NWFDMedic

Great job with the trailer Doug and of course we all hope that it never has to be used. I don't work much in OCEMS now, but is there any plan of cooperation for different agencies providing different specialized equipment to regions? I know that on the fire side we have departments that house haz-mat trailers, all terrain vehicles, foam capabilities, cold water rescue, etc. and they are basically for use within the area. It's a cheaper way to provide service without undue duplication and it fosters cooperation between agencies.

It's nice to see that some of the volunteer EMS services in the county are starting to progress toward interagency cooperation and communication. It's definitely been a long time coming and it had to be pretty tough to push cooperation from the grass roots. Nothing but good can come from this progress (even if I don't get to meet with your ambulance anymore ).

The EMT-I course is still around and I'd like to see it as a trial class for potential medic students. I took my EMT-I class in either 1997 or 1998, having 4 or 5 years as an EMT under my belt. I don't know if the class is taught similarly statewide, but my class was very intense and it taught a lot of the "why" behind the "what" that you learn in EMT class. I felt that the class was more valuable for the knowledge and assessment proficiency than the skills. If you don't like the EMT-I class, you probably shouldn't be thinking about medic school and wasting thousands of dollars.

In the Hudson Valley Region, an EMT-I can only operate within a paramedic system. Loosely translated, the EMT-I can only operate independently if the paramedic resource is not available. I had a couple of instances in multiple patient situations where I was allowed to operate independently as an EMT-I, including a flight job in a remote area where the next paramedic ambulance was going to be forever and a day away.

After I went to medic school, I joined a volunteer agency that was operating at the EMT-I level at the time with a mutual aid agreement from a commercial paramedic service. I found the EMT-I system to be more problematic than helpful, but that was largely due to the providers, not the system. When you give EMT-I's a few new tools, they like to use them, sometimes to a fault, causing delayed scene times with patients that needed an ER or a paramedic. I kept trying to stress that IV's don't save lives or improve patient condition, but we still had many providers that would sit on scene to get the stick.

On the good side, I thought the volunteer agency had some of the best patient technicians in the area. Also, at the time, the volunteer agency did not bill, so if it was a patient that only needed an IV and monitoring into the hospital, you would still meet with the medic, but the paramedic service did not bill if they did not treat. I'm sure that made a lot of seniors in the community happy.

So to end my long rant, I could really care less about the EMT-I skills. An IV isn't going to save a life and neither is an ET tube except in a few extreme cases. Where I think the state needs to move is toward the assessment level for an "ambulance attendant" to be at the current EMT-I level. Providers need to know a little bit more about patient care than an EMT class teaches if they are going to be entrusted with a patient's care to the hospital. The current EMT level is great for a first response agency, but I think the ambulance service needs something more. (I'm not knocking EMT's here, there are tons of EMT's out there that have the clinical experience and do a great job every day, but I don't think we prepare students in EMT class to go out there and assess treat patients.)

I heard through the grapevine that the bond referendum was defeated as well. It didn't really come as a surprise; a $6.8M renovation is quite expensive. I saw the price in the Journal last week and my jaw hit the ground. I've been in the Hughsonville firehouse and they definitely need an upgrade, but looking at my district building a new building and demolishing the old one for $4.9M, I'd think that HFD can find some more affordable options. Hopefully they can restructure the request and get a shovel into the ground soon.

In a lot of places, it's a volunteer v. career and a union v. non-union issue. However, people need to get past that issue and do what's right for the service as a whole. If you need career staff coverage at your house, they deserve the proper training and benefits afforded to a career firefighter. They also deserve appropriate compensation.

The same issue happens in EMS but it's worse... and don't get me started on that. It's my #1 pet peeve.

In actuality it really isn't "your firehouse" I also tell a lot of other firefighters I'm around its not "your truck." Its your customers' apparatus...its the communities firehouse. And if anything is limited its usually in response to an incident that's occurred. We all know that that nothing is harder to kill then tradition in the northeast.

Those 5 members are elected fire district officials. I would vote for any of the 5 that would ban alcohol on premise. Would probaby even try to vote multiple times if I could get away with it.

You can't be more correct. Even if the fire company owns the firehouse, it is/was undoubtedly paid for by contributions of your community. They have entrusted you with a building you can call your own, but with that there is also the expectation that the company will conduct itself properly and provide the service.

As far as alcohol is concerned, I've been on both sides of the fence. I was in a department when my grandfather was president and he had to ban alcohol from the house because it was being abused. Fortunately, we aren't having those problems in my current department. Hopefully this will continue into our new building... if everyone conducts themselves as adults, there never becomes an issue.

Simple question... do these firefighters working up as officers get out of title compensation for the day?

ALSFirefighter brought up a good point in another topic (Click HERE to view) regarding fire departments paying fire companies "rent" to house their apparatus.

I feel this point warranted it's own topic. I too absolutely agree with the above, and have heard of numerous fire companies that do such. What does everyone think of this setup?

It's a simple concept. The fire company owns the building and the fire district pays rent for the portions of the building operated by the district. It works pretty well as long as both parties are responsible to the community but it COULD leave the door open for corruption. For a volunteer department, the disadvantage of having the district own the building is that you could have 5 non-members controlling what you can and cannot do in your firehouse (limiting access at night, banning alcohol on premises, etc.). The major advantage to the district owning the building is that the membership would not be stuck making major repairs.

Up until this year in New Windsor we had owned our firehouse, but we voted to turn it over to the district for a number of reasons (basically to facilitate building our new station). We never charged a rate to the commissioners that was out of line; if you looked at our budgets the amount of money spent on the building was actually more than we received in rent (as it should be, because the commissioners only rent a certain percentage of the building). A few things have changed since the district has taken the building over, but both parties are being cooperative.

On #2: I have no basis by which to judge by NY law, but I'd send the medic in the BLS truck to the hospital and let him/her do whatever was possible. Depending on the pt.'s condition the medic should have better training to spot impending events that could lead to needing defib or changing oxygen levels, etc. In my dept. our principle is that the pt. comes first, all decisions are based on what is best for the patient and that includes undermanning fire apparatus when there are no other calls pending. We always favor the emergency at hand vs. the potential emergency.

Exactly what a lawyer would tell you. Maybe I should move to Maine. Of course, the bottom line in all of these situations is that you need to work together to get the job done.

I know of quite a few places that have these firefighters in sheep's clothing. I am not a career firefighter, but I still think this is the wrong path for any volunteer department to tread down. Not only is it circumventing the real problem, it's actually creating more problems for the District, the Department, and actually the "janitor" as well.

Being relatively familiar with Civil Service laws, if this "janitor" is a full-time employee, shouldn't they require a CS test as a janitor? Now, if the "firefighter" you want to hire doesn't end up in the top 3, you'll be in quite a pickle.

If your department needs assistance of paid firefighters, then get paid firefighters. Shell out the extra money to get the proper training for them and don't sell short the "janitor", the department, the district, and worst of all the resident.

NWFD...I know we've been on the opposite ends of a few discussions lately but I have to agree with Oneeye sometimes it comes down to...just being able to drive the damn ambulance. I understand what you are saying, and to be honest know that I think about it, I agree with you too. But unfortunately this isn't the world most of us are operating in right now and for us, its get me a bus so I can get my patient moving.

When he explained to me the system that you guys operate in where there's going to be a medic and/or a cop on the scene as well, that's a bit different. Honestly, I couldn't imagine the lawsuit if something happened if an EMT and Joe Driver took the ambulance with no other qualification if there was an accident or a patient got dropped. Given the system with other responders available to assist, utilizing any FD driver makes a bit more sense. It would be nice to cross-train the drivers though... my former volunteer ambulance service actually solicited one of the FD's in their coverage area for drivers willing to help. They did training at the fire house and set up procedures for utilizing the FD driver if they were available.

And alsff, I don't take anything personally, unless you're after my parents or grandparents.

Well said Moose and thank you for putting what I was trying to say in a different light and that makes more sense then my words apparantly.

NWFD...you are correct..there is also that form that no one carries that you are suppose to have them fill out and off of memory I think they have to use their own stuff.

Is everyone clear now, especially with the post and link off DOH site?

That form nobody carries is actually part of every patient information/billing packet at my agency but that's beside the point.

Maybe you are correct in your opinion but I can tell you for a fact that my former fire department addressed this identical situation with their lawyer. The conclusion that they came to after reading state regulations was that our medics, even in a non-EMS providing agency, had a duty to make sure the patient was receiving appropriate care and it was not appropriate to turn an ALS level patient over to a BLS agency. Of course my department interpreted what the lawyer was saying as "We're not sending our guys on that ambulance unless the EMT's are completely clueless and will kill the patient."

P.S. This very legal opinion led that FD to stop responding to all EMS assist calls because they didn't want to incur the liability.

"What we have here is, failure to communicate..." lol sorry, had to get that in!!

Most of you fail to see the point that ALSFIrefighter is making, it all boils down to the LICENSURE LEVEL of the responding agency. This Engine is LICENSED as a CFR Unit, and therefore can only perform CFR duties, and the Paramedic can NOT perform ALS duties. SO he cant practise his skills...I believe its called "Practising above your scope", correct me if Im wrong. In order for the medic to be able to perform his ALS duties he would need to be assigned to a Paramedic Level Engine. Without the NYS DOH License on the rig, you cant perform the skills REGARDLESS if you have a medic card or not. Does this clarify for a lot of people?

Actually, we all understand the scope of practice is based upon the agency. You obviously can't perform renegade ALS skills in New York State. However, you still have a higher level of training in the eyes of the state. You don't magically forget everything you learned about patient care when you ride for a lower level agency. It is your responsibility to make sure that patient receives the proper management and even at the BLS level, your patient management skills trump the provider from the BLS agency.

Have you ever been on scene when somebody walks up and says that they are DR. You ask what KIND. Lets say ER DOC. Are you going to let that PERSON who has a HIGHER LEVEL OF TRAINING THEN YOU work on your PT. HELL NO your NOT. How come? Because it is YOUR PT and what are they going to do that you can't.

Actually, an appropriately trained doctor has every right to direct patient care at the scene if the medical control doctor you consult approves his assuming patient care. That doctor is then REQUIRED to accompany the patient to the hospital. Usually when you tell a doctor about this little protocol, they walk away and say good luck. If you are a paramedic on scene and you turn a critical patient over to a BLS agency for transport, you better hope your insurance is up to date.

So did they have their paid EMT in the building at the time of the first call? How is it that you can drive a fire truck and not drive and ambulance. You are not being asked to perform CPR, just drive the damn AMB.

In 2008 I am going to be watching closely. I want to see just how bad it really is. I know how bad it is, I want other people to know how bad it is.

This is quite a shortsighted point of view. It's not as easy as just driving the damn ambulance. The driver of the ambulance with an EMT attendant must be able to operate a stretcher, stair chair, reeves, etc. and at least know where the equipment is in the ambulance. They should also have at least some sort of familiarity with the apparatus. I don't know the situation with the departments you are discussing, but with a 2 person crew, you just can't take any emergency driver and throw them on the bus.

Think of it this way in situation #2. You are the Paramedic that intercepts with the ambulance or arrives on scene as the patient is being loaded...is it negligence if you only perform BLS skills while enroute because your best option is to get the patient to the hospital and that is all you got accomplished while enroute? No. BLS before ALS and sometimes the best treatements are BLS treatments while transporting.

That's a completely different situation. You didn't abandon the patient, you rode the patient to the hospital. If you are the highest trained responder on the scene, regardles of your affiliation you DO bear some responsibility for the patient, regardless of the equipment in your bag or the level of the agency you respond with.

I don't see any abandoment issues. As a matter of fact there probably are lots of FF/Medics that turn PT's over to BLS ambulances everyday right here in this COUNTY. What are you going to do as a MEDIC for a CHF PT with BLS equipment. O2. That is about it. So why put your FULL TIME JOB as a FF down on manpower when there is nothing for you too do? What if you are a COP but also hold the certification as a MEDIC and get sent on a call where no medic was available. The BLS crew shows up and it is indeed a BLS PT. Should I step in and say that I am a MEDIC and I need to ride this call in because I am going to be worried that the BLS crew doesn't know what they are doing. Of course not. Lets use some common sense here.

If you don't know what to do at a BLS level for a CHF PT then you shouldn't have passed your EMT course or be riding on and AMB. Just because somebody holds the title of PARAMEDIC doesn't mean what he/she says is GOSPEL.

If you have FF/Medics turning ALS patients over to BLS ambulances in your county, your system is severly flawed.

Situation #2 is interesting because you should not be turning over a patient requiring a higher level of care to someone of a lower level of care, even if you don't have the equipment. Even if you are operating as a CFR, you are a still a paramedic in New York State and I imagine some abandonment issues come into play here. If that BLS provider did something even at the BLS level that was harmful to the patient that an ALS provider would have known better to do, you would be liable for that harmful care (ie. giving a treatment to a CHF patient).

Just arrived yesterday, New Windsor Fire Dept's new Rescue-Pumper R-445. It's not in service, stocked... heck the Commissioners haven't even accpeted yet. The pics were taken inside but I'll get some better ones once it's in service. It's a 2007 ALF Eagle Rescue-Pumper stocked with Holmatro extrication tools.

Hey Bart, now there's a name I haven't seen in a long time... but for some reason I still remember your medic number.

I don't know the exact numbers, but Mobile Life did somewhere around 52,000 calls. I feel like I did that many last night alone.

The Putnam County system hasn't worked since I worked down there in 2001 and probably long before that. The same problems we're all used to hearing about in the volunteer service have made the problems even worse. The county itself is set up poorly for a countywide system and in a lot of places politics makes it worse because the county line might as well be the Great Wall of China. The addition of the daytime ambulance from the ALS provider I'm sure has helped, but it's kind of like putting lipstick on a pig ... you still have a pig. (Not bashing the provider with this comment, any provider in the PC system would be poised to fail).

What PC needs is to have the important people realize that this is a problem. If you can't make the politicians on the county level realize the problem, get on your town officials and inform the residents. There are plenty of people who have ideas and maybe some brainstorming can result in a better system. However, as long as they try to hang onto this system, the problems will continue to grow.

I guess my question is When staging away What amount of Away Is sufficient? and is enough thought being given to apparatus and manpower placement in these situations?

Hi Mike. I think the answer to your first question is that the answer lies in knowing your response area. If you are in a city environment with short response times, I wouldn't even turn on the lights and siren. If you're responding from further away, I'd cut the response sometime around 5 minutes from the scene. You should consider traveling well-traveled and well-lit roads if possible. You should avoid areas likely to be involved (ie. a bar with a "reputation" that is 5-6 blocks from the scene). Along with this, you should consider the possible means of egress for a perpetrator. I went to a shooting yesterday morning and pretty much all of these things came to mind in my response. All of these things come down to being vigilent in learning your response areas.

Apparatus and manpower placement is a whole different situation. No offense to any police officers on this forum, but a dispatch notification that the "scene is secure" only changes the situation from hot to warm in my book. As an EMS provider or firefighter, your job is to cover your rear end and your crew's, don't take anyone's word for it. I can remember a shooting several years ago where we responded with 2 ambulances and specifically placed one away from the hostile crowd and faced it out in case it became an evacuation situation. We left that ambulance in a close but safe area with a driver ready to go.