ny10570

FDNY does not pick the manufacturer. They establish a list of build specifications and performance requirements that a manufacturer must meet. The cheapest bid that best meets the demands wins the bid. FDNY's ace in the hole against garbage builds is the uniquely long warranty period. The idea is that a substandard product will cost the manufacturer more to repair than to build the rig right the first time. This idea doesn't always work as demonstrated by the previous generation of TL's.

The writing is on the wall. Fires are down and fire deaths are at historic lows. As urban areas are rebuilt, newer construction and advanced safety codes take over these trends will continue. Even though we pack our buildings with a substantially higher fire load and use construction that fails much faster, fire is becoming less and less of a threat. While the threat will never be eliminated, it has irreversibly changed. Depts are busier than ever, but what are they doing if its not fires? Its hazmat, rescue, extrication, and the biggest growth is EMS. More and more depts are taking on first response or ALS while others are proving the full spectrum of EMS for their community. A few have even begun venturing into inter-facility transport duties. Recently Danbury and New Haven have turned fire companies into ALS units. FDNY has closed fire companies while continuing to aggressively expand its position in EMS. Will the fire service adapt or be marginalized?

Couldn't agree more

In 30 seconds of googling I found Pleasantville's. On the dept's website, on a local online newpaper, and on the Mount Pleasant Town website.

That argument goes out the window every time a voter casts their ballot for a dead person. not enough people vote and of those that do, too many vote out of habit rather than with their head.

Sorry ALS. Im a boob. I saw country, not county when I wrote my reply.

FDNY*EMS is currently carrying cyanokit on every ALS ambulance and have administered it over 50 times as of a few months ago. There's also Houston, Tampa and others, but most if I remember correctly are fire based systems (they have a bit of a vested interest in firefighter safety). As a result of user feedback, a new manufacturer (Meridian), and some increased demand the price is starting to come down. What was once nearly $1,000 per adult dose is now $650. With a 3 year shelf life and new training kits made by the company I don't see why more depts aren't carry this.

You can't find a safe environment within a few hundred feet of the fire? How about get outside the collapse area; rapid assessment, initial interventions, and then remove to the vehicle. You may very well discover this isn't just a simple fire victim and maybe shouldn't be removed from the scene. What if you have two or even 8 patients coming out? Are you treating and triaging at the ambulance? That initial stop in a safe place and can now become your triage area.

Too bad I know more resident cops and EMTs who absolutely detest that parade than out of town. Out of town members either hate the detail or love the OT. Local members get to live with that nightmare.

He's not worth the read. He's a bitter and angry individual that divested himself from the system some time ago and continues to rant under some perceived slight from the FDNY. He chases any valid points an factual info with half truths and exaggerations to prove his points. As I've said before there are plenty of flaws with FDNY*EMS but its not the mess some former members would have you believe.

Absolutely. The DA fought this case intelligently and thoroughly throughout the courts. This isn't like some of these prosecutors that bury their head in the sand and try to ignore new evidence. In the end he has no control over what instructions were given to the jury during the sentencing phase. After all of this time and all of the money spent just keeping him in jail its better to just let him be forgotten. Once he's not on death row he ceases to be such an important cause.

That is exactly why I don't call 911 unless its a PD request. I have each fire and EMS phone number. It may take a few more seconds, but its so much faster that trying to talk to the UCT idiots.

Just for how simple Frank made such a complicated mess sound everyone needs to give him a rep point. the EMS CAD is officially "F***ing Piece of S**t CAD". Its a cumbersome name, so we just call it the EMS CAD. Yes, EMS has their own algorithm for assigning priority to each call. We also give pre-arrival instructions to all callers willing to stay on the line. In fact we were advocating hands only CPR for years before the AHA came out with the current standard. Simply because as soon as we got to the mouth to mouth part we'd usually lose the caller.

I've been bailed out by a passing company. 5 guys with axes and haligans is an intimidating and personally appreciated presence. There was also 90/41 making the papers recently for grabbing a chain snatcher.

Maybe things could have improved, but in 1995 EMS was just a division of HHC. With the right leadership staying in HHC would have worked. With the right leadership a third service would have been phenomenal. With the wrong leadership staying with HHC could have made NYC*EMS the next EMS dept to be shuttered and handed over to transcare. With the wrong leadership who knows what could have happened with EMS as a third service. What I know is what we had. A lot of initial ambivalence from within the Fire Depts administration, a very weak union, and a very eager workforce. That's the recipe for exploitation and we floundered. Today we have a Commissioner and COD that both appreciate EMS and what it means to the FD, we have a very vocal union, and we still have that eager workforce. On side perk to being an FD division that is rarely mentioned is Federal Grant money. Can anyone find any regular EMS dedicated grants? As a division of the FD we are eligible and have exploited many additional funding opportunities that would not be available to a third service. It is absolutely annoying explaining to everyone from my family and friends, down to the patients, and passers by on the street that no I am not a firefighter. I am a paramedic employed by the fire department. I would love for it to be different, but it is not. That is my single biggest gripe with working for the fire department. I can deal with that. Every other problem(and there are plenty) I have is not because we work for the FDNY. Come on, with all the back to back to back 16 hour days you guys were doing back then you couldn't have maybe gotten a 12 hour schedule worked out?? Hell, you guys got us these polo shirts. Why not a better work schedule? I was saying that the response times to the hot jobs were bad and the other jobs were even worse. Yes, before the merger the times were the best yet, but still do not compare to the times we are achieving today. Absolutely there are occasional jobs that fall through the cracks, Mistakes happen and they are addressed. Two summers ago when the high priority BLS job in Manhattan waited for a crew from SI, the system was changed to prevent that from reoccurring. The blizzard was an absolute failure on many levels and changes have been implemented and we'll see what happens. Occasionally those non-emergent jobs do wait for for a very very long time, but even on those busiest days during the peak of the H1N1 outbreak when we were still catching up to the queens hospital closings we maintained an EMS response of under 7 minutes for all of our life threatening call types. When was HHC coming close to that?

Its not huge, but I've yet to see an EMS dept that was running in the black without an inter-facility transport arm to prop it up. It may only be 30k per unit but some hospitals are looking at nearly $1,000,000 a year in additional debt. You need to double check who you're getting your information about present day EMS from. When was NYC*EMS ever even close to the response times we have today? I have not been able to get my hands on real statistics, but every break down I've seen has shown response times then were nowhere near what they are now. Anecdotal the picture is even worse. Absolutely, the MVAs, shootings, stabbings, and every other hot job were getting great responses. But the vast majority of EMS calls were often left waiting. HHC was doing nothing to grow and improve EMS. For all of the problems, false promises, and lies as part of the merger/takeover/whatever you want to call it the service has improved. Yeah, the pay sucks and management is half a step shy of evil but those are both problems straight from the days of green and white. The patient steering of the old days is greatly curbed. The real issue is voluntary units work in high insurance areas and crews tend to return to the hospital they're most comfortable with. Jacobi units txp overwhelmingly to Jacobi, Lincoln to Lincoln, and Presby to Presby. After the voluntaries were busted for actively encouraging the steering they're continually watched.

And in this case if your life is at risk the FD will intervene.

Here's one that actually made it to the street http://www.trendhunter.com/trends/police-get-gps-darts-sci-fi-cops-and-robbers

In these cases it is done through medical control. They are also not just being left to their own devices. They are left with at the very least a corrections doc and ideally an EMT. As I said, there's a serious question as to your clinical judgement if you're administering mag and then turning it over to the BLS. If they're that sick they shouldn't be turfed. If they're not that sick why are they getting mag. As for the extended awaiting escort these are cases where they're either stable or you've been so long you've been able to stabilize them. After waiting 2 hours for an escort I've nearly gotten an RMA for an asthmatic that was cyanotic and nearly intubated at the jump. He was getting called to appear before the judge and understandably didn't want to spend another night. In the end we sat in the back of the courtroom while he appeared, was released and then walked to the ambulance.

I don't remember the actual number, but it was a flat fee per unit around $30,000/year. The dept thinks they found a number that will allow most of the hospitals to stay in the game, but helps to fill a looming budget deficit. The argument is the fee pays for medical control and dispatching services. The added costs with absorbing these units are not as severe as they appear. First the dept is saddled with most of the poorest areas and until recently most of the ALS was provided by voluntaries. The numbers are a bit old, but our union commissioned a review that estimated taking all of the 911 ALS resulted in more insurance reimbursements that actually decreased our operating budget. Now I don't know how adding BLS to the mix works, but I'm assuming it was less than favorable to their argument. The research also didn't account for the added cost of new facilities. So while it will probably cost more money the expense is relatively small. There is a greater benefit to any hospital who's EMS division is costing them money. Thanks to the proliferation of specialty referral and the restrictions on patient steering there should be no significant decrease in the hospital's patient census. There is absolutely a bias towards facilities closer to a unit's home station. Hospitals can easily take advantage by simply providing a place for the dept to build a facility.

negative. After administering atrovent, even mag, and steroids I am able to flush the lock, secure it and turn over patient care to BLS. Same applies for diabetics and D50. If the patient were so sick that I went the mag and steroids route there is a serious issue with my clinical judgement that I'm turning over patient care to BLS. Your initial question was a simple neb treatment, and yes I would feel comfortable handing that patient over to BLS. Even the hypoglycemic I've been content to turn over to competent BLS after correcting the condition. In NYC we recently received a clarification, that with some minor tweaks could be applicable in Westchester. In NYPD and Correctional facilities where delays waiting for an escort to the ER become excessive we are now able return care of these sicker people who may still require ALS interventions at some point to the facility medical staff. In some cases that's a nurse or doctor and others it's an EMT. Its a quick call and has been used for the serious asthmatic after treatment, the stat ep, etc. Why not allow a patient to be left with the EMT on scene while they wait for that bus and free up the medic for the next call? Should the condition worsen the medic can be called back or mutual aid medic can be used.

Now if you'd please go back to my earlier post where I stated "Unless Westchester has something specific I'm unaware of". This is something Westchester specific that I was previously unaware of. As I am currently certified in NYC I would actually rather enjoy a conversation with a WREMSCO doc if for no other reason than to compare the differences in protocols. In fact I think it would work out quite well for me. Thank you.

All over the country people opt out of these services. If you live in an area without a school district or community without schools you would be required to pay to go to the nearby schools. Communities without police protection turn to state or county level departments.

So if I choose to not get homeowners insurance, I should be able to come back and say oops looks like I need it now. Do you still question the moral character of a group of people that can allow someone to become homeless and broke after watching all their belongings go up in smoke. How about someone buying car insurance after after they wrapped the car around a tree? The firefighters have an obligation to protect their community and the out of district homes paying the fees. The residents of Mt Vernon have the choice to pay for the dept they have or could absolutely get together and ask for a level of service on par with FDNY. They cannot however call NYC and ask that FDNY come because they'd rather have them come. These residents chose to forgo fire protection. This isn't one dept saying no, you're the responsibility of a different department so we're not going to help. These people chose to not have fire protection.

I know of two families here in NY playing that exact same game. They were given a house that is maintained and paid for by a 3rd party (ex husband or parents) and their BS little job doesn't pay much on the books. Doesn't stop some amazing international vacations while we all pick up the tab on their medicaid and other benefits. One once bragged she could even get food stamps, but they're too embarrassing to use.