose any, in any combination): () Paid Fire fighter () Volunteer Fire fighter () Paid EMS provider () Volunteer EMS provider () Hospital based () Fire Department based () Law Enforcement based () Community based () Industrial based () Are in from "Smallville" () Are in from "Metropolis" () Are too emotionally involved with the case to remember they are talking to trained individuals () Are too drunk to realize they are talking to trained individuals () Are always playing some personal game of "one-upsmanship" to the point of not realizing just how insulting or threatening they appear to others. () Are so full of themselves that they cannot comprehend that anyone else on the planet is just as well trained, or even better trained, to handle the situation.

As most here are aware, I'm in the FDNY EMS, in a city of 8,000,000 residents, with another 2,000,000 transients per each 24 hour period. Our 9-1-1 system logs one point three million responses for EMS per year. In a recent class lecture, the instructor, from the department's Safety Battalion, reminded us that, just in the FDNY EMS, we have at least one ambulance involved in some kind of Motor Vehicle Accident per day. We have to slow down on the roads, people. Better folks than me have advised all of us that you can not help anyone, if you don't get to the scene. It is, after all, and hard hearted as it sounds, the PATIENT'S emergency, not yours. I have noted that an ambulance accident takes your ambulance out of service, takes the ambulance responding to help you out of service, and the ambulance that will be needed to respond to your original call, not to mention the units that, unbidden, despite the dispatchers telling them not to, are going to roll in on you. That is a minimum of 3 ambulances. A different instructor also indicated the emotional toll on other ambulance crews, monitoring the accident on the radio, and feeling helpless that they are too far away to help, as well as worrying about their colleagues, known to them or not. This distracts the other crews from THEIR driving, widening the possibility of other ambulances getting into incidents. No matter how good you are in driving the ambulance, when not doing patient care in the back, you could make an error, or another driver makes the error, and folks are going to get hurt, or worse, DEAD. Remember, to the other guy, YOU are the "other guy." Out of respect, I'll still go, but I hate funerals. I suspect most of us do, too.

I will join in the mourning of our fallen comrades, and hold off on finger pointing of blame until after I hear the results of the NTSB. There will be a time for that, later on.

The FDNY EMS, and before that, the NYC HHC (Health and Hospitals Corporation) EMS, have one simple thing in mind, as alluded to by FormerEMSLT297. They want crew butts in the ambulance crew seats, and the ambulances to become available ASAP to handle more and more calls. (On a personal note, FormerEMSLT297 used to be one of my partners at the old NYC HHC EMS Communications Bureau, now known as FDNY EMS EMD, and then my lieutenant at FDNY EMS Station 47. Took me a while to figure that out.)

OK, no section Three, but, again, this is what is expected for within the State of New York. The requirements, if any, in different locations and jurisdictions, may either be more lenient, or more stringent. Hope this information helps, even if it is only used for a "table-top drill".

Section Two... 18.3 Permit required to hold or promote a public function (a) No person shall hold or promote, by advertising or otherwise, a public function unless a permit has been issued for said function by the permit-issuing official. ( Application for a permit to promote or hold a public function shall be made to the permit-issuing official, on a form and in a manner prescribed by the State Commissioner of Health, by the owner/lessor of the land or facility, and the person who will promote or hold the public function. Application for a permit to promote or hold a public function shall be made at least five days before the first day of advertising and at least 30 days before the first day of the event. The application shall be accompanied by an emergency medical services operational plan complying with the requirements of this Part and any supplemental plans, reports and specifications as the permit-issuing official shall require because of concerns raised by specific circumstances pertaining to the event. In addition, the applicant shall attach to its application a copy of the crowd control plan filed or required to be filed by it with the New York State Emergency Management Office pursuant to chapter 288 of the laws of 1988. © A permit shall be valid for the time period specified thereon. (d) A permit may be revoked by the permit-issuing official or the State Commissioner of Health for failure to comply with the terms of the permit. (e) A permit issued for the operation of a public function shall be posted in the emergency health care unit or function office and be made available on request. (f) Notwithstanding anything to the contrary contained in the foregoing subdivisions of this section, a permit shall not be required under this Part for an event which also constitutes a mass gathering subject to the permit requirements of Part 7 of this Chapter; provided, however, that all of the other requirements of this Part shall be applicable thereto. 18.4 Emergency Health Care Requirements (a) (1) For 5,000 to 15,000 attendees, there shall be one emergency health care facility onsite staffed by a minimum of two emergency medical technicians, one ambulance onsite staffed by at least one emergency medical technician, and the services of a physician available to the site within 15 minutes. Documentation shall be provided showing that local, municipal and public safety officials, including police, fire and local emergency medical services personnel have been advised of the event in writing. (2) For 15,001 to 30,000 attendees, there shall be two emergency health care facilities onsite, each staffed by two emergency medical technicians, one ambulance onsite, staffed by at least one emergency medical technician and the services of a physician available to the site within 15 minutes. Documentation shall be provided showing that local, municipal and public safety officials, including police, fire and local emergency medical services personnel have been advised of the event in writing. (3) For 30,001 to 50,000 attendees, there shall be two emergency health care facilities onsite, each staffed by two emergency medical technicians, two ambulances onsite, each staffed by at least one emergency medical technician, and a physician onsite. Documentation shall be provided showing that local, municipal and public safety officials, including police, fire and local emergency medical services personnel have been advised of the event in writing. (4) For over 50,000 attendees, there shall be two emergency health care facilities onsite, each staffed by two emergency medical technicians, three ambulances onsite, each staffed by at least one emergency medical technician, a physician onsite and a written statement shall be available describing the impact the event will have on public safety and emergency medical services in the area, which must include comments by local police, fire, emergency medical services personnel and other public safety officials who have jurisdiction to provide services. ( Any modifications of staffing or the method of providing emergency health care facilities or the onsite ambulance requirement of paragraph (1) of subdivision (a) of this section is subject to approval of the permit-issuing official. © Additional emergency medical services, ambulance service, equipment, supplies and personnel, as the permit-issuing official may require because of special circumstances, including but not limited to the location and nature of the event, accessibility to existing emergency medical services systems, access and weather conditions shall be made available. (d) A chronological log and individual record for each patient receiving emergency medical care shall be maintained on a form prescribed by the permit-issuing official. A copy of each report and the log are to be maintained on file by the function sponsor for seven years and available to the department upon request. (e) Advanced life support (ALS) services may be substituted for the physician on call or site if the ALS is at the 3 or 4 level as described in section 800.45(d) of this Title and with the approval of the permit-issuing official. (f) The permit holder shall file any report, following the event, as may be required by the permit-issuing official. 18.5 Miscellaneous requirements Bleachers or similar structures at a public function must be safe. If the public function is also a place of public assembly or other place or activity subject to regulation by the New York State Department of Labor, then the permit-issuing official may seek information from that agency to aid evaluation of the safety of such structures. 18.6 Unexpected Attendance In the event that actual attendance at a public function shall exceed the estimate used for determining the required equipment, supplies and personnel by more than 20 percent, it shall be the responsibility of the permit holder to provide immediately the additional sanitary facilities, medical equipment, supplies and personnel required. Revised: May 2005

Here we go... I am going to post this in several sections, due to the size. Section One Chapter I of Title 10 (HEALTH) of the Official Compilation of Codes, Rules and Regulations New York State Sanitary Code PART - 18 PUBLIC FUNCTIONS WITH ATTENDANCE OF OVER 5,000 PEOPLE Last amended July, 1991 Statutory Authority: Public Health Law Section 225 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Emergency Medical Services 433 River Street, Suite 303, Troy, NY 12180 518-402-0996 Printed - (9/97) Sections 18.1 Definitions 18.2 Equipment requirements for an emergency health care facility 18.3 Permit required to hold or promote a public function 18.4 Emergency Health Care Requirements 18.5 Miscellaneous Requirements 18.1 Definitions As used in this Part, the following words and terms shall have the following meanings: (a) Public function means any scheduled or advertised event open to the public and likely to attract 5,000 or more people at any one time, except that the term shall not apply to any single day of a planned multi-day series of events at which 5,000 or more people are not likely to attend. ( Emergency health care facility means a sheltered area or building either naturally or artificially so lighted as will promote the health and safety of patients provided emergency medical care, and containing cot(s) and/or litter(s) and emergency medical equipment and supplies as required by section 18.2 of this Part. © Emergency Medical Technician means an individual who has been certified as such by the department pursuant to sections 800.6 or 800.8 of this Title. (d) Permit-issuing official means the State Commissioner of Health or the commissioner's designee. (e) Person means an individual, group of individuals, partnership, firm, corporation, association, political subdivision, government agency, municipality, industry , estate or any other legal entity. (f) Ambulance means a motor vehicle especially designed, equipped and staffed pursuant to sections 800.21, 800.22, 800.23 and 800.24 of this Title to provide emergency medical services during transit. 18.2 Equipment requirements for an emergency health care facility Any emergency health care facility at a public function must contain at minimum the following equipment: (a) Patient transfer equipment: (1) A device equipped with two two-inch-wide web straps to secure a patient which will enable emergency medical service personnel to move the patient from the incident site to the emergency health care facility. (2) In an auditorium, stadium or similar physical setting with seats in steep tiers, a stair chair-type stretcher. ( Airway, ventilation, oxygen and suction equipment: (1) Manually operated, self-refilling bag-valve-mask ventilation device with a high concentration oxygen enrichment or portable manually triggered oxygen-powered resuscitation device, either of which shall include adult and pediatric-size face masks. (2) Oropharyngeal airways, in adult, pediatric and infant sizes. (3) Two commercially prepared bite sticks. (4) A portable oxygen system with one medical "D" size cylinder including a regulator consisting of a yoke, pressure gauge, flow meter and a spare cylinder. (5) Four disposable oxygen masks and four nasal cannulae. (6) A portable suction device capable of providing an adjustable flow of over 30 liters/minute at the end of the delivery tube and a vacuum of over 300mm mercury when the tube is clamped, including wide bore tubing, a plastic, rigid pharyngeal suction tip and various size flexible suction catheters. (7) One pocket face mask with oxygen inlet. (8) Miscellaneous items for oral use which shall be kept clean and be individually wrapped. © Immobilization equipment: (1) One full-size backboard (72 inches long) with a minimum of two-inch by nine-foot web straps for securing the patient to the device. (2) One padded board splint, 54 inches by 3 inches by 3/8 inch thick with a minimum of one-half inch foam padding on one side covered with a nonporous material. (3) Two padded boards, 36 inches by 3 inches by 3/8 inch thick (cardboard, other malleable or inflatable splints are acceptable substitutes) with a minimum of one-half inch foam padding on one side covered with a nonporous material. (4) Two padded boards, 15 inches by 3 inches by 3/8 inch thick (padded wire, cardboard or inflatable splints are acceptable substitutes) with a minimum of one-half inch foam padding on one side covered with a nonporous material. (5) A head immobilization device (commercially manufactured device), blanket collar, two five-pound sandbags or other device providing equivalent immobilization of the head. (6) One large, one medium and one small extrication collar. (d) Wound dressings: (1) Twenty-four sterile gauze pads, four inches by four inches. (2) Three rolls adhesive tape in assorted sizes. (3) Six rolls conforming gauze bandages in assorted sizes, but including three-inch. (4) Two universal dressings approximately 10 inches by 30 inches. (5) Ten large sterile dressings, five inches by eight inches minimum. (6) One pair bandage shears. (7) Six triangular bandages. (8) Two liquid glucose or equivalent. (9) Sterile normal saline in plastic containers (1,000 cc minimum). (10) Two occlusive dressings. (11) Two sterile burn sheets. (e) Miscellaneous equipment: (1) Spare pillow, four sheets, two pillow cases, one blanket, in addition to linen and pillow on cot(s) or litter(s). (2) Six cloth hand towels. (3) One box facial tissues. (4) Two emesis containers. (5) Portable blood pressure cuff and stethoscope. (6) One male urinal and one bedpan. (7) Potable water, minimum five gallons. (8) Sterile O.B. kit. (9) Carrying case with compartments for essential emergency care equipment (jump kit). (10) One flashlight in operable condition. (11) One battery lantern in operable condition. (12) Communication equipment--two-way radio or telephone between the emergency health care facility and an outside medical facility(s). (13) Six chemical ice packs. (f) Other miscellaneous requirements: (1) an ambulance used to meet the requirements of an emergency health care facility must be certified and equipped pursuant to sections 800.21, 800.22, 800.23 and 800.24 of this Title and must remain onsite at all times during the event except when transporting patients; (2) an emergency health care facility shall place a placard or sign of such size and design at such location as will assure notice to the public of the emergency health care facility's identity as such; and (3) an emergency health care facility shall be maintained at such temperature as will not endanger its ability to care for or will not further compromise the condition of either hypothermic or hyperthermic patients requiring emergency care.

Seeing this, it's time to head to the bomb shelters!

I have sent an e-mail to the NYS DoH, reproduced following. As indicated, my local laws might not be the same as yours, but it most likely will provide "food for thought" as to what questions should be asked in the jurisdiction of the event.

Following the first Woodstock concert, while I am hazy on specifics, laws were enacted in New York State, that at least one ambulance for every specific number of expected attendees at an event, some kind of "game plan" for: treatment on the event scene, transport from said event scene, and local hospitals being aware before the event that they are becoming primary hospitals for the event, that they can activate their own internal plans to treat a potential overload from the event in addition to whatever their usual patient intake would be. The pre-planning for an event can, and should, include the actual event planners, heads of EMS, LEO, FD, and ER departments, food venders, port-o-potty companies, and any agency that might need to have an involvement. You might have to import help from outside the local area. I used to know someone who could assist, professionally, in such planning.

News Headline: Picture accompanying showed the 4th of July Hot Dog eating contest winner at Nathan's Hot Dogs at Coney Island, in the process of biting a "dog"!

I found a sail on sale. However, those who are landlubbers like me, don't know that a sail is a sheet. So now, I have a spinnaker on my bed, and a contour on my boat's mast. LOL.