dmc2007

Copy and paste strikes again...

"We are seeking Paramedics interested in using advance technology, evidence-based medical protocols, and their own critical thinking skills to work for us in Indianapolis, Indiana. "

Curious if this is them exploiting an opening with transcare being gone. They have all but packed up and gone home in Mass. 

Not to beat a dead horse here, but this is where regionalization would help. The residents in this facility weren't beamed down from Mars, and while some may be from out of area, I'd wager (based on my experience talking to patients in these facilities) that most of them came from nearby communities. And, despite the jokes we've all made about gravity being stronger at these places, many of these residents used 911 services previously, so the net change in call volume to the system (on the regional or county level) on the whole probably isn't that great. If you have a regional system, you can easily shift resources to cover the relocation of these residents and their demand for services. Let us not forget that these are services that they have paid for, both in their lifetime as taxpayers and through the rent they pay to the facility, which in turn pays real estate and payroll taxes. 

As for the notion that these calls aren't serious, let us also not forget that falls are one of the leading causes of death and debilitation in the elderly, and can be a secondary symptom of a bigger problem. So while, yes, many of these patients require nothing more than help off the ground, they all need an assessment. Most of the time, these facilities don't have much medical staffing and, if they do, they aren't clinicians capable of making decisions without consulting a physician. Enter EMS. I'm not saying I enjoy going to these facilities at 3 AM after running all day, but the need for the service is there. 

As for the issue of the medic having to respond to every call, that seems like a failure of resource utilization that is indicative of a bigger problem. If the resource is limited, than an appropriate emd program should triage calls appropriately (as best you can given the often lackluster communication and clinical skills of the caller from these facilities). 

On the topic of offering to create a joint system with Pelham-that seems like a pretty clear indication that the contract is empress' to lose, no?  Either way that sounds like a great way to improve service to Pelham at the same time by consolidating systems-something Westchester (and mass too, among others) could use more of. 

The equipment section of the contract had a few interesting points. Granted, it's been a while since my NY card lapsed, and even longer since I actually spent any significant time volunteering there (and only at the Bls level), but the inclusion of video scopes and BiPAP capable vents was a surprise. Are a lot of services in Westchester moving to video scopes?  As for the vents, are medics in ny allowed to initiate them (either for incubated patients or as NIV)?  Or is that provision there for stat transfers out of SSMC/monte north?

Unless I am mistaken it is administered by DCAS as a promotional exam, as opposed to an open competitive exam. Hence the use of the term. I believe I see your problem with it, that EMS is considered a stepping stone as opposed to a separate career track. But personally it doesn't bother me at all, especially when the article is exposing the fact that standards are being lowered for a select group of people in a way that has a negative effect on the safety of those on the fireground.

If EMT/Paramedic->Firefighter isn't supposed to be seen as a promotion, then why isn't there a Firefighter->EMT/Paramedic Promotional exam?

Don't get me wrong, the implications of appointing an unqualified firefighter are terrifying, and I fear for those that have to work with this recruit.

Am I the only one who finds the fact that the article (and FDNY on the whole) refers to the transition from EMT or Paramedic to firefighter as a "Promotion" equally bothersome, if not more so, than the main subject of the article?

Isn't this Chevy model a year old already? Is Chevrolet making the Caprice anymore. I did drive a "14" impala not long ago and it was great but looked nothing like the one they are talking about.

Impala and Caprice are two separate vehicles, with the biggest difference being drivetrain (Impala is FWD, Caprice is RWD).

The Caprice was reintroduced last year as a police-spec only vehicle, and is still in production.

The Impala was redesigned for the 2013 model year (I'm guessing you drove the redesigned model), but the old model (which has been offered in a police package for some time) has stayed in production for fleet and government purchasers. There is no police package of the new model yet (nor will there likely ever be.

I'm in.

Do you know who covers that area currently of Pelham Manor, New Rochelle, Larchmount and Mamaroneck.

Pelham Manor is covered by Empress Ambulance (with an ALS fly car and transporting ambulances sent in as needed). New Rochelle is covered by Transcare with 2.5 ALS Trucks (2 24 hour and 1 12 hour). The Village of Larchmont and the Town of Mamaroneck are covered by Larchmont VAC, while the Village of Mamaroneck is covered by Mamaroneck EMS. The last two have 24/7 ALS staffing through the Town of Mamaroneck Ambulance District.

Like in simple words its a VAC but I want to ultimately take it a step further to be utilized for research in EMS etc. etc. and ALS would be as most VAC do by a paid medic or we could be strictly BLS and call in for ALS so we can start pt. care and head towards the hospital in a serious case and have a rendezvous en route or hopefully in most cases they meet us on scene and we transfer care to them. Thats what we do up in Syracuse, NY with the university ambulance.

An ALS intercept system would be a downgrade from the current system, as all of the areas you mentioned except Pelham presently have dedicated ALS transporting ambulances. You're talking about transport times here of 10-15 minutes max, often less.

Sorry but I have to comment. In a VOLUNTEER district when a call comes in for a lift assist it should be first answered by police. They take the call and do the dispatch. There are many more police officers on duty in cars than there are vehicles for ems. When the call comes in IF the caller indicates that there is an injury or medical need then of course dispatch the ambulance. If the call is just to help the party back into a chair or bed then the call can and should be handled by police. Once again...should the called indicate a need for medical treatment fine then send the ambulance but DON'T send them and tie up the only EMS crew in the district for a LIFT unless the first responder requests one.

Volunteer or paid shouldn't make a difference. Guess what-the citizens in your district probably don't know and definitely don't care whether the crew responding to THEIR emergency is paid or volunteer-they expect and deserve the same level of service no matter where they are. Do all assists need to end with transport by ambulance to the hospital? Probably not, but until any medical concerns are ruled out, the call should be handled by a crew that's trained to identify possible the red flags that indicate something bigger is going on or that an injury has ocurred, as well as to stabilize and properly move an injured person.

If an EMS system doesn't feel like dealing with falls, which are the number one cause of injury death and trauma-related hospital admissions in the elderly (source: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html), then its time to revamp said system.

That being said, if a particular individual, or the family of an individual, keep calling for preventable falls that end up being non-medical, there is a bigger issue of finding a more suitable living environment for that individual that needs to be dealt with.

Sounds interesting. What's the date for the session?

<br />I was finally able to see one a Sprinter in person a few months back and get inside it.  It was an AMR Sprinter.  It seemed roomy with lots of head room.  The EMT that was nice enough to let me check it out didn't seem to thrilled with it.  It does seem a little top heavy.  I am curious what this truck would be like doing a transfer into Boston at highway speeds? I thought I had read somewhere that Acadian in LA etc was going with these trucks now for all their new ambulances.  If I remember correctly was it based on fuel efficiency primarily.  I think only AMR has gone with these trucks in the metro Boston area.  Pro EMS had one but donated it to Cambridge, MA FD for their motor squad. <br /><br />Anyone have any experience with these trucks?<br />

As far as I know, the only other company in the Boston area with Sprinters is Armstrong. Brewster had one unmarked in its garage (a demo maybe?) when I interviewed there back in October, but I've yet to see it on the road.

From the EMS point of view...

I've freelanced a grand total of one time...I was en route to a large scale incident, in uniform and as requested by our command staff, when I came across a MVA that would have represented a small-scale MCI had all but one patient not refused. After talking to the command staff, I secured my POV away from the scene and offered assistance. Given that our area was already strapped from the prior incident, the extra help was needed and appreciated.

That being said, freelancing without permission tends to be a major problem in major incidents. While we roster in house crews and don't have to deal with the issue of toning and hoping for a crew to assemble, we do have people responding to calls without permission, particularly those big calls that wouldn't have an issue garnering a response in other areas. Having responded to calls on the duty crew where this has happened, I'd say it's problematic. It creates needless chaos on scene and increases the workload for the IC, whoever that may be. If I was part of the command staff, I'd add consequences for it. I don't think I'd last very long in the command staff of a volunteer agency in this areas...

Some more info here:

http://woburn.patch.com/articles/woman-killed-in-mishawum-car-crash-early-friday

This happened only a few miles from where I live.

I'm pretty sure you can file for reciprocity with any state, with many requiring a re-test or at the very least a fee. I'm pretty sure CT and NJ have automatic reciprocity without re-testing.

Great shots! Does anyone know if that front STOP sign lights up or flashes with the rest of their emergency lights. I assume this is to tell cross traffic at an intersection to stop.

IIRC those are actually used for traffic stops-side stops are still utilized there.

I haven't read the reports on the sites above but caution must be exercised when considering "blogs" as your source of research. Most blogs are not peer-reviewed research-based journals commonly accepted within the medical community.

Before stating that something is a fact or has been shown to be a myth, consider the source.

My apologies. Those were some quick links I found. There are many peer-reviewed articles that deal with the matter, the citation to one is below (I've included the abstract as the link through which I'm accessing them are specific to my school and likely won't work for anyone not on our network):

Crossley DJ, McGuire GP, Barrow PM, et al: Influence of inspired oxygen concentration on deadspace, respiratory drive, and PaCO sub 2 in intubated patients with chronic obstructive pulmonary disease. Crit Care Med 1997; 25:1522-1526

Objectives: To investigate the response of CO₂-retaining chronic obstructive pulmonary disease (COPD) patients to an increase in FIO₂ following a period of mechanical ventilation with PaO₂ in the normal range. The administration of a high FIO₂ to chronic obstructive pulmonary disease (COPD) patients may result in hypercapnia. Recent evidence indicates that the hypercapnia may be due to reversal of preexisting regional hypoxic pulmonary vasoconstriction resulting in a greater deadspace. This effect would be more pronounced in patients whose initial PaO₂ was <60 torr (<7.9 kPa)

Conclusion: These results show that following a period of mechanical ventilation with an FIO₂ sufficient to maintain a normal PaO₂, a further increase in FIO₂ does not result in an increased PaCO₂ in this group of CO₂-retaining COPD patients. (Crit Care Med 1997;25:1522-1526)

While it may have been a bit extreme for me to call it a myth, it does seem that the sentiment that giving O2 to a COPD patient will result in sudden respiratory arrest is unfounded, and that the effects of the hypoxic drive won't be seen pre-hospitally. This is what I was getting at in my initial post.

FF Potter is the subject of this pretty well-known photograph from the morning:

The hypoxic drive theory has been show to be a myth. See:

http://paramedicblog.wordpress.com/2009/11/19/hypoxic-drive-theory-myth-the-why-and-how/

http://respiratorytherapycave.blogspot.com/2008/06/hypoxic-drive-theory-debunked.html

Also, it looks as though the article is trying not to discredit the use of O2 in the field, but rather the use of high flow oxygen, as titrated oxygen (i.e. through a N/C) can be just as, if not more effective, in raising and maintaining oxygen saturation levels in patients with difficulty breathing.

Just look at the ambulance pictured. Once the patient doors are opened the chevrons are gone. The door side goes toward rig and the sides are covered by the doors. While the rig is visible the lettering no longer is. The real question should be chevrons at what price?

Our Ambulance that is equipped with Chevrons has chevrons on the interior of the doors for the very reason that, when opened, the doors cover the pattern.

I must add, that I was told by FD on scene that the Mustang's safety features worked, and the suspect was wearing a seatbelt, he probaly would have lived. Instead, justice was served via a full force blow into the steering wheel even with airbag.

Airbags are designed to work with seatbelts. You take off the seatbelt, the airbag isn't going to be able to do much (while newer airbags are designed to deploy differently if the car senses the seatbelt isn't fastened, this often isn't enough to make a difference). Thankfully it was only the perp that lost out here.

I think the biggest issue was the timeslot. Saturday nights just aren't a great time for people to sit down and watch a show like AMW. I think it could be very successful as a show in weekday primetime, or maybe spliced in to the nightly news during the week.

Then again, I know very little about the TV industry, so this is just me talking.

an oldie, a Chevy Caprice wagon marked for Highway 2, spotted just recently in Mount Vernon. I took the photo from a train at Mt Vernon West (photo through window)

It's a pleasant surprise to see that there are still any of those around. That thing has to be at least some where around 15 years old.

Congratulations to Officer Hess, on receiving this prestigious award from his colleagues, well deserved, I might add.

Regarding the expected (over)reaction and orchestrated response from the Henry family, que sera sera.

Let me go way out on a limb, here, if I may... I often wonder...

if anything would have wound up any differently in regards to this entire incident, if the police officers involved with the shooting , were black? Or the alleged assailant, white?

Not to defend the Henrys, but I do recall reading that Rev Sharpton did try to make a stink about this one, but ultimately left because the Henrys weren't willing to cooperate with his making this into a race issue. I can't cite a source, but I do recall reading it. Again, this is not to defend the Henrys and their character assassination on the officers involved.

It's a nice idea, and there is definitely much to want to preserve in Westchester, but let's face it: there is a lot that needs to get fixed in Westchester as well. We have departments that can barely cover calls, patchy and unreliable interoperability infrastructure, very little advanced planning, and resources that are either way over-duplicated (and often understaffed) or virtually non-existent. Let's work on fixing these issues first.

*This is not a knock on any department nor the selfless individuals that serve as first responders in the county.

IIRC, MA requires a certificate to be displayed in the patient compartment. While not an exterior sticker like in NY, it has the meaning.