comical115

I don't want to rain on the parade here, but the Lucas device hasn't been shown to improve outcomes...

http://roguemedic.com/2014/03/the-failure-of-lucas-to-improve-outcomes-in-the-linc-trial/

How about spending (a lot of) money on something that actually can improve outcomes, like more medics?

Just my 2 cents.

Having responded to jobs in the projects before, it is no where near out of the realm of possibility (and I would speculate rather likely) that this job was communicated to the housing officers as an EDP, DI or other any other disturbance that they routinely handle.

Unless you have specific and well informed knowledge about *THIS* specific incident I wouldn't dive straight to a soap box...

Look, junior. This is not the forum for arguing. Do it somewhere else.

"There was a time where we took a guy like you in the back and beat you with a hose, now you've got your goddamned unions..."

If you're as annoying in person as you are on this thread, a North Castle brother might just get an MTA officer to 85 with him and find out how Armonk's tazer policy really works...

Out of your league junior, keep moving.

Never heard of nebulized narcan and not sure my medical director would be happy with that, but don't doubt it works well.

Very simply, narcan is there to treat respiratory drive. If there is respiratory drive and the patient is unconscious, they're probably better off that way.

NYC has started BLS, PD, and substance abuse counselor IN narcan already with good results.

According to who? I'm all for the expansion of scope of care but there are times where a patient needs to be monitored more intensively than what a CFR and EMT can provide. The fire service talks about the right tool for the right job, a potential OD of narcotics with respiratory compromise is an ALS job. Period.

Scenario: 45 year old female found on the street, called in by passer-bys. It's Friday evening, patient is responsive to pain with a GCS of 11 (2/4/5). Patient wakes up to sternal rub and quickly nods off. She is unable to provide any information as to her present condition or history.

Resp: 12.

HR: 66, Regular.

BP: 94/50.

SPO2: 97% room air.

BGL: 118 mg/dl.

Skin: Cool, pink, dry.

Eyes: Pinpoint, reactive.

Patient has x3 empty methadone bottles in her pocket.

Narcan or not? Keep in mind that ED's are using 1/10th of what we are in the field as the first line dosage now-a-days (that's 0.04 mg for those keeping score) and I've seen my share of crews bringing in patients who are either actively seizing due to narcan mediated withdrawal or some other acute stress response that ensures the patient's stay in the ICU...

No medication administration is without it's potential adverse reaction and unless you're equipped/trained to deal with it, you have no business administering the drug to begin with. *Especially* if the condition can be mitigated with a BVM and some O2...

I know some rigs, mostly the specialized inter-facility transport rigs have RNs on their crew, but that's because the patients they're transporting are usually using specialized equipment that's above the medic certification. I've never heard of a PA being on an ambulance (I'd assume they'd make more not working on an ambulance), but they might be able to get a waver or something from the DOH to take the paramedic challenge, but they'd definilty have to take the remac exam.

New Jersey requires an RN on board for ALS transports. Paramedics can transport patients on pumps, vents, nitrous, ECMO (usually with a fellow), balloon pumps, etc in New York State without an RN.

...Back to topic. Good luck with the DOH. I'm curious as to what they say.

Does anyone know anything about a Physician Assistant riding as a Medic in NYS? or Maybe being able to get away just with a EMTP refresher?

You're going to have to contact NYS-DOH. Doesn't count the fact that you still need regional authorization to "work" as a medic (REMAC).

2. Private EMS agencies "not playing nice" with the rest of the ICS system. (i.e. we have our own bosses and SOGs, we don't answer to you)

Because arm bands and labels on jackets fix 100% of ICS problems, 100% of the time.

The most interesting part of the new system, now we (the units) can see the time the call originated with the UCT where before we only saw the time it entered the EMS system.

Over the last 16 hours, on average, there was a 4 minute delay between the UTC and the unit being assigned the job. Hint: all high priority jobs. Extra hint: EMD still doesn't pick up the transfer on quite a few and PD sends it out on their own.

I'm in a 2010 Silverado Frazer. We haven't had any issue with the air ride. I work for private EMS....truck runs pretty much 24/7 and gets tons of miles due to LD transfers to Houston. Idk how the FDNY Dodges are set up or how wheeled coach does their air ride. On ours, the bags deflate when the rear doors are opened and only inflate when the doors are closed and the brake is pressed. The older Frazers would raise and lower as the doors were opened and closed constantly. I like the new way, saves on the bags more.

I work regularly in a Frazer ambulance and in the winter, the condensation in the air lines would freeze the dump valves open. You had to wait for the valves to thaw before moving the bus or run the risk of cracking the frame. Ask me how I know...

The most recent order of Frazers we received management forwent the air suspension to reduce out of service time and to save money.

Right...an umbrella! HAhahahaaa......THAT was tense for a minute...."OMG he has a gun pointed at us!" Thank God I chose to brake hard and not run his stupid a** over!

Exactly...

How many times did you hear the story of a crew working up a guy who was shot (*insert number of gun shot wounds here*) in the back of the bus when the perp comes back and asks if the patient is going to make it? *Spoiler Alert* The perp proceeds to unload whatever he didn't use the first time around into the patient in the back of the bus and he walks away, leaving the crew to ponder which protocol this exact situation falls under... Well NOW the perp assumes that the two Paramedics and the two EMT's who are crammed in the back fo the bus are armed, so now he has four *more* targets before he "finishes the job"...

Bottom line, the list of disadvantages for having a firearm on my person while working as a paramedic is *far* longer then the list of advantages.

Don't bother with 5.11's EMS pant, like Goose said the pockets suck and they are way too baggy. However, 5.11's Taclite Pro's are awesome.

Maimo's ALS buses sit quite a distance from their ED, the extra space really helps on those 16 hour tours. This doesn't look any larger then their other ALS buses... FDNY EMS and St. Luke's Roosevelt EMS also runs extended cabs and its been working just fine for them.

I can also vouch for the fact that working up an ALS job in the back of a sprinter *sucks*. Keep them for transport or BLS.

Unlike an Epi-Pen where there is no alternative, a BLS ambulance already has a tool to prevent anoxic injury secondary to hypoventilation. It's called a BVM.

I'm all for it as long as the agency provides the proper training and support and equipment to monitor the patient after administration.

This is a retrospective study that looked at in hospital cardiac arrests. The researchers correlated an increased chance at survival with a longer duration of CPR. This study doesn't say anything about the presenting rythym the patient was found to be in, whether hypothermia was induced, whether it was used during the arrest or on ROSC (return of sponteanous circulation), which rounds of cardiac medications were repeated, etc.

If a physican is willing to take another 20 minutes to try and correct the situation, I'm fairly certain the patient is getting a few more medications or treatments within that 20 minutes which could very well be the cause in the increase of survival rates.

For god's sake be careful out there... drive defensively, wear your seatbelt on *every* job, give yourself the best possible chance to surviving something like this, because it easily could have been any of us. Thought and prayers go out to his family and his current and former co-workers at SIUH and FDNY EMS.

Lots of information missing here. I would hope that the EMS crew did what they were supposed too.

Speculation - I bet the "rib pain" & "get some sleep before your flight" was what the guy told his son so he would not worry. The guy probably didn't want to stay in NY another night and figured he would go home & see his own doctor.

Probably the case, but its still up to the crew to take the RMA through the doctor working the telemetry desk, so (heaven forbid) something like this happens, you still have a chair when the music stops.

Hopefully whatever investigation that is in progress concludes quickly and if the crew did the right thing (like I hope they did) they can get back on the streets. Any restriction is nerve wracking.

"Scoop and Runs" save lives.

...until the transport officer sends 4 red tags to the closest trauma center only to find that PD scooped and ran with 8 and now those 4 red tags are SOL.

There's a reason why we use NIMS. It only works for us if we use it properly.

http://www.firehouse.com/news/10743262/flag-to-be-displayed-on-fla-apparatus-after-dispute

The flags were not being flown as U.S. Flag code dictated. The issue has been corrected and they will be returned shortly.

...this explains a lot.

The last phone call *was* from an FDNY EMS dispatcher because when I asked him if he had a better description of the boat, he said "as per the text ...it's big...".

After he made the call, I had a description of the boat, an update on the patient and exactly where the operator intended on docking the boat... I wish this were an isolated issue.

In NYS a BLS unit can use and document SpO2 if allowed by the agency's medical director. As stated above, at present, there is no SpO2 based treatment. Last time I heard there was a proposed change to the NYC protocol that allowed for titration of O2 for SpO2 < 93% but nothing written in stone.

I don't have the link infront of me, but as per NYCREMSCO SpO2 is manditory for ALS, optitional for BLS.

...really?

I don't think I'm the problem per say as a worker my dmv record is a little crappy no points but like 4 accidents (none of them my fault)

Any item on your driving record within the past 3 years will likely exclude you from the voluntary hospitals. FYI.

If numerous agencies are hiring what are their names that's what the whole point of my post was to find out....so who are they?

Fyi SC is only hiring emts on their website which has been up since the website was started way back when

Just because an agency is hiring doesn't mean that a certain prospective employee and that agency will be a good "fit". The members on this site can provide you the name and phone number of all the managers in charge of recruitment if they wanted to, but I doubt it would help you get hired.

What JJB was trying to do was offer some constructive criticism that might help you get a job. I suggest you re-read his post. A lot of agencies require you to put your time in as an EMT before they hand you the narc kit and throw you on the ALS bus, even if you have past experience as a medic. If you're as desperate for work as you claim, the right attitude and persistence will pay off. Just remember EMS is a small world, even in the tri-state area.

The PAPD Sgt. from 9-11 who survived in the rubble of the trade center has a Physician and a NYPD ESU Medic to thank. Every now and then I see the 5Mary car in the city responding on calls. They are a great resource and it helps to build a relationship between the personel in the field and the doctors on the phone and in the ED.