vtach39680

Well the first thing is to always treat your patient not a machine. I would get a good history while determining if the patient is symptomatic or asymptomatic, determine if the patient is a smoker as a 2 pack a day smoker could have a COHB level baseline of up to 15. I going to assume that we are a BLS unit? if so 100% O2 monitor vitals I am also glad you made mention of it being a co monitor. as we all know that pulse ox monitors the saturation of hemoglobin and using it alone will give you a false reading of O2 sat. sorry for the slight rant. I would confer with the FD to see where the high concentration levels of CO where in the house and the proximity of those high levels to the living space of the patients. asymptomatic patients transport to ED on 100% O2 with constant vitals. symptomatic patients 100% O2 to hospital with hyperbaric treatment and ALS for advanced mon. as ST changes are very possible.

just my 2 cents feel free to correct anything I have written. always good to learn

Don't be afraid to try new things, the Ark was built by armatures the Titanic my professionals

[if you are more intimately familiar with this topic, hold your answers for a little bit to see what others have to say. This will be a dynamic topic so if you have questions, do ask and we'll provide additional information.]

Just curious if anyone has ever seen or used this radio I have never heard of the company but the radio looks interesting?

http://www.holzberg....cts/dbandy.html

What kind of poppycock is that?! How, in all of creation, could EMS responders who DID NOT TRANSPORT a patient be responsible for a nosocomial pneumonia?

Uggggh... this type of frivolous litigation is precisely why that patient had a "$700 headache" the last time she was hospitalized and therefore saw financial repercussions as reason enough to avoid medical attention.

It's unthinkable, from my knowledge base, education, and experience, that any reasonable attorney would even entertain such a suit.

I would file a counter-claim for slanderous damages to the personnel involved and the EMS/Fire agencies, as well as the legal expenses of BOTH the defense and counterclaim.

easy it is called Post hoc ergo propter hoc simply after this, therefore because (on account) of this" "Since that event followed this one. that event must have been caused by this one.

Well with regard to people being confused and not knowing if FD is a tactical unit or the FD we do have ambulances in a town that have police on the side and front but treat patients and also pull people over as well as preform other LE duties. I can not tell you how many times I have heard I got pulled over by an ambulance and they gave me a ticket. (this SOP) causes greater confusion and harm to non LE emergency responders then the PD asking and getting permission from the FD to use there personnel, and the FD equipment to end a possible dangerous situation.

just my 2 cents

I am not saying the police were right or wrong nor the FD just stating facts on the poss. confusion issue

PS the best uniform I ever had was green pants white shirt and orange patches. NYCHHC EMS

Excellent post Chris, you nailed it dead on.

Thank you for hitting it on the head. we need to change the culture of what we do.

Everyone should refrain from doing their accident investigation and posting it here.

What skid marks are you talking about? The ones that start on the RIGHT side of the road and move to the left. Looks like an attempt to avoid the accident. And the skid marks look like they are of both the ambulance and the car involved, or maybe just that of the car being pushed by the ambulance down the road. This may have occurred because the operator of the ambulance, being injured in the collision, may not have had control of the ambulance and was then able to bring the ambulance under control.

There are so many 'what if's', that no one should make statements about who is at fault or what you think what happened. Let the accident investigators make that determination. The comments on the Journal News have the ambulance crew convicted of wrong doings. No one operating an emergency vehicle should be put though this. If you were driving would you want people armchair quarterbacking you?????

sure quarterback all you want dont we do that during QA/QI and call audits? either way names were not used so I have no problem with a heated discussion if it brings change. It does not matter if it was an intersection or not they were driving too fast take a look at the length of the skid marks if they t-boned the car and "pushed" it and ended up on the left side of the road then they were going really fast to have that much kinetic energy to push an object that far.

from looking at the skid marks the ambulance left and them being on the wrong side of the road. it looks like they were going way to fast and not using reasonable emergency driving tactics it is a shame. we have had way too many accidents in the recent years. this is # 2 for spring hill in a very short period of time.

Now is the time to change the cuture. driving fast does not truly decrease your response time. just don't do it (and yes if it was my grand mother / wife / father or any other family member I would rather you drive slower and stop at all lights then go, then o crsh and not get to them at all)

Typical journalism. Light on details strong on emotion. The kid wasn't in arrest when the EMS crew arrived on scene. How did he present? They apparently didn't call for ALS until the kid arrested so what were they doing? What is clear is that there isn't enough information here to even speculate wether or not ALS would have made a difference, but god forbid a journalist let that stop them. All they mention is the "breathing tube", which could be effectively covered by a BVM and opa 90% of the time until said "breathing tube" arrives.

who cares about the ALS / BLS fight. the real question should be why was the time on scene with patient so long without transport. even if the kid was seemingly BLS with mild to no resp. distress and no need for "extrication" why in the world would you still be on scene after 30min

Hey Guys/Gals

So after 2 months of waiting I finally got called in for an interview and was approved!

Here is the thing, it is at a rather large hospital in Manhattan running 911 calls. Fairly busy. A friend, rather well respected at this location, recommended me and they over looked the "4 years experience on a 911 EMS System" thing because of it.

My friend told me not to worry and they will guide me and show me the ropes in the beginning and get me rolling. I got my EMT cert a little over 6 months ago and have used my skills very seldom since them so I have a few cobwebs to clean out since then.

In the past i've volleyed up in westchester and know my way around a BUS and the equpment so thats not really an issue.

Now I have a full time job (in a differenct industry) and am only doing this Per-Diem shift to keep my skills up, help fellow man, and make some extra money.

Questions:

- Has anyone else been in a position as this?

- How well will I be received by other EMTs when they find out I had a "hook" to get in and have relatively little experience?

- Anything else that I should prepare for uniform wise, boots, other gear? Any tips for my first few times out?

- Any experiences with Per-Diems? Things to know?

Thanks all!

Well just show up on time and dont act like a wacker and I am sure you will be fine. your partners may b**** and moan at first but if you know your way around a bus and how equipment works then I am sure they will be more then willing to show you "city way" of doing things. lol just like any new job listen alot and don't talk all that much the first few shifts until you can feel them out

http://www.recordonline.com/apps/pbcs.dll/...12033/-1/LIFE03

"November 12, 2008

NEW WINDSOR - Chris Dineen had no idea his job was in jeopardy until he got a phone call Sunday from a local fire chief:

Was it true Dineen was fired as chief of the New Windsor Volunteer Ambulance Corps?

MOD NOTE: Topic already started here:

http://www.emtbravo.net/index.php?showtopic=28485&hl=

I'm with those who advocate less is more. Even the AEMT written... and practical..... is half BLS. EMT-B and AEMT ought to focus on assessment and history. Many 'emergencies' can be adequately addressed in the field with oxygen and patient positioning.

I had the pleasure of working with a Yorktown BLS crew recently. By the time I got on scene from out of district, the patient was packaged, in the ambulance, a full history had been taken and the 'not well' patient had been evaluated for stroke, ruled out, and the EMT was anxious for me to test blood glucose as he had narrowed his impression to low blood sugar, which it was. Solid, professional basic skills can add as much to level and timeliness of care as ALS.

BLS and ALS alike need to respect the importance of solid basic skills. Good basic care is a craft which we all know when we see and work with it. I'd like EMT-B's to focus on /add pride, thoroughness and confidence.

I am glad that you had a good experience with a BLS crew but the true question is why was he still medic dependent, his clinical evaluation may have been correct but why did he not follow through with a small amount of oral glucose to see if patient status improves. he had the knowledge he had the tools but he only went half way in the treatment of his patient. what if no ALS was avail? do you think then he would have given glucose?

I am not knocking the BLS crew. the person had gone through a class and and had done ride along with strong people. why add more stuff when EMT are afraid to treat pt with the things they already carry

What skills would you like to see added to the EMT curriculum?

EMTs in Israel start IVs, in North Carolina they Intubate, in a number of states they use CPAP, in other places they use combitubes. Nasal Narcan is up and coming for ALS and potentially BLS. What do you think about adding skills for BLS and which skills would you like to see added?

I would rather see a mastery of the skills they already have. and instead of giving them "tasks" and more skills I would like to see better overall clinical judgement and knowledge

New job opening...Vest police...sign me up

While you are out doing that. why don't you catch all the over weight people who have beards that don't make mask compliance that I see masking up and going into fires

Small airports and hospital helipads have been using this type of product for turning on and off runway lights and the like usually 3 clicks of the mic turn it on and off

Some of them already work for multiple agencies.. You never know what will happen down the road.

I am sure they will make the correct decision for thier needs.

I don't remember, does TransCare have a no compete clause like Empress used to (or still does) preventing employees from working for multiple agencies in the same area?

they have a non-compeate clause for "private" companies that have a con in areas that they have a con to operate. so an employee could work paid for a municipality if they had a con that transcare also had a con for.

found this on lohud.com this morning. I am interested in how it will turn out. sounds like they need the money not just for "paid staff" but for general operations as well.

http://lohud.com/apps/pbcs.dll/article?AID...EWS02/808170346

ROCKLAND - NYACK HS

http://www.youtube.com/watch?v=vlpTWX-_t70

Shme the whole story was about the gym teacher doing CPR on a kid that was never in cardiac arrest. I was working the "Twinky" bus that day at Nyack.

I'm aware of no state law, regulation, or other provision that would compel or require any off-duty EMS provider to stop and render aid. There are so many variables that could come into play here that it would be impossible to enforce. For example, an EMT driving home with his two toddlers in the car comes upon an accident scene. Does he stop and leave his small children unattended in a vehicle?

If this were the case I imagine we'd see far fewer MD license plates out there since they're licensed healthcare providers.

It is a very interesting question though.

"NYS statutes do not obligate an individual citizen, regardless of training, to

respond to a situation or provide care unless there is a formal duty by job description

or role expectation. Such a duty to act arises from participation with an agency having

jurisdiction."

"Pursuant to the provisions of Public Health Law, the individual having the

highest level of prehospital certification and who is responding with

authority, “has a duty to act” and therefore is responsible for providing1 2

and/or directing emergency medical care and the transportation of a

patient. Such care and direction shall be in accordance with all NYS

standards of training, applicable State and Regional protocols and may be

provided under direct medical control."

As I was reading around I saw something to the effect that under the volunteer protection act there are certain compensations which are allowed that aren't considered "compensation." Such things as agencies who pay for meals, give uniform stipends and such were still covered.

I figured as much just thought it was interesting possibility lawyers are crafty people

Good post Vtach...isn't that somewhere along the lines as well as why the DOH requires agencies to mark vehicles with "out of service" if you are on the road and cannot utilize the vehicle to answer calls? The having your car marked up with this and that sticker and not pulling over to me is a week and stretch of an arugment. Not to mention the fact I really don't get why people put all those stickers on their cars in the first place...but needless to say as a certified provider I believe its much different then having a known licensed provider pass by.

Additionally after some research I found the following under Public Health Law Article 30, which may have added to my confusion or someone who discussed this in a classroom format I was in stretced it as well:

The way it had been explained to me in my EMT class was that. when you are not working as part of an agency response, you are covered under the good samaritan law. When you treat and or transport a patient as part of a agency response and do not seek or expect monetaryy compensation for the action you provide you have to be found "grossly negligent"

if you are working as part of an agency response and expect to receive monetary compensation for the acts or actions you provide then you only have to be found "negligent"

here is a question that perhaps we could move to a different forum but what are the chances that a lawyer could argue that any person who is part of a volunteer agency that does not receive a "paycheck" from that agency ie volunteers, would only have to be found negligent due to the new fuel reimbursement act and the states "pension" programs for volunteers

also as a follow up. http://www.health.state.ny.us/nysdoh/ems/pdf/98-05.pdf

"NYS statutes do not obligate an individual citizen, regardless of training, to

respond to a situation or provide care unless there is a formal duty by job description

or role expectation. Such a duty to act arises from participation with an agency having

jurisdiction."

"Pursuant to the provisions of Public Health Law, the individual having the

highest level of prehospital certification and who is responding with

authority, “has a duty to act” and therefore is responsible for providing1 2

and/or directing emergency medical care and the transportation of a

patient. Such care and direction shall be in accordance with all NYS

standards of training, applicable State and Regional protocols and may be

provided under direct medical control."

the good Samaritan laws pertain to the lay public. all certified EMS providers in NYS are covered under part 800 of the public health law. below is a segment of part 800 that holds some of the answers to the questions posed

"800.15 REQUIRED CONDUCT

Every person certified at any level pursuant to these regulations shall:

(a) at all times maintain the confidentiality of information about the names, treatment, and conditions of patients treated except:

(1) a prehospital care report shall be completed for each patient treated when acting as part of an organized prehospital emergency medical service, and a copy shall be provided to the hospital receiving the patient and to the authorized agent of the department for use in the State's quality assurance program;

(2) to the extent necessary and authorized by the patient or his or her representative in order to collect insurance payments due;

(3) to the extent otherwise authorized by law;

( when acting as a certified first responder, an emergency medical technician, or advanced emergency medical technician, treat patients in accordance with applicable State-approved protocols, unless authorized to do otherwise for an individual patient by a medical control physician; and

© comply with the terms of non-hospital order not to resuscitate when provided with such order issued on the standard form prescribed by the Department of Health, or when a DNR bracelet, developed by the Department of Health to identify individuals for whom a non-hospital order not to resuscitate has been issued, is identified on the patient's body.

(1) Emergency medical services personnel may disregard the order not to resuscitate if:

(i) they believe in good faith that consent to the order has been revoked, or that the order has been cancelled, or

(ii) family members or others on the scene, excluding such personnel, object to the order and physical confrontation appears likely.

(2) Hospital emergency service physicians may direct that the order be disregarded if other significant and exceptional medical circumstances warrant disregarding the order.

(3) No person shall be subjected to criminal prosecution or civil liability, or be deemed to have engaged in unprofessional conduct, for honoring reasonably and in good faith pursuant to this subdivision a non-hospital order not to resuscitate, for disregarding such order pursuant to paragraph (1) or (2) of this subdivision or for other actions taken reasonably and in good faith pursuant to this subdivision.

(d) note use an automated external defibrillator unless:

(1) he or she is acting as a certified first responder, emergency medical technician or advanced emergency medical technician; and

(2) under medical control; and

(3) when authorized by and serving with an agency providing emergency medical services which has been approved by the regional emergency medical advisory committee to provide AED level care within the EMS system; and

(4) after completing AED training which meets or exceeds the state minimum AED curriculum."

The key to the statements above is "when acting as part of an organized prehospital emergency medical service" so it could be argued with good success that when you are in a non marked IE (full lettered agency vehicle) you are not working as part of an organized prehospital emergency medical service. and have no duty to act.

I happened to be at WMC when they got 23 or so patients almost all by a bus

That sounds like a resonable request of money given, i think it is ambulance 3 is posted for 12 hours and has no station.

(cant have the crew with no AC or heat )

we have a standard policy at my agency that if the difference between arrival time and pt contact time are greater then 4 min pt contact time is to be noted on the pcr in the narrative.