STAT213

My question is this: Why are you carrying it at all? Can you prove that the three minutes that someone got oxygen made a difference? Go to your station and get your ambulance. Transport makes a difference. A couple minutes of oxygen doesn't.

That's an LSD. What you commented on is an LHD. The LSD is designed to mainly carry the LCAC (Air Cushion Landing Craft) and the LHD is designed to mainly carry helicopters to the amphibious battlefront. The LHD does not have catapults like a traditional carrier (CV/CVN). In the interest of landing spots for helicopters (and now Ospreys like you see aboard her) they didn't even put in a jump ramp like the Brits incorporate into their Aircraft Carriers. This severely limits the ability of the Harrier, as it has to take off vertically, or near vertically depending on deck space. It can do it, but it burns more fuel, more fuel aboard means less armament, blah blah blah. Anyway...if you're interested, there is an AWESOME website with all this info on it : http://www.globalsecurity.org/military/sys...ship/index.html I linked the US Military Ships page, but you can find pretty much whatever you want about pretty much any weapons system in the world on there. Most of the info is pretty current. I hope that helps and wasn't too preachy. Not my intent. BTW, great shots!!

No, your whole post was not wrong...just the part about click it or ticket being mandatory. I merely pointed out how happy I am to live somewhere where we DON'T have all those laws. Amazingly enough, we aren't dying in droves here, and have pretty good seat belt usage. I just don't like the NYS approach of throwing laws at everything, that is all. Oh, and the other part that's wrong is the whole yankees thing!!! Then again, what fun would a rivalry be without an opponent, huh? Be safe, seat belt or not!!

WRONG!!! We are fortunate enough to NOT have a seat belt law in New Hampshire (for adults, anyway.) Nor, need we wear helmets on motorcycles. The government does NOT need to be involved in every aspect of your life, no matter what NYS has brainwashed you into thinking. Do I wear my seatbelt. Most of the time, yup. And ALL the time in the fire truck. More laws are NOT a better thing. Less laws are!

We have one kind of firefighter...and we ALL can go inside. I don't really understand the concept of exterior firefighters. Either you can do the work, or you cannot. And, for the record...not meant as a slam. I am being serious about this. The fire service really does need to come to some kind of consensus about what a firefighter is. In my opinion, it is someone who can do ALL aspects of the job. Not just "help out." Again, just one guys .02 As far as actual requirements go, we have to have FF 1 to start the job, and must have within one year of employment, FF 2 and C2F2 (New Hampshire's Certified Career Firefighter). Some departments in the state require FF2 or even C2F2 to start.

For some, it may be ego. Not for me in the example I gave above. It was company policy, and there were valid reasons for it. You may like to have a random FF, cop or whoever drive your buggy. I do not. Its a difference in practice.

Goose, some form of BLS training is a completely different animal from a paramedic using all their skills to take care of a critically ill patient. They are different skill sets. I am not knocking the abilities of firefighters as EMS First Responders, but if I asked one of them to set up my CPAP machine, or do a 12 lead or place an IO line, do you think they could?

I disagree here for a couple of reasons...paramedics bring care to the patient. While it has yet to be proven that we make a bit of difference (but, that's an argument for another day, isn't it...LOL) when I have someone sick...I will generally move to the ambulance and play there. That's my office, my space. I have more of my toys there. So, sitting on scene for 10, 20 minutes after getting to the truck is not unreasonable. To me, this is about style and preference of practice more than anything else. I hear your side, all I am asking is for you to hear mine. I hear you about the whole large service thing. The example I gave was from a large service, one of the biggest in the nation. It was their policy that no NON employees drive the rigs. In my 8 or 9 year tenure there, I had a cop drive me to the hospital once. And, I got spoken to by a supervisor about it, reminding me that cops driving was a no-no. Again...style and practice. Maybe this agency has had really bad experiences with this FD driving their trucks, and finally forbade them from doing it. Maybe the FD is retaliating in the press. I am just trying to present an argument for the other side. I still disagree that sitting on scene for 10 or 20 minutes is a bad thing. Was the patient's issue a time sensitive one? I don't know. What exactly is the ED gonna do in 10 minutes to save someone's life? The list is pretty short and we have most of those tools on the trucks now. This goes back to the argument about what is best for our patients. Is it treatment and care in the field, or is it rapid transport. I believe there is a balance, and that this call is one end of the extreme that I occasionally have lived on. Now, this is NOT me saying that paramedics are the end all and be all of medicine and I stick around on scene all the time playing doctor, so please don't think that. Just another view of the call.

Well, as unpopular as it is, I think I will side with the EMS agency on this one. Here's why: I don't anyone not from my agency driving my bus. Period. I don't know them, I haven't worked with them or trained them. I have no control over them. I have worked in a similar situation as is described in the article, and I agree with it. Remember, there are two sides to every story. Right now we are hearing pretty much one side. In addition, what exactly is gonna happen with a respiratory arrest or cardiac arrest in the ED that we aren't going to do in the field? Twenty minutes of work passes very quickly. There really isn't a lot that is going to happen quickly in the ED (beyond airway management and initial medications.) Now, there is the PERCEPTION that the hospital has more to offer than the ambulance, and perception is everything. I can see that a lot of the providers on here have that perception. That the person expired has little or no bearing on this, in my mind. There are those you will save, and those you won't. To come to the right conclusion from this case, I need a lot more information. A LOT. Were the medics trying unsuccessfully to RSI the person? Or, were they simply working a respiratory arrest that led to a cardiac arrest? I hope you all realize that you can have an MI on the cath lab table and still die. You can get shot in front of a cardio thoracic surgeon and not live. There are a lot of missing pieces here. As for the firefighters "helping out", what exactly are they going to do? Do they know how to assist the medics on critical patients? Do the two agencies work together? And, in saying this, I don't mean do they go on the same calls. Do they work TOGETHER? If not, then this could be an area that needs work. Do they know how to spike lines, start lines, set up the monitor? If this is a system where the firefighters respond as a first response agency only? I have worked in a system that had firefighters doing things like 02, vitals and CPR. That is what you got from the FD. Period. Yes they were EMTs. That doesn't mean that they were used during transports. Is that right or wrong? Neither, it just was what it was. We needed help, we called another bus or the supervisor. I think that training them to a point where they could have been functioning team members would have been awesome, but that wasn't a reality in that system. It was just too big. Were there some FF's that would jump in because they used to work with the transporting ambulance and knew what needed to be done on a critical patient. Sure. But, quite frankly the critical patient is not the time to teach. As a medic, I have work to do, and its a lot easier to just do it myself than showing someone how to do it in the heat of the moment. I can also see the seedy side of this whole thing, where the fire department is saying to the press - "hey we offered to help, but they said no!" when in reality they had little to no intention of helping, and their help would've made things worse for the patient. Does this fire department want to take over the ambulance? Are there darker motives here? Anyway, just wanted to offer the other side of this argument, because I have lived it.

Issued wildland pants, coat, helmet and goggles. Boots are currently whatever you want to throw on your feets, gloves are the same. As an aside, we also wear these for MVAs in the hot summer months.

If it was a Glock, then it for sure doesn't have an external safety. But, for a gun to discharge after being dropped, it also can't be a Glock that is functioning properly. It is just not possible for a Glock to discharge after hitting something. Be interesting to have all the facts with this one.

I'll echo the sentiment of Clutch...I have proctored the NH CPAT (its a requirement to get placed on the state list and thus hired) for the last three years. People usually fail in one of three places. 1) Stair climbers claims the most victims, and most of the women. 2) Dummy claims the next group of folks usually thru exhaustion and 3) running out of time on the molitor machine. The other thing that gets a few people is not knowing what they're supposed to do. The videos are available @ http://www.cffjac.org/jac/cpat/for_candidates/index.cfm . I would recommend watching and paying attention. We have had some people do some really goofy stuff like go in the tunnel and come out the same side, run right out of the building on the hose drag...crazy stuff all avoidable by following instructions and paying attention. Hmm...kinda like you are supposed to do as a probationary firefighter. Good luck!!!

We got them - Strykers - about a year and a half ago. We LOVE them and can't wait until all four of our ambulances have them. I can see some of the complaints, but I think most of them are because you are using them like the old stretchers. We generally load with two people on the end lifting it up. We rarely take it into someone's house - you are all correct its heavy - that's what the stair chair is for. If you're having issues with load height, are they properly adjusted for your rigs? Did you know about the override for load height, that it does go up a couple extra inches? We are specing a new ambulance right now, and load height is a concern. Unless you are in an international chassis, I can't see it being a huge issue. We had all the vendors bring C4500s for us to play with and regardless of spring/suspension types, we found that we would have to assist the head end into the truck only on really steep hills. I LOVE not having to lift the dang stretcher, and can't understand why you would want to keeping lifting when you don't have to. As for type of service/area, we are career fire and ems (transporting) in a mostly suburban/rural area. Derry Fire

Ok, so in my time surfing the web, I bumped into Brian Duddy's web site. Great site, well put together. Its nice to see the Rockland stuff, as I used to work over there. http://www.brianduddy.com/g/ But, I didn't put up this post to just point out his great web site, but to call attention to two of the 2008 incidents, both car fires. http://www.brianduddy.com/g/cn021208 http://www.brianduddy.com/g/cn010508 The department responding to both of these fires is clearly shown, so I'll spare the names, but hopefully you'll go see the pics for your self, and you'll see the name on the title and the trucks. At BOTH of these incidents, these knuckleheads are clearly surrounded by smoke, not wearing SCBA facepieces. At one of them, they bothered to put packs on, and one guy had the common sense to put his face piece on, but no one else felt the need to. At the fire in January, they didn't even bother to pack up at all, and had people on the line not wearing PPE. I hope someone has the guts to come on here and defend these actions. I just don't get it. What part of carcinogen don't you get? I could ramble on, but I think my point has been made. Idiots.

On the job, I don't get it. You say you preach safety, and take care of your guys, but say it is ok to fight a car fire without SCBA. Those things don't go together in my mind, or most of the people who have posted on here. Let's take the anger out of both our posts - I'll take the hit for starting it and dig deeper into this. You have strong opinions, so do I. I think we each assumed A LOT about the other. I am not the fashion police, not even a little bit. And, I really have little time or energy for a lot of the book stuff. I was referring to one thing, one instance. I never said that PPE is the end all or be all. I actually agree with you about the gear killing you. I never said we should wear every piece of it all the time. My post was specifically about SCBA at a car fire. I am not giving up this line of work, and am willing to accept the risks that come with it. I'm just not willing to take extra risks like eating a big ol pile of smoke that I just don't need to.

I've been waiting for you. You should be ashamed of what you wrote. You know what my LT says is his #1 job everyday? To get me home safe. That should be your job to, but CLEARLY you don't feel that way. Thank God you're not my lou. You have been informed that the smoke and particulate matter from a car fire is among the most dangerous out there, and you think its ok for me to put my face in it? Thanks Lou!! You have been informed that in the event of a sudden flashover type situation my PPE needs to be worn properly to protect me, but you've told me its ok to go in a fire with my coat open and hood in my pocket. Thanks Lou!!! Yup, you're right, it is a dangerous job. One of the most deadly out there. But, we can reduce those risks. I want to work my 20 and have a life after. Clearly you don't care about that, or about me. C'mon kid, man up, its a dangerous job. I don't care what you do for yourself, but don't you dare risk the life of one the young guys under you because "Its a dangerous job and people die." Yup it is. I might fall through that floor someday. And, I'll have all my gear on properly cause I stop and have my partner check me - right after I check him or her - before we go into that deadly environment. I am gonna stack the deck in my favor. This call depicts people being wanton and stupid with their actions. Its not a picture of guys doing an alarm activation with their shorts on, or some other benign call where you truly don't need your gear. It has guys breathing carcinogens when they don't need to. What is ok with that? How can you say its alright?

So I decided to look at the protocol and see what it says for myself. I was under the impression that it REQUIRED use of a KED to remove someone from a vehicle. I couldn't find that anywhere in there. I was also under the impression that you HAD to immobilize everyone involved in an MVC. Nope. Only two protocols are relevant. One is the Muscoskeletal trauma one, and it is vague. "Manually stabilize the head and neck if trauma of the head and/or neck is suspected." Ok, I can work with that. I have to suspect trauma. Based on my training and knowledge of the manufacture of modern vehicles, I can conclude that someone without neck or head pain won't have a neck or head injury. It DOES NOT SAY immobilize everyone. If they don't complain of it, I can't suspect it, can I? The General Approach protocol states "consider c-spine stabilzation." That's it. Ok, I considered it. And ruled it out. Sir, you'd like to be checked out after this minor fender bender, absolutely. Please walk to my ambulance and sit right there on the bench seat so I can get a seat belt around you. Ok, all you protocol cop types, prove me wrong. If you can show me a KED protocol or special advisory, that'd be great. I couldn't find it.

ummm...NO. There is A LOT of research pointing to the fact that long spine boards do more harm than good. Immobilizing someone just because they have been in an MVA is uneeded. NYS is WAY behind the times - again, what a shock - in terms of this. I clear c-spines in the field all the time. All it takes is following the pathway and documentation. If they don't have neck pain, there is no reason to immobilize them. Now, NYS BLS protocol requires immobilization with anyone with a mechanism, right. So, do the right thing with your protocols and do what is best for you patient. And, go to the protocol review meetings and ask for changes. Just because its in protocol somewhere does not mean its right.

Oh, you're funny, 636, wicked funny!!! Really, I'm laughing on the inside...really...

Still waiting from someone to come and defend this.

Truly a sign of the apocalypse... Congrats kid...long live Westcom!!!

Good post Seth. We do need to be careful, because there are those who would like to see us armed with OPAs and BVMs again. Problem is, we can't PROVE prehospital ETT is a good idea. We can say it is, but there is no proof. There no outcome studies proving we help people b intubating them. Heck, there is little EVIDENCE to prove paramedics save people. That being said, one of the things we have changed in our operating procedures is to have the ETT confirmed on arrival @ the ED by ETco2 and clinical signs BEFORE the patient is moved from our stretcher to the ED stretcher. That way, when the tube is dislodged with the move, the ED doc can't blame us. I do it by positioning myself between the two stretchers and give any grabbing hands a little tap until the ED doc does what I want. We did educate our hospital about this practice before we showed up and started slapping hands, and they are very on board with it. And, credit goes to San Diego Fire, it was their idea and program that we stole. Rob

We are about to put out RFPs for a similar truck. It'll likely be on the c4500 series chassis, with three captain type chairs in the back, and all equipment - monitor, drug box, etc - fully accessible from the seat along side the patient. The manufacturers all kinda looked at us funny, but have come back with designs that will work out, we hope... Rob

Sweet JEEsus Munson, please tell me you aren't a chief...

I work a 24/72 and love it. I don't quite get the idea of having only three shifts instead of four. Is about having less employees and spending less money?