weaselff

http://www.emtbravo.net/index.php?showtopic=36830&pid=209958&st=0entry209958

Just wondering what other EMS providers here think. What mechanism/circumstances would make you treat a GSW to the foot (possibly from a ricochet) ALS?

What would you do to treat a similiar patient who is alert and oriented without other complaint?

The only time this should be ALS is if an arterial bleed is uncontrolled...maybe for no exit wound or long txp time(30min+)?

Although this is a discussion for a different thread, if someone wants to RMA and is of sound mind and judgement, they have every right to, regardless of the condition they present with to the EMS provider. As an EMS provider, you can not force an individual to seek medical care unless you can document that the individual was not of sound mind (at a minimum alert and oriented to person, place, and time) and therefore incapable of refusing medical care (i.e. altered mental status).

Obviously attempts should be made to convince an individual to seek medical attention, and that includes contacting medical control and allowing the ER physician to speak to the patient to convince them to seek treatment at the ED. Documentation is more important with RMA's then any other PCR an EMS provider will ever write. Important points that you should always document on your PCR:

1) That you advised the individual the consequences to refusing medical care, including the possibility of death

2) That Dr. (insert name) from (hospital facility) spoke with the patient in an attempt to convince patient to allow treatment

3) That you informed the patient to call 911 in the event their condition worsens or they change their mind and do wish to seek treatment

4) At a minimum, the patient should follow-up with their private physician or seek other means of transportation to the ED if they do not with to be transported by EMS.

5) Document anyone else (family members, clergy, coworkers, family, police, fire, etc.) who attempted to convince the patient to seek tranport/treatment.

6) After all of the above measures were attempted, the patient still refused treatment/transport despite fully understanding the consequences to the RMA.

I am aware of these things, he just made the tone of the post sound as if he was ok with allowing someone to RMA with a pulmonary embolism with a trivial issue such as lack of insurance, like he was dealing with a stubbed toe or something. I worked in the NYC system where you had to spend 30 minutes on the phone with telemetry to even consider an RMA like that or it would be your a$$.

I got news for you; almost everything in this country is socialistic; anything that is provided by the government is socialistic in nature; schools, sanitation, police, fire, Highway department, and the list goes on and on. Plus we've had socialized medicine since the inception of Medicare/Medicaid. So this is nothing new; just an expansion of a program or concept that's been in existence for decades; I may not like everything in the bill, but the fact of the matter is that it will help millions of men, women and children who have absolutely no medical coverage at all.

Furthermore, I think this is going to help those who can't afford medical insurance or those who are under insured. Just tonight, we had a rescue call and the woman there thought she might be having a pulmonary embolism. She RMA'd because she had no medical insurance and couldn't afford the ambulance and instead had one of her relatives drive her to the hospital. I hope she made it; if she had coverage, she could have gone in the ambulance with a medic. I'm sure some of you in EMS may have seen similar situations on rescue calls.

Of course its going to cost money; but if the government cuts out these so-called "pork barrel" projects and scales back on other affairs that we conduct around the world, that's a good start to help fund it.

You allowed someone having a possible pulmonary embolism to RMA???

My apologies Tom, you were correct. There's an interesting conversation.... not saying it was the wrong call, but I would like to hear the rationale for going so far afield. Tankers with a at least a couple thousand gallons in Glenham, Hughsonville, East Fishkill, etc.. Did BFD consciously think about where the heavy snow line was and go beyond it? Again, not questioning the decision, just fascinated as to what the thought process was. Anyone from Beacon care to explain?

AND..... what were they thinking in PV when they got called to the big city

Beacon is the big city?

But seriously that is a long trip from PV down to Beacon

Though I don't envy that job in this day and age it is definitely on of my favorite genres...they are usually better than fd movies LOL. I don't think Training Day, Fort Apache, Copland or Colors have been mentioned.

On a side note I always thought report from Engine Co. 82 with the right director, lens and ADVISORS would make a great movie.

yeah its like $10-$13 i think it keeps goon up every year, where from CT you comming down from???

I think you have to pay for parking too

How does this effect religious outfits? i.e.: Hotzolah? (spelling?)

Dont worry they will still be allowed to do whatever they want...

I am as politically conservative as anyone else on this board but my feelings when it comes to property taxes is that you get what you pay for. When I was young and dumb I bought a home in an area where the taxes were low around 3k a year and basically everywhere I went around town it felt as though an episode of COPS was about to break out. I had halfway houses and section 8 on my block. While there were many good families around, there was enough skells to keep me looking over both shoulders day and night.

Now I live in a town where I pay closer to 10k in property taxes but the piece of mind is worth every penny. I don't worry as much about my families safety and I can go to the supermarket without feeling like I am going to get car jacked in the parking lot.

OUCH! Welcome to the modern era of doing without, the era of doing more with less is over! My guess is that about half that number will actually get cut. None will be in Manhattan and none will be in wealthy neighbor hoods.

What makes you think none will be in wealthy neighborhoods or Manhattan? Engine 4 which was saved from the chopping block at the last minute last year is first due on Wall Street!!!

I have lived my entire life in the nyc area and I have never seen a "Tefillin" in my life. If a guy like me who grew up in an area with more Jews than anywhere outside Israel doesn't know what they are, how is a 25 year old stewardess from Kansas with a junior college degree and an 8 hour course in diversity gonna know what they are?

I just read the story in my local paper as well. While I do understand the flight crew having to take any and all precautions, I believe that if the crew had received some sort of diversity training (IE: some sort of cultural differences training) this could have been avoided even if the aircrew from the passenger. Yes in these times I understand that we all have to be aware of the few that want to bring chaos, injury, and death to some... But this did go a little far.

In the military now, we are all required annual training on cultural and religious differences so we can try to identify someone practicing their religion VS. a fanatic trying to cause problems.

I am getting my EMT certification in NYC. I have looked into the process for applying with the FDNY? Can anyone tell me a little more about the process? Is there a physical agility test? What is "boot camp" like? About how long does it take to get called in for an interview once you initially apply? I would appreciate any help anyone could give me. Thanks!

The physical agility is easy. The academy is pretty far from a bootcamp, but was academically challenging. In 2004-05 it took me about a year from when I initially applied to when I was hired. Good luck.

I don't think you understand exactly what I'm talking about. If you have a minute look up crossfit on youtube. Any serious crossfitter would have no problem climbing 6 flights of stairs and going to work. I rarely run but when I do I still post ridiculous times. Crossfit is fast becoming the workout program of choice for military special ops and emergency services personell all over the country because it works. Unfortunately it hasn't caught on as much here in the northeast but it is gaining poplarity everyday.

If you dont do cardio you are going to sell yourself short. This job is balls to the wall for 10-20 minutes. If you are useless after the first 6 flights of stairs what good are you when you need to force that door and make a search or move a handline. Run intervals and do stairs, with weights if you have a vest or with dumbells in your hands. I went through the academy before this BS CPAT test, if you didnt run you were going to be forced out or put in the spotlight, two things you never want.

Do lots of deadlifts, squats and kettlebell swings. If you can afford it go to a CROSSFIT affiliate...if you can't follow their workouts as best you can on the crossfit.com website. Cardio is OVERATED, take a run through the woods every now and then or jump on stairmaster with a waited vest once or twice a week. Also climb ropes and do lots of pull ups and push ups...when you get tired do some more. Eat natural food..don't eat processed crap made in a science lab. Follow this advice and you will be a beast at the academy.

I got to do this for EVOC in FDNY EMS. I think this simulator and the one at the rock were donated by NASCAR after 9/11. I remember the instructors saying and I dont know if this is BS or not but most of the people who get sick tend to be older. Younger people especially males tend to do fine and they were saying this is because we grew up playing Nintendo, play station etc., and we are "condtioned" to immersing ourselves in a video screen. I know I did not feel any dizzyness or ill effects.

The big difference from present and former FDNY ambulances, will be the use of a four door cab instead of the up till now standard two door cab. The new units will all be designated as regular ambulances, with none slated to be fitted out as Haz-Tac ambulances, or Haz-Tac Rescue ambulances.

Why would anyone need to have a four door cab on an ambulance? Please tell me I read that wrong.

I like the idea...makes a safer spot for non essential family members to sit than in the back of bus.

I worked at Sharpe Reservation from 2004-2006, and yes, they were going strong as of then (I am sure still experiencing economic issues as is everyone else), but it is a nature preserve, and protected by many federal regulations, and I am sure it is not going anywhere for a while. In fact, they have renovated, and expanded their facilities on site, and I don't believe any development or takeover is in sight.

I do miss it there, it is beautiful, quite, and serene there, and good people.

Bernie Ruf retired from there in 2007 after 50 years of service to the non-for-profit Fresh Air Fund, and 20 years as director there. A great, quiet, caring man, who will be greatly missed.

http://www.khrfuneralhomes.com/cgi-bin/obit.cgi?Name=Bernard%20Edward%20Ruf

Good to hear it is going strong, I had a good time there as a kid.

Sort of off topic, but that place is still around? I went there twice 20 years ago, once with my elementary school and once with cub scouts. I figured it was McMansion development by now!

Link to Incident Alert

According to the news articles personnel (from four counties) had to hike in 1.5 miles to get to this fire. I'm just curious, did anyone consider calling for aerial assistance? The State Police are right across the river in Newburgh and since this went on for so long they could also have brought a Huey down from Albany (with a larger bucket) to assist.

It looks like there was at least one lake right there and another just down the road.

Does anyone have more info?

A lot of people forget that many countries including those in Western Europe are not democracies as we think of in the American sense. They don't have a bill of rights or a constitution garunteeing freedom of speech, miranda rights etc.

quote name='abaduck' date='13 November 2009 - 11:11 PM' timestamp='1258171913' post='196597']

PFDRes47cue, you were lucky not to end up in jail. OK OK slight exaggeration there, but there IS a new law in the UK which can be interpreted as making it illegal to take photographs of police if such photos could be 'of use to terrorists'. It's a VERY controversial topic in the UK at the moment, and some elements in the police there are already pretty hostile to photographers.

A picture of 75 engine hitting a hydrant "backdraft" style may be too buffy even for this site!

They could never get this project off the ground when the economy was booming how do they expect to get the ball rolling in the current fiscal climate? Yonkers is too far and seperated by its most unfashionable borough from nyc for the yuppies and hipsters to invade. It just doesn't have the sweeping skyline views and proximty to manhattan that gentrified communities like Hoboken, Jersey City and North Brooklyn have.On the other hand Decades of "percieved" high crime and political corruption have given Yonkers somewhat of a poor reputation among more affluent families.in Westchester and the Hudson Valley. It is difficult for me to imagine the average young family in Westchester traveling to downtown Yonkers for anything let alone spending the evening at an entertainment complex. I hope the project works out bit I think its going to be a hard sell.

17.) More guys paying attention to Phsysical fitness. 50 years ago guys were doing "12 oz curls" washed down with "liquid bread" protein shakes. I'm guessing guys started getting involved with "Arnold" inspired weight training in the 1970's, which has now progressed to members doing more functional fitness stuff today like CrossFit and P90X.

weasel...i never understood this; how could you "run" a fire department (not to mention the biggest/busiest) without ever being a fireman? Is the commish appointed by the mayor as more of a business/administrative posistion?

The comissioner in FDNY does not so much run the dept operationally, as he is a more of a business manager. IMO I think it is better to have someone with firehouse and fireground experience who understands what it is like to crawl down a hallway what the culture is like in the firehouse kitchen. This however is not how a business man like Bloomberg thinks, he just wants his represenative yes man in the comissioners chair.

Any word on where he will be teaching? We are still looking for a new Fire Science Director at UNH... haha, unlikely.

You can have him...by the way he currently is not a firefighter, nor was he ever. He is however a career yes man and bueracrat.

AWESOME,AWESOME photos! I am SO envious of you!

Is this the first time this event has been held? If not, I am kicking myself for not knowing about it in previous years.....

When I was in EMS a few years back I was fortunate enough to be the standby for it. When(if) I have kids I would definitely take them back. I was 25 years old and I had a blast, I can imagine an 8 year old would be on cloud 9!

Another member added to heavens fire department...RIP FF Joyce