Richard B the EMT

OK, I am not a researcher. If a researcher wants to use data I normally generate from a response, fine and good. If my On Line Medical Control Physician tells me to use a different protocol for an AUTHORIZED test, I will follow the different protocol, noting on all appropriate paperwork that I am doing so, and why, along with whatever results I do or do not achieve. Cookie cutter? Perhaps. I am not in any position to go outside existing protocols without it biting me in the ass, but, as I have stated in other postings on this string, when the APPROVED ALTERNATE protocol is taught me, and I am advised to use it fulltime, let us say, I then have a new cookie cutter. Now, would someone advise me what is Godwin's Law?

OK, I am not a researcher. If a researcher wants to use data I normally generate from a response, fine and good. If my On Line Medical Control Physician tells me to use a different protocol for an AUTHORIZED test, I will follow the different protocol, noting on all appropriate paperwork that I am doing so, and why, along with whatever results I do or do not achieve. Cookie cutter? Perhaps. I am not in any position to go outside existing protocols without it biting me in the ass, but, as I have stated in other postings on this string, when the APPROVED ALTERNATE protocol is taught me, and I am advised to use it fulltime, let us say, I then have a new cookie cutter. Now, would someone advise me what is Godwin's Law?

What this poster said. I know of Chuckie, and Bruce, and Johanna (my girlfriend, who is a Brown Belt, Shogotan Karate). Who is McBain?

I think I am quoting Mark Twain: There's lies, damned lies, and statistics.

Oops, yet another item I neglected to mention: The CSLs are tied into the Computer Assisted Dispatch system (11 years working in the communications office, and I forgot that?).

When I said that the CSL postings were on computer recommendation, I neglected to mention that the computer is also presuming where the next call will be coming in from, in addition to figuring in area population, expected traffic conditions, ect. Even the IBM "Blue Max" can't predict when grandma is going to have her heart attack, so I think it is still "hit and miss". It does seem to work. As to my station, to use it as an example, the supervisor, a BLS truck, the Haz-Tec medic truck, another BLS truck, the regular medic truck, and my BLS truck all start at half hour intervals. We might not see each other for days, or all get stuck at the hospital's triage desk, or waiting for ED beds, which is when we see each other (except the supervisor, who makes sure each unit goes into service on time, so he or she will see each unit on their tour at the start). On a different matter: While my FDNY building is a station (Station 47), it is also a firehouse, with a ladder company, an engine company, and a fire battalion. If you live at the building, as firefighters do, it is a fire HOUSE, if you just change into and out of your uniform and restock as needed there, it is a STATION. This definition is supplied courtesy of several firefighters I have known over the years

Most of the units under the NYC 9-1-1 system sit at what we call a CSL, or Cross Street Location. Some computer program told the brass that to put these ambulances at these CSLs would improve response time, as the computer figures in area population, expected traffic delays, to the point that an 8 to 4 unit sits pointed east, a 4 to midnight pointed south, and 12 to 8 pointed north. We run the engines to power the a/c, and the radio/computer unit. Some people complain, but I was told, tell them you are "Staging"! (Tell them politely, of course)

As I type this, I am in EMT-B refresher class, so it is very much in my head. FDNY EMS uses the Iron Duck Extrication Appliance (IDEA). Looks like the KEDs, but the straps are removable for keeping the device clean from blood-borne pathogens: they get dirty, replace them. Cheaper than replacing the entire unit. Policy is as follows: 1) Manual Head stabilization 2) C-collar 3) Pulse/Motor/Sensory all extremities 4) IDEA put behind patient 5) Top, middle bottom color coded straps applied and tightened 6) Leg straps applied, crossing the groin with abdominal pads used as padding for the "family jewels" 7) Head flaps, head strap, chin strap 8) Pulse/Motor/Sensory all extremities I may have left some out. In the classroom, then verbalize that you would transfer the patient, in the IDEA, to a long spinal board, secure the patient to the board with appropriate straps, secure the head area using a head-bed device IN ADDITION TO THE IDEA, and reevaluate the patient while on the way to the hospital. Oh, and loosten the leg straps, so the patient could lie with their legs flat to the Long Spinal board. When we used to use the KEDs, we had 2 phrases re the belts, "My Baby Looks Hot Tonight," and "Marlon Brando Licks His Toes", for Middle, Bottom, Legs, Head, Top straps. I always joked that the phrases were My Baby Licks Her Toes, or Marlon Brando Looks Hot Tonight, which had me accused of having "issues" by some of the instructors, not realizing I was joking.

1) I only mentioned my mantra of following your local protocols as mine may be different than yours. My NY State and/or New York City protocols probably have differentiations with that of another BLS provider in Grand Forks North Dakota, Eugene Oregon, Edmonton Canada, Chichen Itza Mexico, Bonn Germany, and insert the city, state/provence, or country of your choice. 2) I am not a medical researcher. If my agency, the FDNY EMS, gets involved in a medical study, then I am involved, but won't be told results until my higher medical authorities advise me of a protocol change, which will then become my bible for treatment. 3) When I googled the word "redigadism", google had nothing for me. If this word is not from the English language, well, then I have no knowledge of it, but might take chances with someone else's language. Also, the spell check didn't have a clue when I checked this, prior to posting.

While anything I posted in this string was either or both anecdotal and memory lane, and nothing I could document as statistics, I was glad to assist, in whatever way my information could have been used.

Try to do what I do, intentionally!

I have also seen a few of my compatriots fired for "freelancing" outside the NYS DoH protocols, or the department's.

I think we might have more dredged up from the bottom sludge by others within the city. Scary, ain't it?

Just as a point of identification, I am using my authorized BLS protocols, as a BLS provider in a multi-level agency (CFR-D firefighters, BLS by EMT-Bs, and ALS by Paramedics).

It seems to me, collectively, we are not watering this one down.

I mentioned the Watkins case as example of how our field continues to evolve. Today, I start treating chest pain, cardiac or not, with the NRB @ 15 lpm. Who is to say, either direction, next week, I get told to deliver a different amount, or next month, use a different delivery system? You see my mantra re local protocols. I stand by them, as, admittedly, I treat patients. If research is being done, I will pass along my results, by either the current standards, or using whatever standards I was told to use in the test program. I, myself, am no researcher, but will follow whatever my higher medical authorities tell me to do, as I am confident all of you either do, or should do.

This was probably an unintended "oops", but Superior was and is a brand name of ambulance. I loved their caddy-lances.

Some years ago, there was this guy, Brian Watkins, came to New York City for the "Forest Hills Open Tennis Matches", from Utah. Travelling from the games, on the New York City subway train system, he fell victim to a stabbing during a mugging. He got a puncture wound to the chest. NYC (Health and Hospitals Corporation) EMS responded, and using the protocols then in place, the crews applied Medical Anti Shock Trousers to Mr. Watkins. The device worked just as it was supposed to do, keeping blood from going down to the abdomen and lower extremities, and keeping it in the upper body for the Heart/Lung/Brain circuits. However, this had a very negative secondary effect too. All that available blood ended up being pumped out of the man's body, and, while EMS did all they could, he bled out. Death would be, in part, blamed on the MAST. For months, the newspapers lambasted EMS, Mayor Ed Koch, and the protocols. Understandably, the protocols, although reactive instead of proactive, got revised. However, until I am told to do otherwise by the proper medical authorities, as I already stated, I will do as trained, until they retrain me in the newer and improved method(s). That will keep me out of the offices of the inspectors from Bureau of Investigations and Trial Services. PS: Mr. Watkins' family got a big piece of NYC Money in the settlement

Reading the updates on this string reminded me of something. There was a time that, instead of a Bag Valve Mask with reservour, they had a fitting that the demand valve fit into, so the "demand" of the "football" expanding would suck the O2 into itself from the demand valve. Figure the O2 would only be what was needed, and not the wasted O2 flowing out of the BVM between ventilations. Something must have been wrong with it, or BVMs would still be set up to accept this type arrangement.

Hmmm. I was told that per the New York State protocols, initially go NRB @ 15 LPM, then told that the medical director of the FDNY EMS wants us to do likewise. Until my higher medical authorities tell me otherwise, that be what I is gonna do! In your local areas, if you have different protocols, obviously, that be what youse guys are gonna do. I see no problem.

I just googled a bit, and from what I think I found, "Vanbulance" is just a nickname for a type 2 Van Ambulance. I did, however, find references to a "Modulance" (brand) ambulance maker, featuring type 3s. Peninsula VAC had at least 2 different models of them, something like 2 decades ago.

That is one thing nice about the EMS in the FDNY: We are issued the boots, and do not have to pay for them. It does NOT, however, stop us from kvetching about the weight, longevity (lack of), styling, and color of said boot.

Anthony, just mentioning my local (FDNY)and state (New York) protocols, if a patient needs oxygen, they get it at 10-15 liters per minute via a non re-breather mask. If the patient cannot or will not tolerate an NRB, then go with a cannula @ 6 LPM. If they cannot or will not tolerate even the cannula, try "blow-by", which is basically stupid sounding but kind of works, that of attaching a paper cup to the end of an oxygen delivery tube via a hole in the bottom of the cup, and holding it a couple of inches from the patient's mouth and nose. Alternate style, just use a big bore type oxygen tubing directly to the same few inches from the patient's mouth and nose.

Following local and state policies and protocol, the Method Of Injury would dictate the use of spinal immobilization, and as a newjack to the site noted so accurately, better to do and not need than to not do and need! (Thanks, Velvet Monkey) By the way, I had never heard of the term of "distracting injury," but I think I get the idea what it is.

"Vanbulance?" Sounds like an existing brand-name that I may have used years ago. Is the "Sprinter" type van of the type described? Also, has anyone ever heard of something referred to, as a type 4? Perhaps that is something akin to a vehicle with box/modular back, riding on a medium duty type truck frame, or something looks like a "baby semi?" There was, briefly, a movement to call old-style Hearse design ambulances a type 4, designating that they were only for display or parade details only, no patient transport allowed using it, but, sadly, it failed. I hated giving up my services' Caddy-lances!