NWFDMedic

Well, from the information there, it sounds like the Taser did kill the guy, although I'm sure an autopsy report will tell the real story. I'm all for the use of "less than lethal" options, but just like anything else, the use of force must be restricted to the situations where it is necessary. If the Taser kills a criminal who put himself in the position of needing to be tasered by the police, the real fault lies with the criminal. I'd rather put a low risk on the life of a suspected criminal who is resisting forcibly than risk injury to a police officer who is doing his/her job.

Great job by all involved. I've seen some civilians relating that this was "overkill" but all you have to do is read the newspapers to realize how important it is to take every precaution in these situations. It may have inconvenienced a few folks, but everyone left the scene safe and that's more important than having to take a detour or leave your house for a few hours.

85 MPH, Thats the right lane of I-684 !

That's exactly what I was thinking.

The interstate highway system is built to standards where the average driver can safely navigate at 75 mph with vehicles of the Eisenhower era. That being said, we are not all the average driver.

Firefighters flock to get a nice ...umm, cat.

And Pennsylvania as well. It's not all about money (note all). The SEMAC takes certain legal responsibility for the provision of ambulance service in New York State. They have every right to make sure the standards they write are followed. Certification is one of the methods used to do that. Otherwise, anyone could just put AMBULANCE on the side of a vehicle and go out to pick up patients.

Personally, with some of the junk I've seen running out there, they need to really take more consideration into what a safe ambulance is.

So this brings up a question. Your truck is broken down as in the situation above, and it's not going to be able to move out of the fire's way. Your have a few minutes of before the fire gets to the truck and/or it endangers your escape route. Do you attempt to save any of the loose gear on the truck? Air pack, AED, TIC, portable radios, nozzles, ect? Or do you hope insurance will cover it all?

I'd atleast make an attempt for the high dolar stuff even though insurance would cover it. TIC/AED/Airpacks/portable radios if there was a few minutes. One guy can carry a bunch of those items out of harms way in just one trip. 2 or 3 guys could save a ton of stuff on their retreat to safe ground. This is all assuming there is no "run for your life" situation. In that case, it's all going up in smoke.

I'm sure you could try to save some of the more expensive and portable stuff if you can but I'd be more worried about the dangerous stuff. If there were any oxygen or other compressed gas cylinders on the rig, they could become a significant danger.

My major concerns with giving first responders Narcan would be airway protection and other drugs on board. We all know the vomiting that is almost sure to occur after Narcan, even if pushed at 0.4 mg intervals. Also, I had a reported heroin overdose a few weeks ago that actually had quite a few other things on board. The heroin was causing some respiratory depression but actually masking the effects of the other recreational pharmaceuticals. Once I fixed the heroin part, I had to manage the patient pretty aggressively due to the other stuff on board. With the tools available to a BLS provider, I think bagging that patient would have been the most effective means of patient care whereas if they had used IN Narcan, they would have had a world of other issues.

This is simply how the health care system works. I don't see any surprises here. MCO's negotiate with providers based on their ability to bring groups, just like you can get a group rate if you buy a certain number of tickets to a Yankee game. Medicare and Medicaid only pay what they determine is reasonable and they leverage their patient base and other federal and state funding. Many doctors have stopped accepting Medicare and Medicaid because their reimbursement rates cause them to operate at a loss. Unfortunately, providers have to make up the gap somewhere and it comes from payments from the uninsured, no-fault, and non-participating MCOs.

Should paramedics be required to go to nursing CME's? I think both sides are very different in the type of care they provide. We work under the doctor's license. Having a doctor at CME's is enough for me.

Personally I wish they would just do away with the call audits at a requirement to renew the MAC or find another way to make them more readily available to EMS providers through some type of web based program. Due to my work schedule, in addition to the days and times the audits are scheduled, I can not make the overwhelming majority of them. Therefore, my MAC gets suspended every 3 years for 6 months until I retake the protocol exam. 6 months of no side work is a big financial hit to the pocket, and I can not consistently take off of work just to attend audits on my own time with no monetary compensation.

There are no less than 4 conferences every year where you can get your year's worth of CME in one day.

We had the smaller S10 Blazer as a flycar at Sloper. The problem with that vehicle was that the aftermarket stuff that was put in to hold the ALS gear took away from the driver's compartment of the vehicle. We had to move the truck when larger medics were working because they couldn't fit behind the wheel.

How about this incident:

(Church van overturned in Cornwall)

http://articles.cnn....e-care?_s=PM:US

I know it wasn't as bad as the bus incident, but it was still a major MCI.

I also remember a situation even further upstate where a double decker bus hit a bridge, causing a similar situation and killing four, that was also dealt with by the local departments

Yes, the situation may have been uniquely and beneficially dealt with because it happened in NYC, but, to say that NYC is the only place that can deal with a situation like that.

You might want to pick another incident as an example of one that upstaters managed well.

I think the problem that the upstate boys are missing, is that FDNY is an anomaly. They are the exception to every rule there is. These guys roll with fully staffed rigs, a superb compliment of tools, and a great scene support structure (ie. EMS, PD,..). I think that you (firstdueorback2bed) are confusing the real world with the FDNY world you live in that says all FD's are FDNY. Name another department in the WORLD that has this many fire houses and staffing? Oh that's right, THERE ARE NONE!! How you gonna handle this type of incident up there when a bus from Chinatown that is going to Woodbury Commons does the same thing? It is completely possible. Bet you will be showing up and after blowing chow for a little while from what you see in that bus, you will go back to your actual job and talk a big game about how you were at the "big one". Is Westchester's system a little out of whack? YA, but no more then any other department in this country. Most Westchester career FD's get more done with less then some of these Vols departments do with all their shiny new rigs and latest greatest little toys.

Why the inflammatory response to people who are just asking questions? From what I've heard, FDNY did a great job managing the incident. However, to insinuate that us "upstaters" would be blowing chow if we came upon a similar incident is just ridiculous. I can remember as far back as 1989 when a bunch of volunteers assisted by a small (at the time) commercial EMS service, managed a school collapse and had all the patients to definitive care within 60 minutes. FDNY is very well trained, but they don't hold the patent on capable responders.

It sure seems like the FDNY did a great job here. I just have one general question. This accident occurred within yards of the Westchester border yet it seems no Westchester resources were used. FDNY obviously has the resources to handle this incident, but wouldn't it make more sense to pull a closer Westchester unit than a far away FDNY unit just to keep the incident all FDNY? Obviously, the specialty resources are going to come from the City, but if there's an ALS ambulance 2 minutes away in Pelham, why wait for one that's 15 minutes away on the other side of the Bronx?

Versed is still carried, but they did away with Valium to reduce the number of controlled substances carried.

The reason for the D50 to D10 change is a drug shortage (apparently). I havent seen a box of D50 in months, we just cant get it up here. Were short on a lot of drugs up here.

Gotcha. The drug shortages are causing havoc down here too.

I'm amazed that they have removed D50 and added D10. Administering 250cc of fluid to a diabetic seems to be something that could take a long time. The justification was to reduce errors. Is my assumption correct that this is to reduce Dextrose pushed through a non-patient IV line? If so, is the issue really the D50 or the provider not properly insuring a patent IV site prior to medication administration?

I've never heard of the "auto-narrative". That sounds a bit sketchy to me. We've been using the ePCR for about 18 months now and I absolutely love them. National studies say that your average report writing time will increase slightly even after the learning curve is achieved, but it results in a much more complete report. I agree with those who posted above though, a short narrative is needed for all calls to explain the things that don't get entered on the menu or sometimes just to paint a picture that will help you remember the case in the future if the case should end up in court.

As does my agency. Here in the Northeast, the concept of civilian EMS providers functioning as Tactical EMT's/Paramedics is not well received by most Law Enforcement agencies. Go down South or out West, and the reception is a little more welcoming. If you research you will find active, proactive, established civilian TEMS teams in Texas (Cypress Creek EMS who was featured on the front cover of a JEMS magazine and got a very informative write-up), Florida (Sunstar EMS and Jacksonville Fire Dept), Colorado (Denver Health Paramedic Division and Littleton Fire/EMS which was borne out of the Columbine School Shootings), Delaware (New Castle County EMS) just to name a quick few.

I beg to differ with this statement. Our TEMS program has been very well received right here in the Hudson Valley. Then again, our program is not one where the medics simply have a "patch thrown on their uniform" and they are required to undergo a good bit of training. (I'm not 100% sure of their standards as I'm not a member of the team.)

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!

Great post. In our area, the only reason why a "second medic" is usually called is for a second set of hands for a 2-person crew. There have been many times that I have called for a backup unit and utilized the second crew's EMT as it is a good training opportunity for the EMT. If a medic is calling for a second medic in a single patient situation on a regular basis for reasons other than the need for hands, I would question their level of competence. There are rare cases where a second medic is warranted, and a few by protocol (i.e. in the Hudson Valley region, a patient requiring RSI needs a credentialed paramedic).

As far as the EMT-I program is concerned, I took it in 1997 before I decided to go to medic school. I didn't get a lot out of the increased skills available. What I did get, and maybe it was a function of how my class was taught, was a feel for WHY we do a lot of what we do on the BLS level. The EMT program basically teaches you to ask a bunch of questions to gather information and if you "find this" then "do that". My EMT-I program taught a lot more about systems and how to do a more advanced patient assessment which could lead to a better field diagnosis. For a while, I volunteered with an EMT-I agency and I actually found the skills part of the EMT-I function to do more harm than good. Providers that weren't getting regular experience doing ETTs and IVs were wasting a good amount of time on the scene trying to perform those skills instead of getting the patient to the EMT-P unit or the hospital.

I've also had the pleasure of volunteering in St. Lawrence County and you are correct, it is a different world. Their program relies on EMT-CC providers, mostly from the larger volunteer agencies, to provide mutual aid to the outlying agencies. There are places in the county where the closest CC unit is almost 40 miles away and given the general condition of St. Lawrence County roads in the winter, that could mean your closest ALS resource is well over an hour away. The EMT-I could prove to be an invaluable resource in these situations. They also teach the EMT-B class differently up there. Due to the limited ALS resources, their EMT-B class teaches their EMTs to exercise much more clinical judgment than we do down here. The volunteer EMTs were very mindful of the fact that they were waking up a volunteer from an agency an hour away and taking away their scant resources if they called for EMT-CC mutual aid. The patients that we ALS for "precaution" are generally brought in BLS up there and I must say, the BLS providers up there are really good. This may be different now, as my experience up there was almost 20 years ago.

I actually don't think it is possible to intentionally misunderstand someone.

Now, to the rest of your point, how can individuals who are not selected by, trained to, and held to the same standards be expected to perform the same duties all of the time? If this is the case, why the need for career firefighters at all in your department? If, as we have already established, the qualifications of the volunteers in your department are far inferior to the career members, why should the taxpayers take on this risk? Basically anyone can sign up to be a volunteer firefighter. If this is not the case, give me some hard data on how many applicants your or any other volunteer department has turned away in the past. Why are there "interior firefighters"? Are there "exterior firefighters"? What are "junior firefighters"? What are "fire police"? What are "auxiliary firefighters"? What is an "ex-chief"? None of these terms has any relevance in the career fire service. If in the example you mentioned one of the volunteer firefighters who is not interior qualified is ordered by his superior to enter a burning building doesn't that fly in the face of your argument?

Taxpayers should not be asked to shoulder the enormous potential liability of those who ask for many perks and priviliges of being a firefighter, yet refuse to be held accountable to any real standard.

I hope my many friends in the volunteer fire service will not take this personally because there are lots of good people out there serving their communities to the best of their ability and asking for nothing in return. Unfortunately, though, there are many others who ask for much and give very little in return.

I find it very hard to believe that you have any concept of what goes on in the real world. The only thing you've done on this forum is sound off for career firefighters and ridicule volunteers. What you don't seem to understand is a single thing about how the law really works. When people have told you within this thread, all you have done is continue with your anti-volunteer rhetoric.

The Board of Fire Commissioners holds the responsibility for setting the standard within their district. If they wanted background checks, psych evals (which are not required of any career FD that I know of), and a full length fire academy, they COULD set that as their standard. Most volunteer or combo departments have commissioners that understand the sense of fiscal responsibility and realize that they can provide a certain level of fire protection at the least burdensome cost to the taxpayer.

The Board of Fire Commissioners has the final say on all membership applications and all officers of the department. They have the final say on all training and continuing education requirements. The taxpayers sign on to the standards required by the Board of Fire Commissioners by electing them. As such, the taxpayers should bear the burden of indemnification of the firefighters and officers that are acting within the standards that are completely in control of the municipality. The commissioners are responsible for providing a level of fire protection that a reasonable district of the same size would offer and they hold the sole responsibility to make changes if that standard is not being met.

In the event of gross negligence, indemnification does not apply. All of the cases you mention are gross negligence and the firefighter(s) would be on their own.

We have at least one NYSP Lifeguard Unit down here out of Stewart Air Base (LG 17 or 18), and, whenever we require a helicopter rescue (aside from standard medivac function) in our area, it requires 2 choppers, one to remove victims, the other for all other associated functions. One chopper is set up as the 'rescue' chopper, for removal of the victim, the other is set up to package and txp the victim.

To clarify Nate's post, it is not that one NYSP helicopter is solely rescue and the other medevac. The ships have to be rigged for the mission that it is intended. Our newest flight medics were actually doing hoist training just last week.

I don't understand...I am an active volunteer...no, not for a Fire Department, but for a number of other organizations....anyway, for our various volunteer activities, my fellow volunteers and I do not ask for, not do we receive indemnification from lawsuits...in fact, my fellow volunteers and I do not ask for or receive pensions, tax breaks, medical insurance, free pool or gym memberships, clubhouses to hang out in, or anything else in return because we are..."volunteers" (imagine that!)

I am incredibly uncomfortable as a taxpayer taking on the liability for anyone who decides to join the local fire or EMS organization...essentially that is what this legislation is asking taxpayers to do...to be on the hook for the actions or inactions of an organization of individuals who essentially are not under the control of local government and thus, not accountable to the taxpayer who is being asked to take on the liability.

I look forward to hearing the opinions of my fellow EMT Bravo members on this topic.

qtip

Volunteer firefighters are under the control of the local government (in my case, the Board of Fire Commissioners). If a firefighter meets the requirements set forth by the Board of Fire Commissioners, he should be protected just as a career firefighter would be. If your municipality's volunteers are not "under the control" of the Board or governing agency, it is the fault of the municipality.

The franchise agreements that towns have with the cable companies are ridiculous. In some instances, the competitor (like Verizon FiOS) has to be able provide services to the entire town before they can apply to be allowed into the market. The cable company, however, had years to develop their infrastructure. I can toss a stone (or could when I was in prime baseball shape) from my house to a county highway, yet I still can't get FiOS at my house.

The we'll agree to differ. I'm not remotely anti-union; my father was a union man all his working life, and I've worked a union job in the past - and refused to cross a picket line during a dispute.

I believe if there is a union you should join it. But I also believe you shouldn't ever HAVE to join a union to get or keep any job; I don't believe closed shops should be allowed to exist. Union membership should always be a matter of individual conscience. That's my view, and I respect the fact that others may differ.

Is there such a thing as a legal closed shop in NYS? When I worked a job with a union shop, I was offered the opportunity to join the union but was told that, by law, I was allowed to decline. However, because the union was still the bargaining unit and they were bargaining on my behalf, I was still responsible for paying dues (or more appropriately stated a fee) to the union if I were to choose to not become a member. Obviously, this would have been stupid as I would have been paying and not getting the other benefits of the union.

Don't worry. If one of those "civilians" ended up with a scratch, I'm sure they'll claim police brutality.