roeems87

Not that I feel what happened was right, but for the time being, let me play devil's advocate...

Firstly, take a look at the description of the patient. The man was thrown an extreme distance from a car with a clearly fatal MOI. The body had obvious signs of death (which according to what is taught only includes "obvious and massive trauma"--which I would say gaping hole and a facture of the skull, never mind the blood, and obvious other fractures and deformities would include), and no appreciable pulse or breathing in any of the three pulse check spots. Let's be serious. Obviously the arriving medics should have checked the body for themselves, but when it is the concurrance of 3 medics looking at the body that it would seem so obvious, and the first found no signs of life, wouldn't you agree with the decision made.

Moreover, hind sight is 20/20. How many times has anyone had a firefighter second guess whatever EMS is doing...right or wrong? How many other times could you hear someone say, "are you sure he's dead?" when a medic makes a pronouncement. This only furthers the point about the public becoming more educated about the scope of practice within EMS.

Obviously there could have been more done to check this guy out, but also take the post-trauma/hospital stay/quality of life arguement. Is it reasonable to continue to try to resusitate someone in PEA after 45 minutes of CPR, defibrillation, and drugs? The quality of life post-incident is obviously taken into consideration where you decide to draw the line. Based on the description of this incident, and the patient, come on now...

You have to assume that this was such an extreme case when this accident ocurred under the auspices of 4 paramedics, whatever other EMS trained people on scene, and a doctor.

I don't think the arguements I present here are unfair... Please feel free to comment, disagree, yell, whatever you need to do, I just thought I would provide another side of the story, even if just for arguement's sake...

Eastchester PD converted an older EVAC ambulance to their "Emergency Response Unit" (ERU, a.k.a. E-1). It's apparently the swat team vehicle. Clearly it doesn't get used all that often (and that might even be an understatement). Most of the IC vehicles I have seen are those mini-buses. That's what Yonkers has, appears to work well.

Date: 1-30-05

Time: 0630

Location: 46 Jackson Ave

Units: Engines 27, 29, 30, Ladder 16 (using 15), TL17, 2101, 2102, 2103; EVAC 57-B2, 57-M1, 57-11

Description: Reported Structure Fire in an 8-story senior complex.

Writer: roeems87

Units on scene began to evacuate building when it was determined to be an isolated compact fire, extinguished by the sprinkler system. Checking for extension. Negative Extension. EVAC diverted to another call (medic 1 staying on scene), EFD released all units approximately 40 minutes later. Residents allowed to return to the building.

Just to clarify the numbers, sorry Pudge...ha ha

57-11 Chief/President

57-12 Deputy Chief of Operations/Vice President

57-13 DC Administration/VP (who was on the scene the other night, not 57-12)

57-14 Captain

57-15 Lt. Administration

57-16 Lt. Operations

57-17 DC, ALS Coordinator

Two things to add. As for using 10-codes for more than the typical, responding, on scene, in service and the little things inbetween, we use for the basics, that's true. Coming from EMS, it's not that bad, (10-17,84,85,86,8,2)... There aren't that many, but like I made the point in my last post, when for example, the first unit arrives directs all others responding to "10-20," (proceed with caution, slow the hell down) I have had the driver ask me what that means. When that is a direction to them, it's important they know what it means...and not everyone does, especially in the smaller towns or voly departments. Another one or two that I see used more frequently that perhaps people don't know 10-5 (repeat) and 10-6 (stand by). Just little ones that people should know, but perhaps don't, and when the 60 dispatcher is waiting for a reply after saying "10-5" and the person on the other end thinks that means "stand by" the two are not getting what they need to get done. So when you are in that situation, saying, "repeat" or "stand by" would be the same amount of time, and get the message across...without confusion. Like I said, the 10-codes sound better, but until people decide to know them, you should use the language everyone speaks, english...

My second point is in response to the question about Yonkers using 10-codes and english sometimes. If you look at a whole bunch of their codes, they are more general where a clarification is needed in english after the 10-code, for example, 10-45 for a medical aided, usually will be dispatched as a "10-45 diff breather" or whatever. Besides that, you will never hear "structure fire, all hands" over the Yonkers radio, 99.9% you'll hear "10-29, 10-30"... More than that though, when the battalion chief gives and update, it's brief and to the point, using 10s when possible. It works for yonkers because everyone working (I mean everyone one of the people talking on the high band UHF--perhaps not the fireground low band) knows what every one of them means. THAT is what makes it effective...

Honestly, I think it depends on the system. Some places use them well because they are busier and use them more often, but for the majority of westchester county in the voly systems or smaller town VACs or FDs with lesser used departments, the 10-codes might not be the best idea. I like the idea, in fact, I use them as much as I can, but I know for sure that if I say something with an obscure 10-code that I am going to doubt whether the person on the other end knows what I am talking about. I can tell you on multiple occassions I have been asked what "10-2" meant by partners with less radio talking time. It may be obvious to some, but to places where people aren't attached to the radio or a scanner, or simply using it, all that often, it's easier and more effective to use plain english. There isn't much of a difference between "responding" and "10-17" and honestly, when someone says "10-84, no 5, no 6, no 10-85 BLS to Lawrence, no White Plains," because they don't know what the hell they are saying, it is clearer and easier (and faster) for everyone if they just said "transporting one, BLS to White Plains"...

Besides that, though, places elsewhere are more apt to handle 10-codes. All police departments in my opinion should use them. That's a safety and privacy thing for both them and the people they serve, so that should be done. I would like to see a more uniform one, but we all know that won't happen, so it works the way it is...

Take Yonkers for example, however. Possibly the best Westchester County example. The PD uses 10-codes to the best ability possible. Empress does as well, though you hear some plain english, they even use the HEAR codes for hospitals when they refer to them... And Yonkers FD sounds incredibly professional on the radio. What I do like about Yonkers FD that is different from other FDs in the county is their professionalism on the radio that is only added to by the 10-codes. First of all, not every Tom, Dick, and Harry talks on the radio. They get dispatched, then the dispatched confirms responses by simply reading the units, they respond like a role call to the dispatcher. "Yonkers to the units responding 123 Main Street, possible 10-29, Engine 314, ..." "314" and so on... Besides that, all the units call is 10-84 and some updates. Besides that, all the radio communications are handled by the dispatcher and the battalion chief. The 10-codes make it more professional and for them, easier to catagorize what the heck is going on, when a whole bunch of things are going on. It's an awesome system.

granted, CPR is not perfect all the time, nor do I think it is always possible to be. The whole 15:2 ratio is kinda thrown out the door when you have three people trying to save someone's life which involves a lot more than just worrying about compressions and bagging. I would like to see that study done in the US before I would make a full judgement on it, but nonetheless, sometimes there are burned out EMTs who tend to have that same "they're already dead, no matter what I am doing, I'm helping" attitude and it is totally out of place. If it doesn't interest you to try to save someone's life (this being the prime example of when that is most needed) then what the hell are you doing in EMS? Sorry to wake you up to someone's parent or brother or sister or grandparent or aunt or uncle who needs your help. That attitude annoys me too. As for not being mentioned...yeah paramedics are mentioned though, that's a step...usually only FFs are the heros...

CPR is something that you do your best with. In a moving ambulance you can't expect perfection, and unless you are in a system where you do codes every other day, CPR is also a skill that no matter how many times you have done it on Anne, you can only get good at from doing the real thing. It only takes a few times to get in the swing of things, and get the feel for what exactly is necessary, but the best point on here (Pudge) is that no patient is the same. You can't possibly tell me that CPR is the same for (though it is on Anne): grandma that is 75 pounds with osteoperosis; or the 45 year old weight lifter with a chest as hard as rock; or the 400 pound McDonalds fanatic who just had her 4th MI with a side of a stroke... No two cases are always the same, and I would like to hear something more positive like, CPR was performed adequately or well-enough on 90% of patients instead of, they "missed one thing" on 80% of the patients.

Just to add to 901 and Pudge, I think some of the problems with these hospitals are that they have the same attitude towards patients when they are not on diversion as when they are. Not for anything, perhaps you're having a bad day (perhaps even a busy day, we'll cut some slack), so we'll take the attitude once or twice, but when you have the attitude every day, then it becomes an issue with me (and I know others). I can't believe the attitude we get sometimes walking in with a patient. It's as if we are offending them by bringing in a patient (you know where I am talking about). Not for anything, IT'S THEIR JOB TO TREAT PATIENTS, THEY'RE AN EMERGENCY ROOM. So how in God's name can they get mad when you are bringing them patients. If we stopped bringing them patients entirely, they might see their job go out the window, then they might complain a bit more.

Not only that. I can't stand it when the situation like is on now, the attitudes run higher. When all of the area hospitals are on diversion...we have to pick one. Sorry if it ends up being yours, but when we walk through the door and get a print out saying they are on diversion I want to throw it right back and point out that every other hospital within 25 minutes is also on diversion.

We're doing our best for the treatment the patient is going to get. Whatever hospital that means we bring them to, that's where they go, end of story, the diversion is just another factor added into that.

On a side note, the deal about bringing in a code and getting hung up on, I am not surprised at all, and if I can predict what happened, when you rolled through the door, they were offended that your patient had to be taken care of first. If they could get away with it, they might just send him to triage (intubated and in arrest), he can wait on line too, "we're on diversion you know."

60-Control has a similar type of thing. To the best of my knowledge it isn't for immediate public information like that Florida County site is, but all the information from the CAD on every call that is put into their computers can be accessed by anyone with a password from any given agency. For example, our captain can access the website with all the call information (for whatever period of time, weeks, months, etc--all the way until seconds ago) he is looking for. When he pulls it up on the screen it gives the same information: location, dispatch info, units involved, times, run numbers. I don't know if it can provide a map, but who cares.

So it does exist. If it's not intended to be public knowledge for a specific reason, then it will stay that way, if it will be soon, then I am sure it's the very near future.

Just a small note, in YFD, 10-20 doesn't mean proceed at reduced speed, it's different than the county code. 10-20 means "nothing showing" or "nothing visible from (specify)." You probably hear it used as "3-1-4, 10-84, 10-20 from the outside" or something like that.

IMO, any responding unit (from any service) should give a size-up when they arrive on scene briefly on the radio. I know Yonkers FD does it all the time--at least, most of the time. "Engine 314, 10-84, 10-20 from the outside, investigating..." (10-20=nothing showing). Obviously, on EMS runs, there is no need for an ambulance or engine to announce what's going on over the air, but a simple "57-B2 is 10-84, PD on the scene." Or at a car accident, for example, "2102 10-84, three cars involved, two patients, possible extrication required." That way everyone responding knows what's going on. If an engine is on scene first, and says "smoke and flames showing on the second floor," the command knows to request another engine, or truck, or whatever he wants, even before reaching the scene.

In general, it doesn't eat much air time, and it's a practice I think most agencies should get in the habbit of doing.

For a complete overview of their varying scopes of training, you can go to the New York Dept. of Health website (the EMS section) and read some of the protocols. Here is the site:

http://www.health.state.ny.us/nysdoh/ems/educ.htm

Why wouldn't you assume that if the engine crew could find the long driveway and make its way up there, the ambulance could as well? There isn't any need for a FF to stay and "flag down the ambulance," but I'm not sure about YFD's policies about being with the truck or manning communications on calls such as that.

I think there was a car accident earlier, like right before the more major incident. SFD was dispatched to an odor of gas at Ben and Jerry's in Heathecote there, right across the street from ScarVAC HQ. I didn't listen to the thing, but it was fairly significant because coned gas and all was on scene. I know they were opening man holes and the like and looking for the source. There was a leak some place.

Sounds like ScarVAC was at that scene as well. I just heard them say "1-8 to HQ we're out at White Plains ER, again." Meaning that must be their second patient, at least...

What's your point though? That could happen with any engine. It was responding to that fire as an engine, and it would have been part of that assignment for that reason, not the squad status. Like was explained above, the Rescue was requested as well, so that's the rescue(/squad) responding to the scene, 311 would have been used as one of the 4 engines (though the squad is additional), not as an additional unit like the rescue was.

As much as it is a specialized unit, just remember that it is the first due engine for a significant area of Yonkers. Besides that, if you listen to YFD a lot, you know that E311 was quite frequently within the first four due engines...a good percentage of any calls on the east side of Yonkers. Having a specialized unit is a good thing, sure, but the need for an engine in that location (or something that serves the purposes in the first due area--i.e. for medical aids) is for sure. If you look at the Rescue, it covers the west side (mostly), but it also has an engine in the area. There are engines in the area for 311 to be replaced, but it doesn't have anything in it's "first due" area that can replace it--if that makes any sense. Anyway, don't over estimate the amount of time spent on medical calls. The only time Yonkers engines are sent on "10-45s" in Yonkers is for a protocol-determined serious patient, not every call for an ambulance--as in some places where it's NOT necessary. Empress I believe has an average response time (if not average, I would say normally within) 8 minutes or so. Which means, with the ambulance crew on scene, barring any real, extra need for FD, the squad could be released right away, or within 10 minutes (roughly). It's not that large a trade off, and until there is another YFD primary response unit that would cover that area that E311 had, I don't think it should surrender its duties as an engine company. As for being one of the 4 assigned engines to a call (minus first or second due)...I'm not sure honestly whether or not it does that. Beyond first or second due, why not just pass it off to 312 or 314, I can't imagine it would make that much of a difference. In that case, it keeps the squard clear for more time.

One thing I think that hasn't been mentioned here is that it really isn't the job of the FD to control a highway scene. That's a PD job. I don't know what highway you were talking about, but where was county PD or the troopers or local PD to close off the area, get their car flashing and putting flares out. Granted, the first on scene vehicle (sometimes the FD or the ambulance) should be able to control and block the scene, but there is something else to realize. The primary job of the FD and the ambulance (I know, "scene safety first") is to rescue and treat the patient(s). When you arrive on scene and you are there and your vehicle is between you and the scene you somehow (though not entirely) have ensured your scene safety. The juniors who were standing out in the middle of danger are just stupid. Prevention is the best medicine, but those kids should be off the corps or department, no questions asked. At the least, reprimanded. It's a major scene leadership problem what happened there. You can immediately tell what is a well run scene when you have a fire captain or EMS chief or PO on scene directing arriving emergency vehicles and having an isolated accident scene. There are others that you can drive by where you are literally face to face with the rescuer or just narrowly missing the emergency vehicles.

As for the I-95 incident. When there are flashing lights, people need to slow the hell down. But that's not something that's going to change...

Yeah, Tuckahoe, Eastchester, and Scarsdale (and possible Bronxville as well) were also down last night. It did have to do with that 1996 Ford Van that they were trying to locate. I am not sure if they ever did.

I don't know. From what I know, at least in lower Westchester it's not 100% required that you call ahead, and if you don't the hospitals won't be shocked. Unfortunately though, it's been my own experience that when you don't call and the hospital is busy, they don't like it. There have been times in the middle of the night (which depending on the nurse on duty) where the staff is totally together and after giving a report on the HEAR, the nurse (usually the same one who does this) will reply, "Ok, bed 11 on your arrival. <HOSPITAL>, out."

Besides that, we have two methods. We have the HEAR radio which works fine in our area and a phone on board each ambulance. Both are used.

The person asking is probably not EMS involved, so let me just explain it for you. BLS means Basic Life Support, or transported by the ambulance crew of only EMT level. ALS or Adavnce Life Support means the patient is in the care of a paramedic (or two). ALS patients are obviously more critical or need more advance monitoring or treatment than the EMT can provide.

Being FFs and POs, the people involved here should know the danger of having a vehicle respond lights and sirens...and yet they still called falsely for one to come... Besides that fact, they stole a police car. Whether they took it back to the police station or not, they stole a police car. If someone took an ambulance for a spin, but returned in 20 minutes later, you'd be damn sure they would be in trouble. Despite that, they were drunk, no? So they were operating a stolen motor vehicle (a police car) drunk...That's enough to put you in jail for a while, never mind the punishment for the fake 911 call.

Moreover, imagine what could have happened there. One: the police officer was called elsewhere for a real emergency where he was truly needed and therefore couldn't get to. Two: He got into an accident on the way to the false call and killed someone else (or himself).

It's just a stupid situation. Never mind not being offered another job, those three should lose the jobs they have now for acting inappropriately. The arguement would be that they weren't at work. Well I would argue, they are emergency services personell taking advantage of a system they work within, fire them.

That's all for this rant.

If EVAC wasn't busting chops, what else would we be doing? Other than that whole EMS thing...

But a better question is this: if EVAC wasn't busting chops again, what would EFD be doing? Oh right, they will be busy with EMS, too... kidding, again, of course...

Perhaps there needs to be some more "pot stirring"...

Was there really a strong need for more man power at the EHS fire? I remember from the Dante Ave. one, for a while there was a desperate need for "more man power," but I don't remember it so much from the other night.

Nothing on there that was too surprising. I wonder how long the moderator will keep that last comment up, Capt. ha ha...

Besides that, everyone was there, the fires were put out, and no one (or at least very few--if any from that first one) was hurt. That's what's important...already said that...

no doubt in Eastchester the radio traffic tends to be high frequency (note: that's not just the FD, that's the VAC as well)...what that says, I'm not quite sure, nor did I mean anything by it. The question posed was about how the communications went with the first "real" fire while both EVAC and EFD were on the same frequency and dispatching...My point was that it was good and that there wasn't anyone stepping on top of eachother. The comment about being suprising is just to say that it is just that, SURPRISING, since it happens a lot around here, and with an ambulance, the medic, 3 FD supervisor vehicles, 4 engines, and 2 ladders, I was surprised that we didn't have anyone on top of eachother. It was a very well organized and executed fire scene.

To just be clear that there isn't anything hostile or anything that really needs defending that was said here, I'm one of your biggest fans on the EVAC-front, Billy...

Kevin's brother, I was at the fire (as were you) last night, we've met...I'll point myself out to you next time...