JJB531

I didn't decipher if you were referring to your mutual aid participation as a firefighter or as an EMS provider. As a firefighter, I can understand why you would choose not to respond to calls for service in their district if you feel your personal well being is being unnecessarily placed in jeopardy.

Rest in Peace PO Crouse

Not to wander off topic, but to refuse to respond mutual aid, who are you really hurting? The agency or the patient?

Very interesting... Leaves a lot of unanswered questions as to why.....

I'm going to be curious to see if there was a known history between the deceased officer and the perp. If so, the officer may have been intentionally targeted.

I agree that it is a fine line and is open to different levels of interpretation based on an individuals views/beliefs of firearm possession. If there is a suspicion about a student/individual, it's generally better to bring it to someones attention rather then just ignore it ("if you see something, say something" is what we tell the general public about potential terrorist activity and suspicious packages). Hopefully if it is discovered that an individual uses firearms for legitimate/responsible/recreational purposes, and doesn't exhibit any other warning signs, then the "investigation" ends there.

First, I never stated it was a solution to the problem. There is no real solution. To address your statement, individuals who are avid hunters or compete in sanctioned shooting competitions are examples of individuals who utilize firearms for legitimate/recreational purposes, and should be identified as such. The individual who owns 92 rifles and handguns, is not an has never been a licensed hunter, doesn't compete in sanctioned shooting events, and utilizes his/her firearms to eliminate the neighborhood dog population, may raise my suspicion a bit. Now combine that with the fact that this individual has a poster of Eric Harris and Dylan Klebold on his wall, and constantly talks about how he wants to wipe out the football team simply because they're the cool guys on campus, and now we're onto something. The points I made as individual identifiers are usually not the sole issue at hand, but it's a combination of these identifiers as a whole that should raise suspicion.

There really is no steadfast, reasonable way to completely prevent these incidents from occurring. There are some steps though that can help prevent active shooter incidents. #1 - Early identification, recognition, and mitigation of individuals who have exhibited signs of being a potential threat. Some signs may include: individuals who gave made verbal or written threats of violence against an individual or group of individuals; individuals who sympathize or have a "morbid" curiosity with previous active shooter incidents; individuals who exhibit increasing erratic behavior, individuals with an "unhealthy" fascination with weapons, etc. The list goes on, but these are just a few examples. With a proper Violence Reduction Program, these individuals, once identified, can be addressed in the means necessary. Doesn't mean it's 100% guaranteed to work, but if it does, then the effort was worthwhile. #2 - Proper preplanning through formal Emergency Action/Active Shooter Response plans. This includes the school and local emergency responders actually sitting down at the table and coming up with a response plan in the event of an active shooter incident. #3 - Increased police presence. This may prevent some individuals from carrying out their plans, but true active shooters are in the mindset that they expect a large scale police response, and yet still carry out their plans. An increased police presence increases the likelihood of law enforcement engaging these individuals early on in the event, thus preventing further casualties. #4 - Proper training for school administrators, faculty, and students on how they should respond and conduct themselves in the event of an active shooter incident. While this may not prevent one from occurring, being properly trained and prepared increases chances for surviving one of these incidents, thereby decreasing the number of casualties. It is near impossible, unless you plan on screening every single student who steps foot on campus, which is just not feasible on most campuses, even community college campuses, to mitigate the problem with 100% certainty. The points I mentioned are just some ideas that can help to deter, prevent, and decrease the impact of these incidents.

Well considering how I'm sitting here on this mutual aid call (it's BLS and OVAC came in mutual aid, so no, I'm not ignoring the patient) Croton's paid EMT as of right now is contracted from 7a to 7p, so the paid EMT went home 4 hours ago. Croton EMS had one member show up, but unfortunately couldn't get a second member to complete their crew so OVAC's BLS truck had to take the mutual aid request.

The first line in the New York State Protocol for Respiratory Distress is to request ALS if available. If you're on scene, you're available. Correct it doesn't say that ALS needs to necessarily intervene, but it appears that it is inferred by this statement. New York City REMAC Protocol for Asthma for ALS providers states: "Administer Ipratropium Bromide 0.02% (1unit dose of 2.5mL) by nebulizer, in conjuction with the first 3 doses of Albuterol Sulfate." Ipratropim Bromide is not in the BLS protocol. As an ALS provider in NYC, if you just decide to administer Albuterol, and withhold the Ipratropium Bromide with the intention of passing off the patient to BLS, are you considered to be withholding treatment and/or violating NYC REMAC protocol? On the flip side, if you administer Ipratropium, and then pass off to BLS, are you handing off a patient to BLS who is now administering a medication outside the scope of the New York State DOH BLS protocol for nebulized albuterol? I'm merely playing devils advocate, because although I know we are talking about relatively benign medications when used properly, the potential for a negative outcome for a medic who just passess off an asthmatic is rather high. No one wants to be a "cook book medic", but in the end, a governing body just has to go back to the cook book and see how you changed the recipe.

Let us know how that works out for you with the REMAC and medical director. Here is an excerpt from the WREMSCO protocol for nebulized albuterol use by BLS providers, notably the last sentence: "EMT-Bs working for ALS services may participate in the Nebulized Albuterol Program as long as the BLS providers have undergone the required training and the agency has received REMAC authorization. ALS Services utilizing the program as part of a tiered response must continue to ensure the request for and provision of ALS for patients receiving BLS administration of nebulized albuterol."

If you perform an EKG and decide your patient is BLS, then you can turn them over. Your statement is exactly what I stated, so I don't see where your going with your post. From your patient assessment if you determine you're going to work up the patient ALS with ALS interventions, you are now "married" to that patient. Once you start with more invasive procedures (advanced airway control, IV access, medication administration), you can't just turn them over. Let me ask, would you give an asthmatic a nebulizer treatment then just turn them over to BLS if they showed signs of improvement because albuterol is a BLS skill?

Yes ALS was able to correct me, so I stand corrected (Thanks ALS)... as far as the tax funding, that I have no idea about.

Tommy if you can correct me in the other thread, I was not aware that Croton was a part of Town of Cortlandt, I was only aware that Croton FD/EMS did have part of the Town of Cortlandt within their jurisdictional boundaries.

Is this serious? All I see is a lot of apprehended rear bumpers from this "tool".

No, Croton to the best of my knowledge is its own individual entity, although Croton Fire/EMS does cover part of the Town of Cortlandt in it's primary response area.

Mid-Hudson is actually the formal, legal name of the Ambulance District for the Ossining School District (Town/Village of Ossining and parts of New Castle), not a company or other such EMS entity. Croton, in essence, has joined the Ambulance District, where Ossining VAC is essentially the vendor that has been contracted by the Mid-Hudson Ambulance District to provide EMS services for the community the District encompasses.

As a paramedic, once you commit to caring for a patient at the ALS level, you are "married" to that patient, meaning once you determine the patient is an ALS patient, and begin ALS interventions, you can't just up and leave the patient with a BLS provider. Patient care has to be transferred to another individual of equal or higher certification (i.e. another paramedic or emergency department staff). In essence, you are abandoning your patient, which can open you up to legal liablities and litigation, and violates Department of Health policies. In short, if a medic is treating a diabetic, and a chest pain comes in... that medic is already committed to the first ALS call until they can transfer care to an appropriate authority.

One other comment of correction, the Fly Car system is not a part of Phelps Memorial. Phelps, although very involved with OVAC and the Tri-Village ALS System in terms of oversight, medical direction, and medical oversight, provided financial assistance to OVAC in the purchase of these vehicles, hence the Phelps "advertisement" on the side of the vehicle.

Yes, before the paid EMT was introduced to the system, the medic at times would have to ride in a BLS call just for the sake of the wait time for a mutual aid ambulance. Now with the paid EMT in place, I would have no issue transferring care to the EMT, whether there was a driver or not, if it is a BLS level call so I can handle another call rather then commit myself to a BLS call and deprive someone else of ALS level interventions. At times it is a judgement call based on the availability of additional ambulances in surrounding communities, proximity to medical facilities, etc, but if I'm on a sprained ankle and another call for a chest pain, unconscious, difficulty breathing, or any other call that has a high potential to be an ALS level call based on dispatch information (eventhough we know that sometimes dispatch info can be highly inaccurate), I'm triaging care to the EMT and responding to the call where I can do the most good for the patient. If that means that the patient with the sprained ankle has to wait 10 minutes for a mutual aid ambulance to arrive with an EMT on scene, I personally feel that's not on me, that's on the local ambulance agency for not being able to adequately staff their ambulances like the community should expect them to. The simple fact is that the concept of "well the medic can just ride in the call" is not only an abuse of limited resources that are available in the system, but hinders the whole Tri-Village EMS system just because one agency won't fully commit to addressing and correcting their staffing issues.

There is no staffed 36M2.. there is another Fly Car that OVAC owns and is lettered 36M2. 36M1 and 36M2 vehicles are rotated as 36M1 to prevent wear and tear on any one vehicle, and may be staffed during inclement weather, but it is not a regularly staffed unit.

If it's a BLS level call and the paid EMT is on scene, the medic is not tied up. They can triage care to the EMT on scene and go back in-service and/or handle another call. Now the only one tied up is the EMT who has to wait.

Ossining VAC is an ALS level agency providing EMS to the Ossining School District which encompasses the Town and Village of Ossining, as well as parts of New Castle. They are also responsible for the 36-Medic-1 system which provides ALS response to Croton and Briarcliff, and serves as a back-up for OVAC. #1 - OVAC staffs the 36M1 Fly Car, (1) ALS level ambulance 24/7, and when manpower and staffing permits (1) BLS level ambulance #2 - Last year OVAC responded to roughly 2200 calls, and the 36M1 Fly Car was right around 1,000 calls for service #3 - The number of volunteers has dwindled in recent years, but there is still a small core group of dedicated volunteers. Years ago there were several active volunter Paramedics, but now there are no active volunteer Paramedics. The majority of the time, there are not enough volunteers to staff an ambulance on a regular basis, but there are some night crews comprised of dependanble volunteers who show up weekly for their steady shifts #4 - 36M1 is a solo-paramedic Fly Car, with one paramedic working per tour #5 - Not quite sure what you mean? #6 - I believe the ambulances are PL Customs #7 - The current building can house 3 ambulances and 2 fly cars in the garage. There is a male bunk room, female bunk room each with 3 beds, and a seperate room for the Fly Car medic.

I really not trying to put you on the spot, but I have to respectfully disagree. Working the Croton system for 13 years now, I know first hand that Croton at one time was superb at covering calls, and the "abuse" of mutual aid was absolutely never an issue. but in the past year, there have been serious, serious issues with Croton being able to staff an ambulance, and I commend the Village and the agency for recognizing this and stepping up to the plate to address and correct this issue. If 7a to 7p coverage is sufficient, then why did Ossining have to take their one and only ALS ambulance out of service at 3am this morning to cover an MVA in Croton because they couldn't muster a crew? This now means that not only is Croton uncovered in terms of EMS since there clearly is no crew available, but now you leave Ossining uncovered as well because their one ambulance is being utilized to cover someone elses work. Ossining ended up receiving another call in their district, and fortunately the crew was able to do a quick turn-around and handle that job as well. I'm not trying to bash Croton for not getting an ambulance on the road, I'm trying to use a real life example from 10 hours ago that 7a tp 7p coverage is not the answer, and that the decision they made to go to 24/7 coverage is the right answer for their needs. You may like seeing when the 36 medic rides in a BLS call, but you know who doesn't like it? The unconscious diabetic, the active MI patient, the witnessed cardiac arrest patient, the exacerbation of CHF patient who would benefit from early, timely ALS intervention, and doesn't get it because their paramedic is tied up driving someone with a twisted ankle to the emergency department. It's an unjustifiable misallocation of resources in a system where BLS ambulances should be staffed by BLS providers to keep ALS level providers in-service to handle calls that required ALS level interventions. I can undersand you think nothing would be greater for CEMS to go back to a 100% volunteer agency, and I honestly do hope that they can boost their membership and get some new blood in there to increase their volunteer numbers. Personally, I think nothing IS greater then CEMS realizing that they had a problem, identified it, addressed it, and are now taking steps to correct it... and for that I applaud them.

Although I am in no way involved in the Fire Service, I think the idea of egos in Westchester is a problem that affects the 3 main emergency service fields (Police, Fire, & EMS) to varying degrees. I think first we have to understand why the egos exist before we can start coming up with feasible ways to eitehr get rid of them or circumvent them. I think there are two main reasons egos exist. First being that generally people involved in any of the emergency service fields are typically "Type A" personality individuals. True professionals have the ability to remain calm, cool, and collected, even when the world around us may be falling apart, and do what needs to be done to get the job done. Our services are routinely sought upon by those in need; and it's this dependance on us not just as a service, but as individuals that builds our egos. Knowing that we can do certain things that most ordinary people can't, are empowered with certain responsibilities that most people aren't, and knowing that there is a dependance on us and the services we provide all adds to our egos. Where would society be without Police Officers who maintain order, enforce laws, provide society's blanket of security and stand guard to protect those who can't protect themselves? Where would we be without Firefighters to prevent and extinguish fires and provide lifesaving rescue services? Where would be without EMS providers who nowadays utilize an expanded scope of practice to provide emergency medical care to sick and injured persons, and transport these individuals to definitive care? Our professions (whether paid or volunteer)by their very nature are ego-boosters for some and fuels the "Type A" personality individual. I think the second reason egos exist here in Westchester is because of the dynamics of the emergncy service "system" (if we can even call it that) that we have created for ourselves here. The adage of "too many chiefs and not enough indians" is extremely prevalent here in every service. To simply state it, when you have 70 different agencies across the county (a ficitious number just for sake of my opinion/arguement), each with individuals who have hopefully come up through the ranks and invested time and experience to obtain positions as Officers/Management/Administration, with each bump up the "emergency service food chain" comes the potential for a bump in an individuals ego. When subordinates continually refer to an indivdiual as Lieutenant, or Captain, or Chief, sometimes it goes to people's heads. When individuals are in charge of running an agency and feel that they are the greatest thing to come along to their agency in the past 100 years, the title and position has gone to their head. When people think that their agency can't possibly survive without their "expertise", the position has gone to their head. The truth of the matter is that in reality, any one of us is replaceable. Some may do a better job then others, but no single person is that important that their job can't be just done as well, if not better, by the next guy (or gal). I can even see how the perks of having a Department car can, and does, go to some peoples heads, because, especially in smaller communities, a Fire Chief driving around is his/her marked Chiefs Car becomes a figure head within their community. What can this lead to? A boost in one's ego. So now you want to tell an individual, who may have given 15 years of dedicated service to their local FD and finally made it to a Chief position, to be open to the idea of consolidation and/or regionalization. Of course there's going to be resistance to the idea of it, because this individual is now saying to themselves, wait a minute, I just dedicated 15 years of MY life to MY FD, and now they want ME to consolidate and take away MY Chiefs car, possibly take away MY title, take away MY power and authority that I worked for and deserve, etc (see the pattern there). It doesn't go over so well with a lot of people. But we created this mess ourselves by creating 70 different agencies within one County and adopting an "every man for himself" mentality. Even in EMS in Westchester, you have some individuals who have worked hard to create positions for themselves as EMS administrators overseeing EMS systems that they worked hard to set-up. Will they be willing to give up their system that they worked hard for to now become a part of a regionalized system where they may not have the same perks (i.e. pay, title, take home car, etc)? I don't know, maybe some will, but I have a feeling the majority won't. I don't want any of them who are reading this to take offense, because I know that most did work hard and deserve to get to where they are, and I can't fault them for looking out for themselves and developing a career out of EMS in a County where EMS is so fragmented and dissheveled. So how do we get rid of, or circumvent, egos in Westchester County? Like a previous poster said, it's gonna take a whole lot of people to put aside their pride, perks, and tradition to start looking to improve the system as a whole county-wide and not just within the borders of their Town. Is it possible, maybe. But it has to start with changing the mindset of our rookie Cops, Firefighters, and Paramedics for things to change. It's hard to change someone's perspectives and thoughts who's been in the same FD for 50 years and is so resistant to change and has fallen into a mindset that is against consolidation and regionalization because it's a concept that takes away from each individuals fiefdom. The newcomers coming on to the emergency service fields are the future of emergency services in Westchester. Whatever mentality they adopt from the time they come in is only going to become more solidified in their minds as the years go on. We can "groom" them to the benefits of consolidation and regionalization and looking at improving the system beyond the borders of their town, and make these individuals more open to the thought of doing such as they move up the ladder, gain more experience, and become more influential. I believe what would really have to happen to see any kind of change in the near future in any way, is pressure from politicians and the public, as well as legislation and more governing powers at the County level to control emergency services. Now I'm not up to the par with the legality of County government being able to control FD or EMS within it's geographic boundaries, so if this is even feasible is beyond my knowledge, I merely stating my opinion. End of my rant, these are just my personal opinions, some may agree, some may not, but I think the idea of abolishing egos is one that is definitely an uphill battle in a field where egos are as abundant as the stars.