Richard B the EMT

Uh... Cynical as hell and TylerHastings, you do realize you are answering a string dated to 2008, don't you?

By that line, you just promoted Certified First Responder-Defibrillator (CFR-D) Fire Fighters. When the system works, as they get the dispatch first, they arrive first and, if needed, start CPR and apply the FR3 Defib unit to zap the patient. Still within the NYC 9-1-1 system, BLS (the EMTs) can administer aspirin, albuterol, and Oxygen (which is a prescription item, still surprising many), and assist the patient in taking their own Nitro pills. ALS (Paramedics) go from there, with a big list of drugs and narcotics they are authorized, standing orders, to administer, or with a "Mother/Father, May I" authorization from OLMC with certain items, or in addition to dosages already administered. On a slight rant here, I note that most "overwhelmed" 9-1-1 EMS systems are used by the public as a taxi to the hospitals, and the legislators won't change the rules to prevent this. Also, with visions of instant service by being brought into an ER by ambulance "guaranteeing" being seen sooner, they will tell the 9-1-1 calltakers almost a rehearsed routine with "flag" words ("heart attack", can't breath") that get the higher priorities assigned the "job". Then the Triage nurse, or Doctor in charge, puts a pin into their bubble by having them wait in the waiting room, and not get an ER exam bed immediately. My final rant of this posting, repeated often, is, 9-1-1 has become a victim of it's own success, as everyone calls 9-1-1 for almost anything.

The problem with putting advertising on the hood is, if they don't move for mirror writing "AMBULANCE" (ECNALUBMA), as they will be reading the ad, won't move out of the way, as they will be reading the ad!

I don't know about inhumane. The ratio is 2 or 3 BLS to 1 ALS, and when the call matrix doesn't have the ALS dispatched in the first place, the BLS crews can always request them (preferably at the soonest opportunity of recognition ALS is needed, as already described).

It seems to me the general consensus is, nothing is idiot proof, as they keep improving the idiots.

I have vague memories of an article, in JEMS, on some fool lost their kayak carrying their supplies in a river, called for assistance on their cell phone, primarily due to lack of water. Lack of Water, in the middle of a river! Perhaps understandable, as the person had no inkling of if the water was safe to drink or not. This individual was fined and billed for the "Rescue". I say: charge and fine those who do something stupid that results in need of rescue, or ask for help when they don't truly need it. For actual accidents, those who "truly" need assistance and/or rescue, bill them directly, or their insurance carriers, just like you'd bill for an ambulance response for more mundane calls.

With the understanding that any military medical group would want to train their personnel to their own standards, I have a friend who had been a hospital volunteer, became a New York State EMT, and had been a combat nurse in the Israeli Army in 1973, was not even allowed to maintain a first aid kit for her own unit when she joined the US Navy. With all that medical experience, they made her a "Signalman".

FYI: FDNY EMS Command, and it's predecessor, the NYC Health and Hospitals Corporation EMS, operate on the premise that the majority of calls don't require the higher level of training of ALS Paramedics, and only require BLS EMT-Bs. In essence, someone with a broken arm from a soccer match (Congrats to Spain yesterday, by the way, in a game I usually don't follow) doesn't really require the services and expense of a Paramedic team response, and can quite easily be handled by an EMT team, at lower cost.

The Bermuda Triangle, perhaps? Atlantis (the island, not the Bahamas Resort)? Shangri-La? Middle Earth? Hogwarts? Fantasy Island?

Thank you, "D-Man", it has been quite a while from when I had heard of what you described as the "H and Ts". I just never had them called that before.

I have vague memories of Nitrous Oxide/Oxygen machines from the mid 1970s in JEMS, but aside from printed and electronic ads, never seen the unit, or similar units, in person. Link for brand name "Nitronox" follows. http://www.class1inc.com/product.php?nv=&cat=product33

Franklin D. Roosevelt, excerpted from the State of the Union Address to the Congress, January 6, 1941 We cherish these rights as Americans, and I hope the world can adopt them, each to their own country.

Nothing personal,daedalus, but I often ask members of the city to avoid acronyms, as what you use might be different from mine. Well, I have no recall of what is/are "the Hs and Ts", so could you translate, please?

Only Nancy and Rabbit.

In the last week of June, on a class trip, a 12 year old girl from Harlem, New York County, went into the Atlantic Ocean off Long Beach/Atlantic Beach in Nassau County. Lifeguards were not available, as the season had not yet opened. She was dragged out by a rip current, and wasn't found for almost an hour. She died of drowning. The next week, in the Riis Park area of Gateway National Recreation Area, in Queens County, a 14 year old boy from Brooklyn went into the water at Riis' Bay 4, an hour after the lifeguards went off duty. Despite rescue efforts for the next 2 hours, by regular and specialty trained personnel from the NYPD, the FDNY, FDNY EMS, Rockaway Point Volunteer Fire Department and EMS (4 wheel drive ambulances), the National Park Police, and the US Coast guard, he was not found. His body floated up 4 days later. 2 days ago (from day of posting), again, after the Lifeguards went off duty, a 22 year old man from the Bronx defied repeated warnings from a New York City Park Enforcement Officer (an unarmed "Peace Officer"), and went into the ocean off of Beach 116th Street, in the Rockaway Park area of Queens County, and got pulled under by high surf and rip currents. He was found roughly 20 minutes after being dragged under, moved to street-side by a Parks Department 4 wheel drive pickup truck, and with CPR continuing, transferred to an FDNY EMS ALS unit. He was pronounced on arrival at the nearest ER. His fiancee, and another friend of the deceased, were transported to the hospital, with the fiancee visibly in emotional distress. As per the Park Enforcement Officer's statement, the trio had been chased out of the water by her, at least 3 times, before she found the 2 screaming for help when the third had gone missing. Lifeguards in this area, when seasonally on duty, are only available from 10 AM to 6 PM. We're fighting to have their hours of coverage extended. The water closes at 6, when the Lifeguards go home, the beach itself closes at 10 PM, and the boardwalk, where we have one, closes at midnight. Lady J, my better half, wants to launch a campaign that all New York City TV and radio stations should announce, repeatedly during the summer season, that nobody should go into the water when there is no lifeguard on duty. If it is done at all, Public Service announcements like that are put on late at night, when the people who the message is for won't be awake to hear them. Neither of us has any ideas on how to pay for such public service announcements. What do you think of this? Nobody seems to know or understand that an unoccupied Lifeguard chair with a red flag on it means no swimming, except us locals by the beaches. I'm open to suggestions.

Some people ask for advice, but don't plan on following it, even before the advice is stated. I can only guess that was the case with that woman. I'll posit that she probably doesn't support Doctors without Borders, and would have been somewhat insulting to all EMS personnel who went to Haiti, following the earthquake, as having abandoned their posts in whatever area they came from. Tell that to the 2 kids that USAR NYC Task Force One pulled out of their collapsed home.

While I would not say it in that manner, the statement is, unfortunately, accurate.

Just advising as under NY State DoH and FDNY EMS Command's protocols, EMTs are allowed to "assist" patients in taking their own nitro pills (presumed standard confirmation that the patient and prescription names are the same, the pills are not expired, and the pills appear to not be "damaged"or contaminated from anything). FDNY Paramedics carry their own supply of the pills as a part of the drug bag setup.

Once again, I remind the city that I work in a system where almost all calls are 15 minutes from an ER, once we start towards that hospital. When I, and the other EMTs, make that determination that ALS is needed, we request it, continue our evaluations and treatments, "package" the patient, and move them to the ambulance. At that point, we again radio, this time requesting an ETA. Determination now, of "stay and play" versus "load and go", depends on the ETA. Which is shorter, the time from your current location to the nearest appropriate ER, or the time until the ALS joins you at the location? While I won't say it doesn't happen, mid route meet-ups (intercepts) seem rare within my operation. I do recall one time we were 90 seconds from the location to the ER doors, with CPR in progress. Due to a heavy call volume, an ALS crew from another station a distance away was en route, and saw us pull away from the location while they were still 30 seconds away. We declined to stop, and continued to the ER, where they arrived in time to assist in the off loading of the patient. Then, they got nasty with us for not stopping to allow them to jump in and do their "Thang". The lieutenant arrived, having heard the 2 personnel, who were driving, arguing over the air as to "Stop!" "No!", and stated the delay would not have made any difference either way. The patient was pronounced within 5 minutes of arrival.

Your reference makes me think you personally know the main OLMC doctor. When you find out why she wants you to limit practices of your skills level, let us know by this string? (I'm presuming it is all the Paramedics on this task she is not allowing to do full state protocols, and not just you, as that would be stranger than the limiting in the first place)

Over my 37 years on, protocols, obviously, have changed. Extrapolate for the dudes and dudettes just starting out, referring back to 2010 from 2047, and what changes will they have witnessed?

I'm BLS (EMT-B in New York State and City), and I'm trying to establish a background re the question of this string. I recall, years ago, my ALS providers giving an automatic dose of Lasix to all cardiac arrest patients, even before attaining ROSC (Return of Spontaneous Circulation), via the "KVO (Keep Vein Open) line". Now, after establishing ROSC, they deliver a cold saline IV bag. The delivery of cold saline is new, under a pilot program. When did they stop with the automatic infusion of Lasix?

I'm a Yankee (actually a "Mets" fan), and I don't get it either. I understand that you're referring to Prawns. It's food, and THAT I understand!

While there have been numerous small fixed wing crashes in recent times, this is the first one with an air ambulance. Most I have read about have been involving helicopters. Please add my condolences to family and service family members.

These folks mentioned are either bucking for "World's Stupidest Criminals" candidacy, or rejects from the Honorable Mention list of the Darwin Awards!