Richard B the EMT

Dispatch: 101, where are you? 101: Peninsula Boulevard at Mill Road. Dispatch: 102, where are YOU? 102: Tailgating 101 Dispatch: OK, 102, you're closer and have the call back in Far Rockaway. (Both were returning from the Far Rockaways area, returning home to the base in Freeport. I was driving 101 at the time!)

Just a reminder: Until all the eligable doctors were being drafted during WW2, Interns used to get experience by being assigned to ride the ambulances. Not as a ride along with either EMTs or Paramedics, but as the actual ambulance CREWS. They were teamed with Motor Vehicle Operators, actual AMBULANCE DRIVERS, or, from a few years prior to that, a "teamster" driving the horse drawn ambulance. (I saw a picture of a horse drawn ambulance driver holding the reins from his ambulance, back in the 1920s, just before the man retired as the head of that Manhattan-based hospital's Ambulatory Care Unit, in 1980.)

I had mentioned that, in the "Do You Take Vitals" string, that I got into trouble because the extended medical facility RN complained that I was taking vital signs, which seemed to them to be an affront to their "authority". As far as I am concerned, if I am turning a patient over to anyone, from my agency, from another agency, a flight crew, paramedics, flight nurse, or the occasional in-the-flesh Flight Surgeon, if they don't do even a quick re-evaluation, something is wrong. Figure it this way, even if it is only a moment apart: "This was the vital signs of the patient in the immediate past, from the other crew. From when I took over responsibility for this patient, has anything changed, for good or bad?" We all know, or should know, a patient's condition can change in a very short time period, so, even when you are still unwrapping a BP Cuff from the patient, and start presenting to whoever assumes the responsibility for that patient, they will be starting their care as they relieve you. It should NEVER be "This patient is mine until you close the doors between us and yourselves in your conveyance for the patient to the ED". (PS: When a Certified First Responder-Defibrillation Engine company has made it to my scenes prior to my arrival, I make a point of telling them "I am going to take my own set of vitals, compare it to yours, and see if anything has changed from when you took them. Thanks for the baseline set of vitals.")

The wallet chain is not optional, it is included.

Damn! I thought I filed the patent for that a few years ago!

Someone posted not to drive faster than you want to wreck? Think about the wall poster, with religious overtones:

Ambulance equipment and supplies left behind by an endangered crew bailing out...$31,000 Being alive and able to worry about it later on...Priceless!!!

From 1973, when it was founded, to when it folded (due to lack of money and members- the infamous M&Ms) in 1996, the guy who founded my Peninsula Volunteer Ambulance Corps never elevated his medical training beyond that needed by corps requirements, that of American Red Cross Advanced First Aid, and ARC or equivalent CPR. He dispatched, which didn't require any first aid training, and he drove, which did require that minimum, by the SOP we had in effect back then.

Well, sometimes it can be a good thing to have the right "nasty Triage Nurse", so when they get routed to the waiting area instead of being immediately seen for the paper cut that they are dying from, your ambulance crew doesn't get blamed. You did your job, even if it was a truly non emergent call.

If there were 2 others, I hope you went as a group, not as separate individuals.

Let's go ALL THE WAY... [marq=left:6b8af06978]NUKE THE WHALES!!![/marq:6b8af06978]

The line being used some years ago by my agency was, "the city Sanitation department picked up garbage that usually was lying quietly at the curbside, lift it into the truck and take it away. WE haul it down from upstairs, to the curbside, usually with the garbage protesting each step of the way, lift it into the truck, and take it away. And they get paid more than us!" Disclaimer: I don't talk like that, I am quoting others. PS: a 5 year longevity Paramedic is still getting paid less than a new-jack city Sanitation person.

PS: I use "Run,"'Job",' and "assignment" interchangeably.

I have been on a few "Leap-Frog" transports, usually going to the trauma center, which is outside my usual coverage area. Concept is good, but has the problem of some civilian vehicle, as already described, thinking the Cop Car blockade of the intersection doesn't apply to them. No matter what roadway, or what coverage by the LEOs, best everyone in our biz follow NYS Vehicle and Traffic Law #1104, which states that you drive the emergency vehicle "With Due Regard for other drivers"

Oh, then the 5th edition is the newest one ("duh!" at me), with newer information than the previous editions. Check the publication dates, newest is best, as your instructors probably are aware.

Side note: If you watch the movie, "Mother, Jugs and Speed", the "Jugs" character is seen reading a copy of the first edition of the Orange Book, just before she tells the company she is now an EMT.

Are the books by different authors or agencies? In 1973/1974, when I was taking my first training as an EMT, we had "Emergency Care" from Brady, known as the "Yellow Book", and "Emergency Care and Transportation of the Sick and Injured", from the AAOS, known as the "Orange Book". The Yellow Book was almost a comic book, as I recall, and the Orange Book was, at least to me, written as a post-graduate College textbook. However, both gave me the information the instructors wanted me to have. Nowadays, I am aware, without remembering who the authors, agencies, or publishers are, of a "Black Book," and a "Blue Book", which, over these 34 years, I have also used at various refreshers. The information in any of these books, as used at my refresher classes, must have helped me pass my state tests, as I am still an EMT. So, figure it like this: "Essentials of Paramedic Care" and "Paramedic Care: Principles and Practice", are probably written by different authors, and are in competition with each other, as well as Dr. Caroline's Paramedic training text (sorry, I forget the exact name of her book), a text used by numerous Paramedics working in my area. Whatever text your instructors have you use, these instructors feel the training from which ever book the class is assigned to read, is the best one, which can change as the next editions of each get published, as your local protocols change, following new medical developments.

Not knowing the specifics of the geopolitical areas being discussed, I feel I must mention something. In their respective areas, a number of full time and part time/volunteer fire departments,on their own initiatives, took on the responsibilities of providing EMS, at either BLS, ALS, or both levels, to the service district's residents, and to cover their own personnel at fire scenes. They seem to be good, at least what I have observed in my 34 years in this crazy biz. Also, in their respective areas, a number of full time and part time/volunteer fire departments were requested, or ordered, by the politicians, to take on the responsibilities of providing EMS, also at BLS, ALS, or both, to the service district's residents, and to cover their own personnel at fire scenes. Some blended successfully, others, successfully but with rough spots. In others, there is almost a battle of the badges between the Fire Fighters and the EMS crews. Some agencies are cross-trained, others have fire fighting and EMS as separate "specialities". As you have heard me mentioning ad infinitum, and ad nauseum, in 1995, Rudy Giuliani, then the newly elected mayor of New York City, pushed and got passed, legislation to move EMS away from management of the NYC Health and Hospitals Corporation, and place it under the management of the FDNY. This happened at Midnight, into Sunday, March 17, 1996. Numerous long timers from both sides took exception to this. However, as more and more long timers retire, and as more personnel are hired, it is becoming the norm for FDNY to be the primary 9-1-1 EMS provider in NYC. Yes, there is still some friction, but we (in the FDNY) seem to be getting it all together.

Someone posted that patient care is secondary to your own health and safety. A former partner of mine posited: "Look out for your self, your partner, your vehicle, and then the patient, in that order, and everything will be all right." Good idea, but she also posited, and, over 22 years later, I don't know if she was joking or not: "Sleeping is a Commie Pinko plot!"

3? Don't walk away, RUN!

I am told that ALL US Military Academies have a policy, equating cheating as reason to throw someone out. They also have a policy, knowledge of cheating but not reporting it, that would also get a student thrown out. However, what I just read, of enforcing a "No Cell Phone In Class" rule, seems to be an easy way out of the situation.

Don't see it happening here anytime soon. We had a case where an FDNY EMS crew gave a patient and his family a choice between hospitals equally qualified, and at similar distance, from where they encountered the patient. They chose the one hospital, because there was a McDonalds Hamburger across the street, so they could eat while the patient was being seen. As the other hospital was about to put the first private service ambulance,under contract to them (the hospital) into the 9-1-1 system, and the FDNY EMS union was protesting this, the FDNY brought charges against the crew for "Patient Steering," claiming transporting the patient to the hospital that actually received the patient was an "obvious protest". The 2 EMTs had no seniority, and were initially fired without a departmental trial. Go after the system abusers? No, go after the crews trying to do both the right thing, by rulebook and following patient and family request. (Someone know if these 2 guys got reinstated? I am lacking that answer. )

Hmm, you just reminded me of a call... At the conclusion of a barricaded person call, even though there was already both an ALS and BLS unit on the scene, as well as the local "Conditions Boss" (Lieutenant), and numerous members of the NYPD, my unit was called in to transport a pregnant woman to an out of area hospital, a part of why she had un-barricaded herself. The incident had apparently started with an argument with the boyfriend, who had overheard one of my on scene FDNY EMS colleagues request the NYPD respond, via radio, and had gotten verbally abusive. Nobody deemed it nessesary to brief me about that aspect of the call. With the woman on my streacher, my partner in the back, and me acting as the wheelman, pre-approved for the out of area transport by our OLMC, we were transporting without incident, with the boyfriend following in his POV. On arrival, my partner advised me, during the half hour ride, that the boyfriend had called from his car, to the patient's cell phone, and asked to speak to my partner. The main item of what he spoke to my partner about, was, why the expletive deleted are you talking to my girlfriend? Answer: I am doing my job, gotta hang up now to do it. Partner's retelling hinted at potential violence towards him, patient, and me, not nessesarily in that order, threatened by the boyfriend. Had he told me of the call during the ride, as the destination hospital was in Nassau County, I would have requested either NYPD or Nassau County PD do a mid route meet-up to stop the boyfriend's car. My partner stayed with the patient as I went to advise the hospital security to keep an eye on the guy, and why. The ED nursing staff, recognizing trouble, directed the boyfriend to the waiting area; as she was being moved to a "patient and staff only" area, he couldn't come with her. True or not, he went to the waiting area. Wish I could have found out what the conclusion was on that call.

No offense, but, gee, why not? (LOL)

Sounds kind of like the Wicked Witch of the West is looking for Dorothy again, Aunty Em!