ny10570

Bush really did care about our troops. He did the right thing for Buckles and always tried to show his support for the men and women overseas. Bohner cares only for himself and his own agenda. He typifies many of these tea party candidates and Its disgusting.

Phelps and the rest of the starry-eyed cretins that follow him only be encouraged into broader actions by this unfortunate ruling. I must say, however, that I have to agree with the court on a Constitutional basis. I'm certain that not one of the Justices supports the ruling in their heart in this particular context, but the law is the law. Such is our Democracy.
What I'm afraid of is that because of their incredible offensiveness and cruelty, Phelps and his followers will eventually bring violence and tragedy upon themselves. Such are the limits of human tolerance.
I can't say I would be "glad" to see an enraged, bereaved loved one commit an illegal act, but I don't think I could condemn it, either.

Personally I believe placing a standard, be it 5 years, 10 years, 50,000 miles or 100,000 miles is not truly effective or practical. Whenever you paint with such a broad brush you do not have clear, concise and effective legislation. Best example is the law that sympathomedic quotes. While a 10 year old bus may not be the best or first choice for an emergency service as a "new" first line vehicle it might very well suffice as a interfacility transport vehicle for non-emergent/non-critical patients. A 3 to 4 year old bus run 24 /7 in a high volume high mileage environment with over 100K in mileage may not be fit for a coffee run nevertheless being registered as an ambulance. I think standards aside, maintenance, mileage, and conditions of operation need to be made on a case by case basis with standards as a guide not a steadfast rule.

I had in my lecture just last night--Intro to Fire officer- a segment about being held to a higher standard. Guys thats just the way people see us, they see the shirt-the hats- the uniform- the fire car--the apparatus. We are in position of trust. We go into peoples homes when they might not be there. Our EMS handles children and the elderly. We have to be carefull. Every day someone is watching us and some of them dont like us. I know its hard to believe but it is true.

Metro-North has done a text book job of bringing the M-8 online. They spent a great deal of time planning and researching a new design. Once the first sets arrived, they began an aggressive daily testing routine. As per the contract, they cars had to withstand 4,000 problem free miles before acceptance. When there is any failure of any kind, the clock resets to zero. There are always issues in the beginning that need to be ironed out. Those first cars were running all hours of the night to rack up the miles and put them through their paces. Corrections have been made and now they have been accepted. They have entered revenue service as fast as MNRR could have possibly gotten them there.
The only person to blame is the previous governor of Connecticut. His short sighted administration delayed funding repeatedly. Ct. is responsible for 70% of the New Haven lines costs, including fleet purchase costs. The M-8 design was finalized almost 5 years ago and funding was the only delay.
Metro-North can't pay for them without gov't funding.
Metro-North can't put them inservice without the appropriate testing
Metro-North can't make Kawasaki build them faster, nor can it make the ships, trucks and trains get them here any faster.
You'll note that when NY was solely responsible for the replacement of the M-1 and M-3 with the M-7, we didn't wait this long.
Your anger is completely misplaced. There is only one group responsible for the delay and that is the Conn. Dept. of Transportation operating under the previous Governor's administration. Thankfully Gov. Rell took office and saw funding delivered.
As for MNRR being a corrupt organization...well, no one doubts an interstate agency's high level of bureaucracy, but you should travel back in time 25 years and see what the railroad looked like then. MNRR under MTA has transformed a hodge-podge of railroads and equipment, with dilapidated infrastructure and rolling stock into one of the smoothest running commuter operations in the United States.
Your comment certainly negates your knowledge of any "back-story".

Every day we ask for special treatment and perks because of what we do. Well it cuts both ways. When we screw up we get treated special as well.

Your anger is directed in the wrong location. It is the State of Connecticut's fault. Metro North owns 50% of the cars and wanted to replace them years ago. The state dragged its feet until it was too late. MTA Metro North did the best they could with the cards dealt to them.
Only The first train did the 4000 mile acceptance test, now the rest only have to do 1000 miles of trouble free testing. Better to wait the get stuck between stations because something new and untested failed.

Full Story
"In other words, we were the typical cocky Americans no one wants around until they need help winning a war."
After serving as an ambulance driver in WW1, the great depression, surviving over 3 years of internment in a Japanese civilian POW camp during WW2, and countless other milestones Frank Woodruff Buckles has passed away as the last surviving doughboy and one of 3 WW1 vets world wide.

Full Story
"In other words, we were the typical cocky Americans no one wants around until they need help winning a war."
After serving as an ambulance driver in WW1, the great depression, surviving over 3 years of internment in a Japanese civilian POW camp during WW2, and countless other milestones Frank Woodruff Buckles has passed away as the last surviving doughboy and one of 3 WW1 vets world wide.

Yes, the lights are blue and they make the rig able to carry more equipment and help the firemen on-board to be better at their jobs.

Auto narrative takes away one of the real perks of digital records. Substantially more space for a detailed and accurate narrative.

Just a few thoughts and a quick disclaimer; I currently operate as a career paramedic but previously was in law enforcement. While being involved in both fields, I have never been a “Tactical Medic” affiliated with an active team, although I have attended tactical medic training through several institutions in the northeast and southeast.
Tactical medicine provides some great advantages; both in a hot zone and perhaps even more so in the staging area/warm zone providing occupational health oversight and team monitoring. There is no need to go into the benefits of such a position as we all are well aware of them.
Some comments on TRAINING:
One of the biggest problems is that providers are under the assumption that completing some form of a TEMS course is sufficient to have them effectively participate on a team. I am constantly running into civilian (and some currently detached LEO) EMS providers (Paramedics, EMT-Bs,I,CCT) that say they are “Tactical Medics” because they took a TEMS course. All the TEMS courses (CONTOMS, HSS International, U.S. Training Center etc) provide a basic introduction to TEMS and some basic firearms instruction. They provide the mindset needed; but do not qualify someone to operate on a team (for the safety of the team, their safety and the safety of the general public).
Simply being able to manipulate, engage a target and render safe a firearm coupled with EMS training is not sufficient to make a TEMS provider ready to operate on a team.
ERT operators (LEO Officers) are highly trained in special operations. In additional to consistent firearms training, operators are educated in coordinated movements, tactics and procedures that make up a majority of the curriculum.
Someone previously mentioned that it is more desirable to have an active paramedic operate on the team because they are currently practicing. I agree with that principle, however, the same principle applies to the skills required of an LEO.
ERT operators train frequently; not monthly, but weekly. Movements need to effortless and second nature. Firearms must be readied, sighted in and used. To be a proficient ERT operator, just as a proficient Paramedic, your skills must be used constantly and maintained.
Some comments on PROFICIENCY/ACTIVITY
Being a proficient Paramedic comes down to having a solid education and being active to keep your skills up. NYC provides an excellent environment for Paramedics and EMS in general (coupled with a significant amount of BS). There are many voluntary hospitals that have per-diem staff members who can select from a plurality of locations to work ranging from the Bronx to Northern and Southern Manhattan. Paramedics who may be in a practical slump can select tours in busy areas to practice skills and procedures.
Unfortunately, as most EMS providers know, it is common to work 50-60 hours a week as a Paramedic to make a living.
LEOs also need to keep their skills up. Range days, team trainings and working the street are all part of a law enforcement career. With respect to LEOs on ERT teams, even more practice is necessary. Transitioning between carbines/pistols, non-lethal weapons, tactical reloads etc etc etc, ERT movements, room clearing…and then the legal aspects of entry and engagement. Distinct from EMS, most urbanized law enforcement agencies are primarily FT career based operators. Almost, if not all, ERT teams are comprised of full time LEOs.
DISCUSSION
While everyone should agree that it is desirable and necessary to have Paramedics and LEOs who are both proficient and active; that very concept presents and inherent conflict. There simply are not enough hours in the day to truly do both.
I know there are a lot of civilian Paramedics who really want to be on an ERT team (including myself), but we need to take a step back and think logically about what the job entails. It is not just attending a TEMS program and purchasing a drop holster and a chest rig. The job requires 100% dedication to the ERT team which includes maintaining proficiency at every skill that the LEO ERT member has as well. Teams by definition function as a group. Each member must be an equal participant and be predictable. This requires constant interaction. All dreams aside, without 100% dedication, an unnecessary risk is placed on the team and the public. Working 50-60 hours a week and an addition 20 hours per week plus deployments just is not possible anymore.
However, it is essential to have medical trained providers on the ERT team.
During deployments, 70-90% of the time, no medical interventions are necessary. However, when they are, they are generally trauma related requiring immediate intervention.
Many LEOs are also per-diem paramedics. It is possible for them to have a primary job on the ERT and have a per-diem job in EMS. To maintain their proficiency as a paramedic, or at least their skillset as it relates to traumatic injuries (GSW, hemodynamic comprise, IV/IO access, ETI, advanced airways, bleeding control; almost a NREMT-I curriculum will suffice), they have the ability to pick up tours in busy areas. I cant remember a time that a 12 Lead ECG or advanced medical case present/was treated in the hot zone. Not saying that it won’t happen, but the victim would be extracted in that case anyway; and complex aided case is not going to be treated with an active cqb scenario.
One of the important aspects of this is that the LEO/Paramedic can pick up shifts INDIVIDUALLY based on his schedule to maintain his skillset as a paramedic. He can select a busy bus in the BX for example or BK. A career paramedic does not have the ability to pick up a shift on the ERT without deploying the entire team. Fulltime LEOs are already on the team regularly and train with them as a group; practicing as a paramedic can be done per-diem to maintain proficiency. Several NYPD ESU members work per-diem for the hospitals and are very capable and proficient.
In summary, while it a civilian Paramedic may find it desirable to operate on a ERT team, while theoretically possible, it is far more efficient to simply train an existing LEO with EMT-I or EMT-P skills and require they maintain proficiency in their secondary capacity as a TEMS provider.
When 70-90% of the job is going to be LEO related proficiency, the remainder can be trusted to a proficient LEO TEMS provider who has the ability to stabilize the patient to allow extraction.
Just some thoughts, I do not mean to offend anyone. Best of luck with everyones endeavors!!
M1

While training someone to be a medic is harder than than training someone to use a gun, a tactical medic doesn't need to be a full paramedic. They need to be a trauma medic. A blind airway, hemostatic dressings, and tourniquets are your primary tools. Have your civilian medic parked at a staging area so you can maintain your opsec and keep the most useful tool to a downed officer, rapid transport, available

I'm sure I will draw the ire of some with these comments but having experienced some of these things first-hand, I have some strong feelings on the subject.
The need for a second medic should be a rare call because a paramedic should be competent and able to handle a single patient without a second paramedic. That said, there are always those calls where IV access or intubation is challenging and the condition of the patient warrants the expeditious handling that two medics may be able to provide.
In cases where an intubation is difficult or suitable IV access can't be obtained, the benefit of an EMT-Intermediate on scene will be limited. As was pointed out, in this area EMT-I's don't get a lot of opportunity to hone their skills and they would not be my first choice to back me up if I couldn't get a tube or line in someone. This is not to say that an EMT-I is not valuable or their skills useful in some areas (St. Lawrence County probably has more EMT-I's than P's but Westchester is the opposite).
I suspect that the EMT-I program never really caught because we have people who are resistant to the length of the EMT-B course so taking another course of nearly the same length with no prospects for employment or skills practice had no appeal. Another big problem is that there are some skills that paramedics don't get to practice often enough to maintain their own proficiency so they're not going to let the EMT-I perform them.
As for people being able to assist the medic with EKG's, setting up meds or IV's, or other stuff, there was a time that we called those indispensible assistants EMT's. You don't need to be an EMT-I to put electrodes on a patient and set up the monitor while the medic does other things. EMT's routinely used to do most of the things that are being discussed here and I've never understood why that skill set diminished as much as it did. I guess turnover, apathy, delayed response times, and other things all contributed to what I'll call the demise of these kinds of EMT's and that's a shame. I worked with EMT's who were able to do almost everything I could do as the medic right up to the venipuncture or intubation or other invasive skills. They were crackerjack EMT's and truly a pleasure to work with.
Unfortunately we have EMT's out there now (and I'm confident that they're still the minority) who are barely competent in their basic skills so helping a medic is stretch.
Good topic!

I have a feeling that more than 90% of the time paramedics either beat VACs or are only a few minutes behind them in westchester. I just don't really see the point here, especially when the scope of practice is so limited.

Why do you infer that YFD is not the "real world"??
Why do you assume that I am advocating for WC DES?
I am surprised that you are apparently not aware of this but the concept of formal typing of resources, credentialing, and county coordinators coordinating, was not created by me. Since you are a retired supervisor in FDNY EMS I am surprised, first of all, that you can't conduct a civil disagreement without resorting to personal insult, and second of all, that you would propose such a haphazard and ineffective solution to a serious problem when the obvious solution is staring us right in the face and is apparently working just fine in counties throughout the U.S.
Professionals (which include both career and volunteer) must discipline themselves to not take these issues personally and to see the big picture. So, I didn't like your idea. Get over it. Admit I am right or make a better argument based on facts, not feelings.
To further illustrate my point I will use as an example a major terrorist attack or natural disaster with widespread media coverage. While it may feel good to respond from wherever you are with whatever you got and tell yourself that you are helping, it is recognized by professionals in this business that this type of response normally does more harm than good. The unitiated may ask, "how so? What can it hurt? And if our response saves a life or makes a job easier then it will have served its purpose, no?"...Well, no! Uncoordinated and undisciplined efforts typically do more harm than good. Communities are stripped of protection and the community where the major incident is occuring is overwhelmed by well meaning individuals with mostly the wrong equipment or skill set for what is required, and before long these 'helpers" who have crowded the area and slowed the response of those agencies who are actually requested and needed, are asking the already overwhelmed Incident Commander (or hopefully Incident Management Team) for food, fuel, bathrooms, and shelter. I realize this analogy is not exactly what we are talking about, but it's germane. Just because it feels good does not mean it's effective, and it may even be harmful.
Westchester County has people who are supposed to be coordinating all the emergency service assets of this county. I will not criticize them because I all too well realize that not every boss has adequate assets to accomplish everything he is tasked to do, so he or she must prioritize. Maybe that is the case in Westchester. If individuals such as yourself are concerned that this should be given a higher priority, why not use this forum to mobilize people to request / demand that assets be put in place or priorities shifted to accomplish this in a professional manner?
And please, lean away from the computer for a moment now before typing, take a deep breath, that's it...now let it out, and yes, qtip...

And when they become a chief or IC for that matter they too will have to follow the law and comply with the respiratory standard (2in 2out).

Yes, colors are important. Red stands out, chevrons stand out. A maltese on a door and a town name is not apart of that visibility package.

The lettering on emergency vehicles is not what makes them visible, it's their emergency lights. CT State troopers have no lettering on their vehicles. Does that make them more dangerous / less visible when responding lights and sirens? I don't think so. Whether you like it or not, I don't think you can argue that it is a safety issue.
That being said, I don't see the point. It makes it less likely to be spotted by civilians who need to "flag down" an emergency vehicle, (as rare as they may be)

That all depends on your environment and the citizens inhabiting that environment.
I'm a fan chemical restraint when use appropriately. I'd rather worry about R on T or some rare and obscure drug interaction than the patient harming myself, my partner, a police officer, or themselves. Versed, Haldol, and Ketamine are all used frequently around the world with little adverse reaction. Hell, as soon as we reach the ER with that EDP or drug induced psychosis that we spend so much energy trying to physically restrain the first thing the MD usually does is order up the old Haldol/Ativan cocktail.
My 2 cents about nasal drug administration, it sucks. It works great on paper and with compliant patients. I've used it with great success to sedate for pacing on a diabetic with zero IV access. Also used it for Narcan on a cyanotic heroin OD. Just pinched his lips, waited for the inhale and bingo right to the turbinates.
Now take a comabtive EDP who will likely try and bit anything you put near his mouth. So, you're not getting the best access to the nose. If they're severely congested you're drug isn't going anywhere. Squirt something up your nose, and your first reaction is to blow it back out. EDPs do the same thing. More of your drug winds up on your hand and running down their face. If you can control the head well enough to put your hand next to their mouth then you can control the arm well enough for an IM injection.

Roll, I like your thought process, but you're missing some key facts. These are warriors in training. However these cadets have not been through extreme exposure training like that of the SEALs, at least not yet they were Freshman. They were dressed lightly as this was supposed to an afternoon of physical exertion. They were stuck exposed to the elements for at least 7 1/2 hours. None of the articles mention when their day started, but the FD got on scene at 6:30 and aviation was there at 2am. The two were smart enough to tie off on a ledge so they weren't just hanging there, but they were exposed to freezing temps and high winds for hours. An experienced soldier would have a hard time functioning at that point. An 18 y/o just out of H.S. would absolutely be hypothermic, have zero dexterity and be unable to follow simple commands.
To me this eliminates climbing back up with them unless its truly a last resort. Going down, definitely more viable, but how far are we talking? If none of my ropes can make it top to bottom I do not want to be engineering an anchor on an 18" ledge that I'm sharing with two hypothermic and potentially AMS cadets. If aviation feels they can perform the grab, have at it. If not, then we can resort to climbing.
Here's the NY Times article with interviews from the flight crew.

Ever call 911 in NYC? Now it is horrible, you will have to go through the same BS, and if you have a fire forget it!. I don't even call for car accidents anymore they ask what exit number, I didn't even know they had numbers!

There was a bulletin out several years ago clarifying that each agency was responsible for determining what was an acceptable method of soft restraint with their medical director. The rules are vague, but clearly put the liability on the agency. If pt's are escaping your cravats then you are tying them wrong. Its not easy, especially skinny people with narrow hands however if done right cravats are effective. I've long ago lost count between EDPs, head traumas and combative intox/od's how many, but after they escape a few times you figure out what you're doing wrong.

http://articles.latimes.com/2011/feb/07/local/la-me-texas-budget-20110207
After 2 years of republicans touting smaller government and free market economy saving the day, the best example of Republican policy in the US is forced to show its true colors. After balancing their budget with the evil economy crushing stimulus funds last year Texas is facing a $27 Billion budget deficit or 30% of the current state budget. This problem isn't an issue of healthcare, pensions, welfare, social reform, education or any other societal woe people try and peg this on. The problem is politicians spending money like a kid with daddy's amex during economic prosperity. Republican and Democrat led states have all fallen into the same hole and followed the same exact path into this nightmare. They spent more than they had and when faced with looming revenue shortages worked the numbers and shuffled their debts hoping the shell game would outlast the economic down turn. What is most distressing, is that since neither party has a proven solution and neither side is willing to negotiate it is becoming increasingly clear that the working class is going to get murdered. The left cares only about the poor and the right only wants what's best for the wealthy. Their version of compromise screws us royally and we continue to dig in behind these animals on the grounds that Obama is after going to tax us to death, Boner is going to take our pensions, Pelosi is gonna blah, Palin, is going to blah blah...and on and on we go. What is the solution? If all sides are apparently doing their best to sink us, who is going to screw us the most gently?

So there you go, by my extremely precise guestimated perception statistics a generous 30% of the calls are accurately typed and get the paramedics they need. The system is toast and I'm sure M'ave can attest to all the improvements UCT has made. The future sure looks rosy for NYC.