NWFDMedic

Also as far as not going to Saints...I am a Paramedic and I don't question it at all. I'm sure the Paramedic on scene had their reasons as to why they felt a Level 1 Trauma Center was the appropriate choice versus a Level 2 for this patient. Transport decisions based on injuries is a common and important part of patient care, particularly when you operate in a close vicinity of a Level 2. You must know their limitations and what criteria when present dictates the need for Level 1 and in Trauma there is discretion for Paramedic interpretation of injuries also so I'm not sure what this is an example of. We don't know what the injuries were, what the patient status was and what the interpretation and impression these injuries and associated conditions with them was by the Paramedic in charge of patient care. Just because its there and it is an "area trauma center" doesn't mean its the best fit for every patient.

You couldn't have said this better ALS. I was working that night and unfortunately I was moved to Orange Co. earlier in the night and wasn't paying attention to the UHF radio that intently. The helicopter may have been called for by the FD before the ambulance got there because as I understand it, there was some delay with the ambulance getting there as they originally went to 9D and Alpine Drive instead of Route 9 and Alpine Commons. I have also been told that despite the call being a pedestrian struck, there was some "extrication" from the vehicle to be performed. If you can get the helicopter there or close while you're doing extrication and rapid trauma assessment at the scene and the patient needs a Level 1, then it's the right call. Without all of the information, nobody can Monday morning a medic deciding to send a patient to a Level 1 over a Level 2.

Actually I have since I live there and before you say anything I know full well about Regional losing St. Luke/Cornwall, Mobile Life is now doing the work out of there, and New Windsor is going to be a full ALS provider for themselves and the Town of Cornwall. But Regional knew full well about New Windsor wanting to go full ALS and alot of what has happened to Regional in Orange County has happened since Mike has left. Mike left a position with Regional/RPS and ventured out on his own. I don't know if what has happened in Orange to Regional would have happened on his watch. I have heard through the grapevine that HVP is looking at contracts in Orange as well as Dutchess. Ulster county has always been a crapshoot at best for the most part it is a Mobile Life strond hold, except for those areas that provide their own ALS Shandanken, Saugerities etc. As I wrote earlier the next month and half should be interesting remeber the Putnam contract becomes Transcare's at midnight on 10/01/08.

Well I get the feeling that Mike wasn't getting the support from the south end of Regional that he needed to grow the operation in Orange County. I'm not privy to any of the information about Luke's and Cornwall (and if I was, I obviously couldn't write it here), but as far as the ALS mutual aid contracts were concerned, they are selling their municipalities short and I don't think that was Mike's doing at all, but the unwillingness of the powers-that-be down south to give him the needed resources.

As far as New Windsor and Cornwall are concerned, you are correct, NWVAC is soon going to be a full ALS provider. I don't know what's going to happen to Cornwall, because I would think that NWVAC couldn't legally provide ALS to them and I can't imagine Regional would keep a presence here for that small call volume, but who am I to guess. I live in New Windsor and personally I'm happy to know that I'll have a full-time provider for my town.

I wish the employees at HVP the best, because although they are the competition, they all have mouths to feed and rent to pay and we are all brothers and sisters in different uniforms.

Regional comfy? Apparently you haven't been in Orange County lately.

In my opinion, the IAFF feels that by having their members volunteer, they are in effect reducing the possibility of obtaining new members..... Ie - if the volunteer fire service fails, someone will have to do the job and that someone will be a paid IAFF member....... I personally think they should have no right to tell a FF what they do during their time off unless it is a direct conflict of interest or some other legitimate reason...... I truly hope that this get challenged but I doubt it ...................... Bill

I actually see their point here and I don't have a problem with it, at least for firefighting. Volunteering in another jurisdiction is effectively helping to keep union firefighters out of that jurisdiction. However, I don't see why it would matter for police officers. Most police officers are union and I don't see the conflict. EMS is a middle ground, because there are many IAFF shops that want to keep or bring the EMS work into their shop.

Trancare got the Putnam contract. I guess this will spell the end for Empire/HVP. They have nothing left in Dutchess and Ulster is hanging by a thread.

It's good that the EMS crew knew what to do, I don't think many EMS providers that aren't firefighters as well would have thought to make the effort to mitigate the hazard. This might be something I'll talk to new employees about when I'm doing field orientation.

Well, I think you made a good choice to immobilize because of the unknown incidence of trauma (ie. how did he get there?). Otherwise, airway, breathing (O2 via NRB), circulation. Considering the patient is initially combative, your treatment could be limited. I see no indication for Glucagon. If you can stick someone with an IM injection, there's no reason you can't obtain glucometry to potentially rule out hypoglycemia, especially in the presence of a potential head injury.

My course of action would have been as follows after the c-spine and oxygen: First, I'd call for help. Get enough people to hold him down to safely immobilize him and get an IV started. If the help is unavailable, skip the IV and some IM ativan would probably be my choice. Even in the event of hypoglycemia or a head injury from a fall, it won't have a detrimental effect. Then get your IV started, check blood sugar, have the PD check his person for possible drugs or paraphanelia (?sp), and have an officer find out who on the construction site might know him and a little bit more. From there, if his vital signs seem to be indicative of an opiod OD, I'd give some Narcan and obviously if it's indicative of hypoglycemia, I'd give Dextrose.

It sounds like a simple seizure, but with unknown trauma, you'd obviously be immobilizing. I'd keep a close eye on respiratory status, mental status, and of course vital signs to look for signs of a closed head injury. If I thought any of those were compromised or about to be, I'd be ready with a BVM, Lidocaine, Atropine, Etomidate and Succhinycholine because I'd rather get the patient intubated while I can and before he's seizing again or dead.

I'm from the Hudson Valley Region and I'm honestly impressed that you got orders for 10 mg of Versed IM right off the bat.

The following is not directed against anyone in particular so don't take offense.

I don't know about anyone else but my kids know the taste of Ivory and Lever ...just as I did. As for a good crack in the a** ect. well we practice it when necessary..and quess what no matter what those Phd.s say...it WORKS !!

But that's just in my house.

By the way my family is in no way "well off" and my kids (11, 10, and 8) don't have alot of "things"...but even if I had billions in the bank I wouldn't just give them everything they want. So even being lower middle class my kids get what they NEED from my wife and I. We work damn hard on instilling and reinforcing those core values I mentioned earlier. For all our hard work we've been blessed with respectful, decent young people who actually give a s*** about others. It ALL starts and ends in the home folks. We can lament the society of today all we want, but we are the only ones who can change it. For my (and my wife's) part we've done ok and will continue to do what is necessary to be a part of our kids lives...maybe if others in this world would do the same some of these problems would be solved.

Cogs

And I'm sure your kids will make good firefighters one day. I agree with you too, there's nothing wrong with a little soap.

Congratulations and good luck in a great profession. Will they let you fly school bus yellow planes???

I'd venture to guess Wheeled Coach built it, judging by the upper corner strobes (trademark).

It is indeed a Wheeled Roach. You can see the logo above the ford logo on the front quarterpanels.

And on the cover of today's Times-Herald Record, the top 10 overtime earning cops in the county. I haven't seen them publish the OT pay of the county's DPW workers.

All the more reason why its important that we police our own from within our ranks, whether you are public or private sector if at all possible. The public tends to stereotype based on the actions of a few without looking at the overall picture. As some in here have suggested, image is very important when it comes to the public as in most cases, they indirectly control the purse strings.

It's a shame that a few bad apples can ruin the bushel. Career firefighters are, for the most part, respectable and honorable men and women. Their unions are there to fight for everything they can get, that's what unions do. Unfortunately, the media doesn't help either, for career or volunteer departments. How often do you see in the news "Firefighter arrested after drinking binge"? Well you don't hear about the "Wal-Mart greeter arrested in drinking binge". If that even made the news, it would be a "local man". And if you think the fire service has cornered the market on disability, you ought to go into any local sanitation or highway department one day.

When I joined my first fire department in 1990, I did it not because I wanted to, but because I had some sense of obligation to my family. My grandfather was a member (and in fact President) of my local volunteer department, my father was a member (VP), and both of my uncles were members. A past chief sold the family all of it's insurance, members of the department sold us our produce, fixed our cars, owned the local deli that I visited every morning, ran the Boy Scout troop, managed our Little League teams, and countless other things.

Today, just 18 short years later, kids do all of their shopping at Wal-Mart, there are very few locally owned corner stores, most of the time we get our convenient store supplies at the Qwikie-Mart, we buy our insurance online, we go to Pit Stop for our oil changes, the local Boy Scout troop is gone, and the Little League is managed by people who are more concerned with their travel teams than an outlet to let EVERYONE who wants to play have fun and learn something about teamwork. Excuse the run-on sentence, but the community is gone from the community; heck even our kids are bussed away from their local schools in the interest of some sort of racial equality (???). In the Hudson Valley, we all know about commuting parents and bedroom communities, people who work 10 hour days and spend 3-4 on a train, etc. etc.

So, what do we get in the fire department these days? No offense to the kids (younger members) who are out there doing the job, but for the most part, our younger members are the outcasts. They have very few friends and are looking for some type of identity. Some turn out to be great firefighters, but for the most part the new generation of young firefighter turns out to be more of a headache than a help. I'll take my 40 and over crew any day and twice on Sunday because I know they'll be willing to work with me as an officer, not against me. The young kids only want to do what's in it for them and they rebel when you actually ask something of them. Again, there are some great members in the 16-24 crowd, but they are the exception now and not the rule. I have no problem with kids wanting to party, get drunk or laid ... we all did it, but when it's time to be a firefighter, it's time to be a firefighter.

They are not all that bad Rob. In fact, I just got back from one (surprise). They have procedures that they have to follow that we don't understand in a lot of cases. I just go with the flow; anything that happens before I make patient contact isn't on my watch.

non-emergency? ...Hell No

County, State and Feds have their own transport units and they bring sick, non-urgent patients to WMC all the time. to put ems into this is wrong...but for those EMS COMPANIES...as long as someone is paying the bill, what they hell do they care...

being in valhalla vac we do mutual aid calls to the county jail a little too frequently and when i did my rotations at empress we id a non-emergency transport for the Bedford jail - mind you we went code 3 to the jail FROM YONKERS and transported the pt. non-emergency to the hospital, which i think was st. agnes.

and, NO GUNS have even been in the ambulance while i've been on the calls. the CO in the ambulance gives his gun to his partner following in their van...the way it's supposed be.

The state prisons generally bring their prisoners to and from non-urgent procedures in those beautiful blue vans. However, if a patient is non-ambulatory and cannot sit in a wheelchair, they have to go by ambulance. My company currently has the contract with Fishkill Correctional and we take patients fairly regularly to Mount Vernon for routine procedures. In fact, I was just there Wednesday night (and I hate Mt. Vernon with a passion).

You have brought up an interesting point though. Would it be appropriate for NYSDOCS to provide our staff with any type of training regarding issues with the transports? Is there any type of training available for civilian personnel that have to deal with the prisoners on a regular basis? Personally, if something goes wrong, I would lean toward saving my rear and my partner's rear and let the corrections staff deal with the rest. I know there are some issues regarding driving with the corrections staff and with a "chase" vehicle (ie. no quick lane changes, signal and then let the chase vehicle move first, etc.) but those are things I picked up along the way.

Was this a one time incident or a regular occurrence? I have been transporting prisoners from state and federal facilities for 12 years and have never seen anything other than a handgun brought into a medical facility, with two exceptions. One patient was a (very) high profile prisoner from Otisville Federal Correctional Institute and the other was a patient who the state considered a high risk of activity because he was being transported to St. Luke's Hospital (Newburgh) and had been involved in an incident in Newburgh and still had friends (and likely enemies) in Newburgh. The latter patient we actually transported code-3 to the hospital at the request of the facility.

I'm very interested in knowing what your near miss was that not having a seatbelt on saved your life.

Well, I'm not going to argue your points because they all have merit. As far as my accident was concerned, I was hit in the driver's door by a vehicle that decided not to stop at a red light (and I was young and stupid and thought that the green light was my ok to go). The impact actually sent my upper half across the center of the car and basically into the passenger's seat. The driver's seat was crushed into the steering wheel and broken in at least 3 places. I know it's the exception rather than the rule, but on that day I was lucky not to be belted in.

I don't know if this thread will make me change my mind in my personal vehicle (I'm a stubborn getting-older son of a gun), but the post regarding the safety of the other occupants of the back of an engine left an impression on me.

I think we all need to remain objective here. I'm sure that everyone here could tell stories about this agency doing this and that agency doing that, but if we look in the mirror, every agency and probably every paramedic has had that call that just didn't go the way you would have wanted. Each and every interaction I've had with Empire State has been less than pleasant, but it at least sounds like they are making an effort to turn things around. If patients start getting the care they deserve with this change then we all come out winners in the end because our profession looks more professional.

So when the rig crashes and your 100, 200 or 300 (or whatever) pounds slam into me ending my career thats ok......I'm wearing mine and my injury is not caused by my actions, they are your fault. And if I (or my family) can sue you or not or even win is not the issue.

The issue is you may believe you can be hurt or not care. But if your on my rig your job is to protect my back. If you can't or won't do that ..........I can not call you "Brother".

Excellent post and quite frankly something I had never thought about.

I am no lawyer but I believe chief's and districts can be held liable wether there is written policy or not. I recall a case in upstate NY where a firefighter was killed and two others severly injured during a live burn. The result was the chief did time in jail and also faced ( or is facing) civil suits because there is a standard out there that regulates live burns that were not followed. There are also standards out there that say wear seatbelts. Not having a written policy is no defense.

The difference in that situation is that the Chief was the proximate cause of the problem. If there's a seat belt in the truck and you are told that you should wear it (which we all are told in OSHA class) and you choose not to, YOU are the proximate cause of whatever happens to you. I'm sure there will be an attempt at civil litigation, but unless they can prove that the Chief willfully promoted not wearing seat belts, then the litigation will be DOA.

Sorry, I'm just sick of people putting hammers over people's heads with fear of litigation. Call me stupid, but I don't wear my seat belt in my car either. I was in an accident when I was 20 years old that would have killed me if I was wearing my seat belt. If I end up ejected and dead, that's my own dumb fault. If I end up getting a ticket, I'll be mad, but again, it's my own dumb fault. Seat belt laws and helmet laws drive me nuts because they are a victimless crime (unless you consider the financial burden). You can't hurt someone else by not wearing your seat belt or helmet. The only place I wear it is in the ambulance at work because I'm required to by company policy (coincidentally not by state law).

not worth arguing over ware your seat belts.10% 15% 25% still a lot and still too many

Well, when you consider it's less than 10% of 25%, you're talking less than 2.5% of the total LODD that occur responding or returning on an apparatus. Less than 2.5% is a lot less than 25%. I'm not a fan of scare tactics and that's what your entire post was.

30 or 45 it wasn't my point.. Why send a vehicle Lights/Siren, you are risking the crew, possibly the patient, and all the others on the road.

I think any agency would be hard pressed to explain after an accident why they were going lights/Siren for a simple transport..

Unfortunately, most paid services don't want to decline jobs if a crew is not within a reasonable distance or can't get there in a short period of time.

I know what your point was, I was just razzing you a bit. Our dispatch does something novel with direct calls from skilled facilities (and a few unskilled ones). They ask the facility whether they want the crew to respond lights and sirens. Generally, the nursing staff will say no unless it's a true emergency, where the EMD information may warrant a different response. If I'm going to ABC nursing home for difficulty breathing, EMD is always going to place that in a code-3 response. However, the nurse might know that he has pneumonia and has been a bit short of breath for 3 days, which would not require the same response.

As far as response in a reasonable amount of time, I'd think the same rule would follow. If I'm paid service X and I know the closest unit I have to respond to a facility is 25-30 minutes away, why not advise them of that? If they say that they really think the patient needs to go sooner, then offer to get a closer resource for them and turn the call over. If the delayed response is the exception rather than the rule, your facilities will understand and you won't lose your contracts, so long as you don't lie to them, send inappropriate level units, etc. etc.

As for donning the SCBA, SCOTT has a little thing on the bracket (kind of a seat belt) that prevents the pack from dislodging on its own. This strap is intended to buckle the bottle and harness in place behind its shouldner straps. The idea is, when you get into your seat, you should already be suited up with bunkers and your coat, then just wrap your arms under the shoulder straps of the pack and then buckle your seat belt. Now you can concentrate on donning the rest of your gear on the way to the call. It sounds confusing, but it really works, if done properly. Remember, the yellow strap must secure the SCBA in place behind the shoulder straps, leaving them available for you to begin the donning process as soon as you get in the truck.

Like I said in my last post, I will neither support nor speak against the use of seat belts in the back of the apparatus, I'm simply stating facts. I don't like when people like the previous poster create facts or scare tactics to make you think wearing a safety belt is that critical. If I get killed in the back of the truck because I'm not wearing a safety belt, however, my parents wouldn't sue the fire district because I was the idiot not wearing the belt. At work, we have a policy, so I have to do what they say.

The whole SCBA thing is a convenient excuse people like to use for not wearing safety belts. As a larger person (nicely put), in today's apparatus, I have a hard time trying to don an SCBA in the front seat, not to mention my district is the size of a postage stamp and I have to call out to two bases and talk to whoever else is trying to give me information (that I usually don't care about ... sorry chief). I usually put my pack around one shoulder, it comes with me when I get off the truck and it takes about 5 seconds to don outside. Coincidentally, that 5 seconds also gives me time to relax, finish up my size up that I started as I approached the scene, and then go to work without the huge adrenalin rush of jumping off the truck.

As far as those yellow straps are concerned, I hope you have more luck with them in Wiccopee than I do. If there's one thing that I hate about checking packs on our new rescue, it's those brackets.

Personally I never understood the purpose, of going from Kingston to Poughkeepsie lights and siren for a basic transport (45 min travel time), in some cases the patient could have walked to the ER quicker, the NH was that close to Vassar.

It took you 45 minutes to travel the 16 miles between Kingston and Poughkeepsie? I did Newburgh to Kingston at a nice leisurely code 1 pace in 30 minutes the other day, and that was on 9W, not the T-Way.

Someone said it earlier in the post 25% of firefighter deaths occur during responding to and from alarms. Waring seatbelts just might bring those stats down. The life you save may be yours.

Drivers of apparatus if you allow some one to ride without seatbelts it may be you named inthe law litigation.

Chiefs if you do not have a seat belt policy--you better get one written in a hurry or your name will be added too.

OK, I'm not going to argue the issue of seatbelts in the back of a rig persay, but here's a bit of information regarding the statistics that are being quoted. While it is true that 25% of FF deaths occur during responding to and from alarms, less than 10% of that 25% actually occur while responding or returning in an apparatus. The majority of those deaths occur in personal vehicles. While no death is a good thing (obviously), the numbers are not nearly as alarming as one might like to portray.

Second, the concept that drivers of apparatus would be subject to litigation is absolutely absurd. In New York State, there is no law for back seat passengers requiring them to wear safety belts of any kind. If there is no department policy regarding safety belts and the drivers' responsibility to make sure they are worn, then there is no grounds for litigation against the driver. Stop trying to scare people.

Finally, while chiefs or districts may be subject to litigation, the possibility of the litigation actually sticking is somewhere between slim and none. In fact, a chief or district would be more likely to be subject to litigation if there was a written policy that was not followed and something happened.