Richard B the EMT

On that, I worked 2 different companies where you got paid by the call between 1600 and 0700 hours. Both paid $5.00 per call (this was late 1970s to mid 1980s). One company had "guaranteed 3 calls", so if you did none, one, two, or break even three responses, you knew you were going to get a minimum $15.00 per night. Some of us hustled a bit, and did 15 transports in an overnight, earning $75.00 for the tour, in what is probably illegal today, transporting multiple, unrelated patients from one facility's ED to bed admission at a different building a few miles away, but run by the same hospital. Some calls, if passing certain arbitrary boundary lines set up by the company in advance, that call paid as a double, or even a triple call, say, a Brooklyn VA Hospital (Brooklyn, NY) IFT to the Roosevelt VA facility (in Ossening, NY) paid $15.00 as one call. They did require us to stay at various "bunking facilities they paid for, or remain on the radio, as they didn't use pagers. The other company felt that you were burning their fuel, and only paid if and when you did a response, as otherwise, you were getting a free ride home at night, and a free ride back to the office in the morning. We were "on the leash", wearing pagers. I think both these companies are currently elements of the MetroScare Ambulance Service now.

Did I leave out Drs. McCoy, Crusher, Bashir, and Zimmerman? Oops, guess I did. Sorry.

Oh, then I'm notifying Dr. R. (for Abraham?) Quincy, of the Los Angeles Medical Examiners Office

Should we be notifying Lt. Horatio Caine (Miami-Dade PD), or Dr. Gil Grissom (North Las Vegas PD)?

Duplicate send, please disregard.

Well, it IS April Fool's Day...

You posted musical communications with a different society? Try this musical communications on for size! http://www.youtube.com/watch?v=2DN5i8AMnzI&NR=1 (Sorry, haven't yet figured out how to imbed a video directly, yet.)

If nobody already mentioned this, I'll bring it up now... With multiple levels of EMT and/or Paramedic practices between states being recognized, or being denied, don't forget that some levels are not even recognized by the next county over in the same state! Example: Nassau County, NY, has EMT-I. The 5 counties of New York City, NY, doesn't recognize that level of training. Charles Dickens had it so right:

I consider myself a decent EMT, but, without the proper training of a paramedic, to assume paramedic duties, Inspector "Dirty" Harry Callahan, of the San Francisco Police Department said it best

Back in the mid 1960s, MAD Magazine sometimes included records for their readers. They actually said on them if they stuck to the spindle, to use a .45 shot thru the hole. MY copy of "They're Coming To Take Me Away" NEVER stuck to the spindle.

For the most part, everyone has been behaving, even with this being an ALS level session, and my request for further information for myself at the BLS level, earlier on. As I have commented in other strings, and now here: Tell someone they are wrong, and then explain how and/or why they are wrong, but don't tell someone they are wrong, and say it's because they're stupid. THAT is counterproductive! Remember that the beatings will continue until morale improves!

What a time to run out of sugar! (from "Fantastic Voyage")

katbemeEMT-B wins a free blood pressure check! Correct on both counts. (I thought I was the only one remembered the "writings" of Victor Appleton the third, the committee designated name of authorship, the Tom Swift Jr children's SciFi series of books. Let's go back to the moon using the ol' Repellatron!)

As per your avitar, we never would have guessed! LOL

Looking for opinions to be expressed on the following: Every time there is a mass evacuation, or large scale disaster, here comes the big names of the electronic media to report on it, and then the President takes a foot tour of the area. Do you feel the possibly limited resources of the area need all the networks converging on them, depleting them more? Can they not cooperate and go with a "Pool Camera" and reporter? Do we really need a reporter from channels 2, 4, 5, 7, 9, and 11 on the scene (and that's just the New York City area stations, don't forget the reporters from Chicagoland, Detroit, Los Angeles, Cleveland, Washington DC, Podunk, and East Cupcake)? Then the President shows up. Due to security concerns, the Secret Service understandably stops everything, so the President (it does not matter which one, they all seem to have done it, and whoever comes in probably will too) can do the quick handshake tour, look concerned, and announce all the money FEMA will be authorized to spend to help the affected people in the disaster area. Can't the President do his looking from Air Force One, and look concerned, and announce all the money FEMA will be authorized to spend to help the affected people in the disaster area, from an airport a distance away? Of course, if the president is there, so is the governor, the state legislators, the town council, the Mayor, the chiefs of Police and Fire...Wait a minute, if they're all there, who the heck is minding the store?

Just as a reference towards sleeping disorders, here's a site for Sleep Apnea patients. Be advised that I am one, and am using a CPAP for ongoing treatment American Sleep Apnea Association

No, you speak often, the Pink Panther only spoke in one of the older cartoons, in Rex Harrison's voice, and if memory serves me correctly, he said, "Why can't the English learn to speak", from "My Fair Lady" (or something from his role in the first, musical version of "Dr. Doolittle").

Perhaps they have links at your state or provence department of health web site?

Does anyone else remember the picture of a restaurant serving frogs legs, where there are about 12 frogs in really tiny wheelchairs rolling around the floor? Sick? Yeah, but that's probably why I remember it. Stuck in my mind. Oh, as for the dead frog legs kicking when an electrical charge is applied? Check out your patient in LEO custody, when they use either a stun gun or TASER on them. Same generic type jumping and flailing around. Or, notice when a patient is defibbed, they almost always seem to arch their backs? Extra credit question: What does "TASER" REALLY stand for?

Most here know I live beachfront by the Atlantic Ocean. My girlfriend's mom is in an extended care pavilion of a local hospital, and if we have to do a coastal evacuation due to an inbound hurricane, I know which facility inland she's going to. As for me, if I'm not stuck at work, my mom and I have to relocate to the Aqueduct Racetrack. The Racetrack? Yes. That is where we are supposed to meet the busses that will transport mom and me to a "host" area. Considering the population, thats the 2 of us, and a couple hundred thousand of our closest friends. Me, personally? I'm thinking the Superdome during Katrina, except with "Noo Yawk" accents, instead of "southern/Cajun". My friends at the New York City Mayor's Office of Emergency Management at least advise me that I am in a "Level 3" area. 1 and 2 go first, as they are lower to sea level. As for those who should evacuate, but don't because "We've never run from a storm," can I have a contact number for your next of kin? Those who feel that, when the OEM orders them to leave their pets, "if it's safe for the pets, it's safe for me", same deal. It'll hurt, but you can get a new pet, but where am I going to get another YOU?

Uh, no, I don't believe it was the Breakfast Club.

Wait one! Which rendition of the Pink Panther cartoons? Your description sounds more like the cartoon "Inspector Clewso" (spelling?) who was always trying to stop the panther, or are you referring to the Panther series where PP spoke? From THAT same studio, leave us not forget the Jackie Mason voiced Anteater and the Dean Martin sounding Ant he was always after.

When former Presidential candidate Rudy G was first elected to the office of Mayor of New York, but had not yet been sworn in, he interfered with 2 Paramedic ambulance crews, and a Paramedic Lieutenant. A boy living in Rudy's building had been hit by a car in front of the location. The patient's mom wanted the patient taken to the hospital where the boy's dad was a surgeon, at a facility that was not a trauma center. Please note that, even though both ambulances were not NYC EMS ambulances, and neither one was based at the nearest trauma center, all 4 Paramedics wanted to take the boy to the trauma center, and finally convinced her to go to the trauma center. Then, Rudy G walks out of the building and orders (!) the crews to take the patient to his dad's hospital. The crews requested the supervisor, and the EMS Lieutenant was there quickly (probably because the Computer Assisted Dispatch system had a premise history that it was the Mayor-Elects home). Both Paramedic crews were from "voluntary" hospitals, which were both closer than the trauma center, and the dad's hospital was further away than the trauma center. Are you going to have the LEOs on the scene arrest the guy, who is going to be their "boss" in a couple of weeks, for interfering with authorized emergency crews in the performance of their job? Didn't think so. Unfortunately, due to the delay in moving the patient, at the mayor-elects interference, the press corps played up the time delayed, lied that the boy remained on the street for the entire time, and quoted the mayor as calling the lieutenant all sorts of nasty names. While not a personal friend, I knew this lieutenant from before the incident, and consider him, both professionally and personally, to be a right good guy in all respects.

I just called the section of the FDNY EMS/EMD that handles diversions, and before I continue, will mention 3 things, the first is, per the "diversion desk", what I am about to relate is in review, and might not be policy as early as tomorrow, the second is, this is per FDNY EMS/EMD policy, in conjunction with the State of New York policies, and might not be transferable to other jurisdictions, counties, states, provinces, or countries. The third is, the wording is my loose wording interpretations of policy for diversions When a duly authorized hospital Officer of the Day feels that they need their ED temporarily closed, the ED must meet the following criteria, either singly, or in combinations. There must be more patients waiting for admission than available beds in the hospital. There must be more patients needing telemetry/monitoring than there are monitoring beds available. There must be more patients waiting to be seen in the ED than the ED can, at that hour, reasonably handle. At the discretion of either or both the EMD Tour Commander, or a Chief of EMS, a diversion for "Total" or "Critical Adult" will be authorized, for a period of 4 hours. After 4 hours, they can call back and make a fresh request. All diversions are canceled at the tour changes of Midnight, Eight AM, and Four PM. If there is any question, an area "Conditions Car", usually a lieutenant at the nearest EMS station, will be sent to check out the situation, and report back to the EMD Tour Commander. If several hospitals in a specified geographic area, referred to as a "pod", request a specific category diversion, the diversions will be accepted, but only up to a point. If and when that point is reached, all hospitals in the pod are reopened to the category, for what is called "Catchment". This means the field crews can, and will, bring patients in the category to the nearest hospital, despite the previous diversion request. Also, the "Conditions Car" will make periodic checks on the status of all the hospitals in the pod, even those not requesting diversions, and keep the Tour Commander updated. All hospitals understand that a request for diversion is considered as a courtesy, and is not ironclad. Field crews understand that diversions don't hold if the patient they are treating is "in extremis", they will go to the nearest hospital anyway. The categories are, but not limited to, "Total", "Adult Critical", "Pediatric Critical", "OB-Labor", Pediatric EDP", "Adult EDP", and "Trauma". This might not be complete, but it is some food for discussion. Now, my history lesson. In the early 1980s, a crew from Brooklyn's Midwood Ambulance Service brought a patient to the Kings Highway Hospital. Back then, you backed down a narrow driveway, rang a phone by the door to get them to buzz you in, and then, with the strecher halfway in the door, rang for the elevator to take you to the first floor, and either the ED, or be met by an admissions officer to tell you where the patient was going. Kings Highway had earned a bad reputation, as, when a patient arrived at their doors, someone, usually a "Pops" type security officer, would advise the patient, or the ambulance crew, that the hospital was "closed". When the Midwood crew got to the ED, that is just what happened. After advising the dispatcher of the situation, it was decided to move the patient, against the family's wishes (they wanted, and had paid for, transport to Kings Highway) to the Kings County Hospital. Highway was a "private" hospital, County was, and is, a municipal hospital run by the New York City Health and Hospitals Corporation. During the transport, the patient went south, and CPR was started while enroute to KCH. There was no good news, as the patient was pronounced shortly after arrival at the KCH ED. Lawsuits abounded, but at least the Midwood crew was absolved of any blame (good for them, I had worked with both of them when I had worked at Midwood, and they were both good, caring EMTs). The family was also, apparently, well connected politically. Then-State Senator Stavisky wrote a state law, requiring any patient presenting themselves, or being presented, for care at an ED, had to be checked by the original hospital's ED, to determine if the patient was stable enough to go to some other facility. A copy of such documentation would be included in the receiving hospital's chart on the patient, and attached to the ambulance call report. Even this got abused, as seemingly anyone connected with a hospital would call up the local Ambulance Services, and tell them "We're on diversion". The way that the City EMS, then still under HHC itself, responded to this, was, a list, updated monthly, was to be submitted to the EMS EMD, indicating which persons were authorized to request category diversions, and most of what I described above came into play. Also, putting teeth into the rules, anyone basically "standing in the doorway, denying anyone requesting medical help from getting that help (again, my wording) could, and would, be personally fined upwards of $1,000, and the hospital itself risk really being closed by the NY State DoH. One time I was running the Diversion Desk, I declined taking a request for diversion, as the caller clearly stated he was the security officer. I explained his name wasn't on the list of authorized persons to make such request. Would you believe he actually asked me what names were on the list? I was NOT born yesterday (perhaps the day before, but not yesterday), and told him the hospital administration had to make the call. The idiot actually called me back, not stating his name, but saying he was the on duty hospital administrator! "Sir, you WILL have the authorized administrator call me back, and IF that person's name is on my list, and if policy is followed, MAYBE the requested diversion will be authorized. If you call again, it will be considered as fraud, and you can be fined a minimum of $1,000!" I hung up, turned to find my lieutenant standing behind me, smiling! PS: The only 3 times I can recall when diversions were not accepted at all, on a citywide basis, were the 1993 truck-bombing of the World Trade Center ("What do you mean, no diversions? The WTC is in Manhattan, and we're Staten Island."), the 1995 Blizzard, and the September 11, 2001 Attack.

Addressing the sub-subject of communicating between the cab and the cabin: I have worked all 3 types of ambulance. Yelling is sometimes not a good method of communications, as, no matter of a walk-through with door, or just a transom window, sometimes, due to pain, the patient is screaming, and the tech driving closes the door or window, as not to be distracted from the driving by the patient's noise. Regrettably, I have both had it done to me, and done it to my partners. I think the manufacturers still have available, a 3 color light "silent intercom", a red, yellow, and green light that shows in the cab. Green is obvious: Go. Yellow, in some systems, is "go gently", one of those calls where you might not want to shake up the patient. Beware, though, when different system users work together. I needed to have the ambulance stop for a moment for a BP check, signaled with the red light, and then, the new to my system partner driving did a Mario Andretti imitation the rest of the way to the ED. I couldn't let go to take care of the patient, or I'd risk being bounced off the walls, even with the seat belts. After transfer of care to the ED crew, I had a conversation with my partner (with me holding him by the collar against the wall, the other hand cocked for a punch!), where I discovered that in his previous system, the red light meant the patient had gone sour, and to increase speed to the ED, instead of "Stop" as it meant in mine. Some manufacturers also have voice intercoms, but these have a habit of breaking down, or being broken by crews, within a month of delivery. It must be the same reason they close the door or transom windows. Me, I actually liked the voice intercoms, but not so my partners.