Turborich

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Posts posted by Turborich

  3. Posted

    [Aside from the readers of this forum who believe that EMTs are stupid. :lol: :lol: ]

    Those whom think EMTs are stupid should look at their cards and see that before the "- Paramedic" or "Intermediate" there are the letters "EMT". Never forget your roots.

    You bring up a good point about the Epinephrine and these are the ideas that individuals should take to their peers, officers, REMAC/REMSCO/SEMAC , Etc.. to discuss and furthur review. However...

    .. Keep in mind Training, Cost efficiency, liability, and practicioner compliance are all things that are weighed into such decisions. Does it make sense for that or other progressive ideas/ treatments to be rolled out if it is good for the patient? OF COURSE! Do we as dedicated practicioners or John Doe as the patient give a damn about the cost? HELL NO! However to the individuals that ultimately make the determination that we should roll such things out in the field these are substantial topics that cannot be dismissed. As I have learned over the years.. what's good for one is not nessicarilly good for the other. As we strive to take a holistic approach to the patient we must now keep in mind that same holistic approach to the EMS system in general regarding such decisions.

    [Masterfully said. Sounds like you're writing from experience. ]

    What the hell do I know.. I'm just an EMT like everyone else on this forum... :P

    Rich

  4. Posted

    Just some things to keep in mind..

    In NYS curriculum and NREMT the EMT-B, I, CC, and EMT-P assessments vary only slightly. The EMT-P may intervene with advanced skills however interview, transport determination, ABCs, SAMPLE, OPQRST, etc.. are all the same.

    IMHO, the individual provider at any level must master the art of a proper interview and assessment above all else. This is the framework that defines the best practitioner(s) in the field today when practiced alongside outstanding patient rapport. These are the skills that will definitavely provide the patient with the best care possible aside from all of the fancy auto injectors and B.S. electronic PCR pads.

    It is the almost unanimous thought that the EMT-Basic Curriculum is lacking in many aspects and should be more "holistic". I believe that the EMT-B curriculum in NYS provides just enough for the individual to develop a framework to become an informed prehospital provider. It takes years in the field to become a true "practicioner" of prehospital medicine and this is a thing that all 57,398 providers in NYS at least strive for I would hope. Unfortunately time constraints, second and third jobs to make ends meet, and demanding recertification processes almost make a longer class for those interested parties unrealistic. Think of those Vacs up in St. Lawrence County for example... how many new certs.would you get if the class was say 450 hours.. how many new Paramedics would Alamo get if the class was a 4 year program and paid the same as today.. would we still be satisfied being called a McJob after 4 years of schooling?

    As far as advanced skills are concerned I believe it is an asset to our patients that basics may administer select medications such as Albuterol, assist with NTG, ASA, etc.. however it is the duty of the provider's agency and medical director to affirm the competancy in every advanced skill outside of the normal scope of practice. It is the duty of providers to live by that certain thing that we live by day to day in the field and we learn the first day of EMT-B class.. the phrase that is erroneously thought to be contained in the Hippocratic Oath; "Primum non nocere" or "First, do no harm". It is the duty of our regional EMS councils and SEMAC to determine which expanded practices may be implemented which are in laymen's terms "foolproof" keeping in mind that same premise. This is why, while also looking at national and statewide statistics, EMT-Bs do not intubate. Combine with the overwhelming statistics the overall costs of outfitting squads with the additional nessicary equipment to do so and you have successfully ran most volunteer and even some paid services out the door. With the recent (unfunded) regional mandate for continuous capnography you are seeing agencies in spin mode. Believe it or not there are agencies out there wondering how they are going to equip their personnel with ANSI compliant vests due to the economic status of our municipalities locally... let alone the 10 other unfunded mandates by National/ State/ Regional entities this year alone.

    It is without a doubt that 12 lead EKG and transmission, endotracheal intubation and advanced airway devices, adult I/O, and prehospital delivery of select medications are a great benefit to those in need of immediate intervention and are proven to work, however the opportunity and economy costs of such investments do not facilitate changing regional or statewide protocols to allow basics to provide such services secondary to those costs, and quality assurance/ improvement issues.

    Not to start a flame war with the previous statements, but to put it into perspective with a true example- why do you think most services rely on Albuterol as their primary bronchodialator and not Levalbuterol (Xoponex)? It's not because Albuterol is the better or more efficient drug... it's because it's cheaper! Levalbuterol is a bronchodialator just like Albuterol with the exception of that it effects only the receptors in the lungs (beta 2) as opposed to both the heart and the lungs like its cheaper counterpart. The issue is that most agencies can't stomach the $60.00 per box of 24 and the local EMS regulatory agencies realize that. Thus we deal with a drug that basic level providers can administer, however they now have to worry about a list of contraindications which you must contact medical control about even before administration instead of one that produces far less untoward effect. Is that worth the $52.71 you are saving buying a box of 25 Albuterol? You do the math... is a transmit capable LP12, recieving staion at the hospital, end tidal CO2, continuous waveform capnography, intubation kit, secondary "blind device" (ie. King, EOA, EGTA, Combitube, LMA), CPAP, and nessicary communitcation devices feasible for your "expanded practice" BLS VAC or grassroots BLS commercial service? If so I envy you and do not envy your taxpayers.

    For the record I am a HUGE proponent to expanded service however I know that dollars and cents will dishearten me as it has over the past 10 years I have been involved in Emergency Services. I think that CPAP foremost, should be a BLS skill. However knowing the overhead with such equipment I know that this would be a shot in the dark at best if made apparent at a REMAC meeting secondary to compliance and QA/QI.

    The sad truth is that ALS providers are far more likely to face the eradication of field intubation before BLS providers will see it as an alternative in their protocols of taught in their curriculum. As much as we have seen it work in the field nationally the decision makers see it as a shortfall. The best thing that present day practitioners can do is keep up on your CME, stay informed, and above all practice good medicine in the form of thorough assessment and early informed determination of treatment modality. Remember that just because it sounds like a "cool" idea and you might be capable of it the other 36,943 EMT-Bs in NYS might not be able to.. and the same goes to Is, CCs, and Medics as well. If you think that something could be better or work more efficiently tell your agency head/ medical director/ region and maybe you can make a difference.

    Be safe out there,

    Rich

  7. Posted

    Quote from article-

    "The accident occurred at around 9:30 a.m. at Snail Road and Route 6, during a routine test run of the 75-foot-long truck, Trovato said. The intersection is near the town line with Truro and is often deserted"

    LOL.. 75 foot long truck!

    Seriously thoough It was a neat truck.. I saw it a few years ago when I was up in the cape. Perhaps they can buy Orleans' old maxim mid mount and do the same refurbishment or similar.

    That truck was spec'd for years before built secondary to Provincetown's cramped streets.. a replacement will be tough if they want to go new.

  10. Posted

    I am here at Punam Valley Vac, (Medic 2). This is just shy of half of my last shift working in Putnam under Hudson Valley.

    I would like to say to all of you that I worked and have become friends with, " Thank you and I have enjoyed working with you all." I am going to miss working in the county, but will still enjoy volunteering in the Valley. To all my senior Medics, Rizzo, Tracy, Bill O, John, Eric, Mike, Matt, The Dr Rev, & others that I havent named. Thank you for all that you have taught me & standing up for me and with me while doing my job. I have had a great time riding with Put Vall, The Falls, Mahopac, Carmel, Garrison, Brewster, Lake Carmel, Kent.

    Philipstown, John E, I also thank you. You where a great Boss. To the Putnam Dispatchers, thanks as well.

    Oppie

    Tom Orpikowski

    Man, do I miss working Putnam...great calls and great people. Best of luck to all in future endevours..

    Tom, seems like yesterday we were down in P-town "swoopin' the loop"

    Have a good shift and hopes that all stays well "down south".

    -"Turbo"

    P.S. You missed Seth!!! If anyone is "SENIOR" he is LOL! BTW he owes me a beer..

  11. Posted

    Four killed and one critically injured is the preliminary from my source in MSP. The helicopter was returning from an MVA in Charles County with 2 patients and another medic from Charles County. The lone survivor is a patient. The crew encountered bad weather while enroute to Prince George's Hosptal and diverted to Andrews to meet with ground units for the remainder of the transport however crashed about 3 miles out.

    Our prayers go out to the flight crew, other patient, and their families.

    Unfortunately this is a seemingly increasing trend in aeromedical services this year.

  13. Posted

    Guess there's a little less "Turbo" in Rich now that your a daddy. Welcome to the lack of sleep club....and also the countdown to the dad was once a man himself anxieties...lol.

    Thank you for all the kind replies :D

    Gianna came home last Friday and has been up ever since it seems..LOL! The lack of sleep is definately taking the "Turbo" out of me.. hence the reply at 2AM, I think she just pooped again actually.

    ..And I thought the pager tones woke me up abruptly.. the crying in the middle of the night definately takes the prize...

    ..wouldn't trade it for the world, she's the greatest! We'll worry about the "anxieties" at a later date however I will need opinions on the most efficient handguns and a pistol permit application just in case :blink:

    You guys are great!

  15. Posted

    Not that it needs to be justified, and in no way are these official positions of AFD, but hydrant testing is done by Town Water, not Arlington, and as stated on PoJo, vehicle sirens are not evacuation alerts. I can assure you the sirens were used en route to the call. If anyone stands on the Q while pumping to alert the neighbors, I'd love to shake your hand.

    As far as the cat, feline CPR was performed by a heroic AFD Medic and EMTBravo member

    As per Arlington Animal Hospital following the incident the cat was under observation however stable and was either released last night or today :P

    An Excellent job by all and looking forward to the post incident review.

    It was pretty intense pulling the line to the misting fan.. LOL.. damn rotation ;)

  20. Posted · Edited by Turborich

    Ok, so technically speaking a true Ladder Tower device consists of a pair of longitudinally extending, laterally spaced apart truss members and a plurality of longitudinally spaced ladder rungs interconnecting the truss members. Each truss member includes an upper hand rail, a lower rung rail being spaced below and lying in a common plane with the upper hand rail, and a plurality of braces extending between and interconnecting the upper hand rail and lower rung rail of each truss member. The ladder rungs of each section extend between and interconnect the rung rails of the truss members thereof. A bucket with a capacity for firefighters/ potential victims is hinged to the end of this structure. Most conventional aerial platform devices are of this type and examples can be seen in the E-one '95 mid or rear mount platform, Crimson, Pierce, ALF, Metz, a whole lot of others....eg. Arlington's tower, Tarrytown TL78, Peekskill's tower, Yonkers' tower(s)...etc

    so,

    the ladder looking from the turntable appears to look like this -

    [___]

    However, in a true Tower Ladder the longitudinally extending members are solid in a boxed beam type of construction traditionally consisting of telescoping sections with solid exterior which generally do not incorporate a truss design (Sutphen aerials are the only exception to this rule as the telescoping box beams incorporate a trussed design with a "huckbolt" assembly, but that's an entirely different soapbox). These aerial devices generally have a small "escape ladder" built on the top of the beam which may or may not have siderail protection (except Mount Vernon which has no ladder for some reason). These vehicles were pioneered by Baker/ Aerialscope and were made wildly popular by FDNY. eg. Hartsdales tower, Mount Vernon, Bedford hills, Rombout, New Hamburg, Hyde Park.. blah blah...

    so,

    the ladder looking from the turntable appears to look like this -

    I-------I

    I____I

    Hope this clears things up.

    Rich

    *Note I said longitudinally extending member at least once or twice..

  22. Posted

    How come there is not more of a presence from Ulster County guys? There are some really well educated departments and well run districts up there.

    I think an incident alert section for Ulster should be added, there is always something interesting going on there. Not sure if it is possible to do at this time but I think it is definitely something to think about. I will also keep trying to pass the word along about the site and hope for the people I tell to tell others. Who knows I guess only time will tell if they decide to join up with a great site and share their knowlege.

    Hey, we're around.. just alot of us are afraid to admit it :lol: I believe there is also a guy from Woodstock and one from New Paltz as well.

    I have only seen a few alerts posted from Ulster and they have been in the regional section. If the alert volume increases then I could see that happening... I'll certainly try to contribute more.

    Rich

    Co. 45

    Co. 78

  25. Posted

    Yes the ladder is on a drop down ziamatic bracket. The truck was delivered tonight and underwent our pump test. Hope to have it in service in a week or two. Once the weather is a little better(snowing now) ill get it cleaned up for some good pictures. Heres a Camera phone pic I took the day I applied the graphics in albany

    1207071427.jpg

    We have 5 stations all together.

    Company One (woodstock)

    2 Engines

    Tanker

    Mini

    Rescue

    Utility(pickup)

    atv

    Light tower

    Company 2 (wittenberg)

    Engine

    Tanker

    Mini

    Company 3 (Lake Hill)

    Engine

    Tanker

    Mini

    Company 4 (zena)

    Engine

    Tanker

    Mini (i think thats what you think is our new rescue)

    Utility/rope resue (old ambulance)

    Hover craft

    Company 5 (rescue)

    2 Ambulances

    Medic flycar

    Yup... that must be it.. 67-42.. was @ the NYS Chief's show but didn't have a chance to look closely at it. Saw it again on 28 @ MVA and figured it was a second rescue LOL.

    Wouldn't mind getting more info on the engine for apparatus committee PM if you have the info. Thanks

    Rich