STAT213

B/c that said patient was in cardiac arrest...

BTW.. Monday night quarterbacks are NOT appreciated in this case... esp. considering the circumstances! SHEESH BACK TO YOU........

  And even so, Pleasant Valley is 15 min. at max from the local level 2 trauma center (SFH) as well as VBMC ....and it is CURRENT HVREMAC protocol to transport all unstable trauma patients to the nearest facilities if accepted following contact for stabilization, then, if needed transported to a specialty center no matter if pediatric or not. Otherwise that is considered a WASTE OF RESOURCES.

  I am sure that EMS command contacted the hospital and acertained that the recieving facilities could handle such patients... if you would like to contact them and ask the Rescue Captian's name is John Cassidy... PM for contact details if you would like as well as all of the LT's contact info as well.

  I don't give a s*** who you are, how long you have been doing this, or what agency (particularly flight agency) you work for... but in my experience and opinion (as well as the majority of the rest of the community here) I would rather have a patient transported to a local hospital, stabilized, then transported to a specialty center (ie. WMC) than transported by helicopter to a specialty center initially if delay in transport will ensue (in this case more than 45 min). After accounting notification to Lifenet, assembly, warm-up, take off, LZ coordination and communication , landing, stabilizing PT, loading, warm up, taking off, landing, and transferring to the facility the process can take up to 1 hour when a good ground crew can get the patient (granted they are not in cardiac arrest... ahem... ) to the nearest medical facility within 20 minutes.

  I can speak from experience, as I was not only a member of PVFD, but was also a rescue line officer, and can tell you that they have a top notch crew and I respect any choices they may have made on that scene. I may not have been on scene, but from my few years in Fire and EMS I can tell you that not only are your comments out of line and unprofessional, but that ANYONE that was outside of that scene, or had nothing to do with it operationally should STFU if they have ANYTHING NEGATIVE TO SAY and should give the department their prayers that they are able to digest the terrible things they had to see that day.

Sincerely,

Richard W. Muellerleile

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Well, well. Feathers ruffled already.

So, here is why I posted what I did. First off, I am not looking for a fight. Just dialogue. Hopefully it will be good dialogue. We'll see.

Second, there is this whole theme on this site about not questioning decisions. Why not? Explain more, maybe we can all learn. You don't learn from making the same mistakes time and time again. I like people to ask me why I did something. Don't just hide behind the whole, you weren't there you don't know what I did line from backdraft. What if mistakes were made? We just supposed to accept them because it was a bad call??

So...back to why I posted that. I cannot tell you how many times as a flight medic I have been on standby, or enroute to a call to be cancelled, and then to return to the local hospital to bring the patient where they needed to be, only HOURS later. Those are bad decisions. Going to the local hospital for stabililzation adds hours to the MS trauma patient's adventure. Add to that limited trauma system resources and the difficulty gaining acceptance once the patient is IN a hospital as opposed to sending them directly to a level one center, its just better to move them to a Level One right off the bat.

Five traumas for just about any hospital is WAY too much. Its too much for WMC, they only had one or two trauma teams available when I was there. So, how can a smaller hospital handle that?

How bout this? Call 3 helicopters and send 1 pt to WMC, 1 to pt Albany and 1 to pt Danbury. Or, drive them to the Level one center yourself. It does your patients NO good to overwhelm one hospital, any hospital. MCIs need patients spread out among hospitals. Medevac is a great way to do that. Have you thought of putting four BLS patients in 2 helicopters and moving them somewhere else with a pad?

There are a lot of points in this whole discussion. I hope it doesn't get locked, I think there is a lot to learn here.

Bottom line for me is that this call seems so much like so many calls I have been part of where I had no chance to offer my perspective to the crews on scene. I am taking the chance to offer it here.

Regards,

Rob Atwater

And the medevac was cancelled why?

And you think its a good idea to bring 5 trauma patients to one level 2 hospital why?

Sheesh...

It sure is a BK 117. In fact its N117NY, the same one serving as Air One right now. It was originally out of NY Cornell hospital, based on the East Side of NYC on one of the helipads. Memory escapes me as to which one. They were doing next to no calls, so moved it up here to WMC in a deal with the old county hospital. It gradually evolved to STAT Flight, and now Life Net.

But, it is the original aircraft. She's a 1987 BK 117 A 3. Some of the pilots who are still flying with Air Methods picked her up off the boat from Germany 20 years ago. The lead pilot has been flying it for its entire lifespan. It came up to WMC looking like it did in the photos. The paint scheme is what makes it look like something other than a BK.

Hope that helps.

Its a great aircraft...Did a lot of fun calls in it.

I say as little as possible. If its BLS, it is literally agency ID then 46 female ankle injury from a fall, awake and alert, see you in 5. ALS, I might give some details if I want them to be ready for something big, but if its a routine workup, I'll just say 46 female, CP workup, had the meds, vitals are good, see you in 5.

There really is no reason to say things over the radio that you'll just have to say again to a different person. Up in the syracuse area, all but complicated cases are transmitted to the ED's via computer through the dispatch agency. It works slick, and once the EDs get used to it, they actually love it. No more answering the damn radio every few minutes.

A plapable pulse will decrease in those places as the blood pressure drops.  Blood pressure differences between the radial and femoral arteries typically differ by about 5 mmHg.

A good rule of thumb for assesing hemodynamically unstable pts is plapable pulse in the radial, femoral, and carotid mean minnimum systolic pressures of 80, 70, and 60 respectively.

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Actually, this has been busted by the ACS and ATLS. I don't have the literature at hand, but here is the simple way to show its is just bad information that we all have been taught. How many of us have taken an upper arm blood pressure to find 50, 60 or 70 palp? I know I have. Applying what we (including me) were taught, this should not be so. Not having a radial pulse, or a femoral for that matter is good indication of severely impacted perfusion, and should be treated appropriately.

As for taking BP's on any extremity, I concur with what has been said by others here. You can take it anywhere and frequently on burn patients, you are forced to do just that.

However, palpation of carotid pressures is as of this point still discouraged.

Something that I remember to this day from paramagic class: 50 % of what I am gonna teach you numbskulls is wrong. I just don't know what 50 % yet. - Dick Cherry

If your agency truly uses the magnetic placards, you’re in the minority.

Just out of curiosity, do you have documentation from your insurance carrier? I only ask, because, as most people have probably encountered, any excuse for your Insurance not to cover a claim, they will jump on.

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I would be really careful relying on your insurance company. I had a friend who filed a claim for a stolen green light, and when they found out he was running lights on his car, they dumped him.

Just make good and sure before you rely on someone else's word about your insurance company.

I heard everyone did a great job on the call, but can someone explain to me how the ambulance could get that close to the helicopter???

Driver error?? LZ error??

Maybe more details of what happened, so people dont speculate and learn from the mistakes.. we all can learn, some just take longer to understand...

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Having done the helicopter thing for a while, it is astounding how people completely lose their minds when we land. I have had to yell, swear, manhandle and almost tackle a few folks. Bottom line is don't approach the a/c unless you are told or asked to do so, don't drive, smoke or wave your arms when near it, and stay away from the darn tail rotor....

Someone get him one of those big clown horns to mount on there, gotta make noise!  

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I was thinking tassels, a basket and some small LED's...

Get well soon!!!

RA

try this as a starting place..

http://www.phillyfirenews.com/apparatus.aspx

How about Mr. mobility?

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I think a rascal would suit you!! And, that you could fix all up with your strange color for apparatus and the blue stripes. Probably could get a larger battery and have some decent lights on the thing.

This is a shame, a St. Patty's day parade just doen't seem right without the local PD and FD marching in it. There will probably be departments from all over showing up to march, it will be strange without the local department involved. These parades are when the people of the community come out to have a good time and show their support for the people who protect them. Hopefully the bosses can work something out to get their crew there. It doesn't seem that it should be that big of a project to get this done.

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All I can say is that its about damn time. Committing your entire department (or for that matter a front line piece of any kind) for a parade is nothing but a betrayal of the public trust you are supposed to hold so dear. All you people who think that it is your right to go march in a parade and show off your trucks should be asking yourselves why you are in the fire service. Is is to help people or to march and look pretty? This is total pet peeve of mine as you may guess, but I am glad to see that some town administrators finally got on the ball with this and pulled the plug on a ridiculous tradition. I have heard people say that "well that's what mutual aid is for". Wrong, sonny. Mutual aid is for when you are stretched to your limits and unable to cover your call or calls b/c you are already tied up, not so you can go march in a parade. Sorry for the rant lads and lasses, but this really bugs me. If someone can come up with a reasonable offering for why I am wrong, jump on it but you can't tell me you have the public's best interest in mind by tying up apparatus paid for with tax dollars in a parade.

Its quite funny that many, many years ago Westchester County Medical Center started a small ground transport team based out of the hospital that grew into STAT Flight. Back to the future...

Yeah, apparently there were a number of problems with the 6.0 Power Stroke. We had some issues with fuel filters.

So, I guess they aren't ditching the whole econoline series, but no more diesels.

The 6.5 won't fit unto the E series chassis, I guess.

Seth is right, this will change things significantly until they sort it out, if at all.

I hope this works...front view of said Big ol Rescue.

From what I have heard, LifeNet/Air Methods wanted zippo/zero and nada to do with the ground aspects of the program.

So, according to one of those "cuties" - and she truly is...the STAT Ground team is alive and well, operating out of what she calls a closet with two RNs and a driver, mostly made up of those team members that wanted nothing to do with the pay and benefits package Air Methods threw their way. I only assume that Metrocare/Transcare is still providing the buggies and now the drivers as well. The pilots from the STAT Team no longer have to hang their heads in shame as being the only ones who have to fly and drive the program's ambulances.

I did see the other day a posting on www.flightweb.com from a medic who was implying he got hired there to work on the ground team.

But, bottom line they are separate entities and sadly Seth I can't tell you what they are wearing.

TCD this transition was years ago when WMC failed to pay Air Methods. Air Methods took over the program and now controls all aspects of it. Those who were in the employ of WMC and wanted to continue to wear the red suits and play helicopter were given the opportunity to interview with Air Methods.

I am not sure how ground hiring/selection is or was done.

Any comparison model that can be used for replacement?  I'm surprised also, I figured being it such a popular chassis that it would live forever.

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My AEV buddy said its now gonna be Chevy, Dodge or GMC. No more Fords.

I bet there was a lot of similar discussion and surprise when Chevy dropped the caprice...

Yeah, I was pretty shocked to hear it too. He was pretty insistent though, saying that Ford is ditching the whole line, and that AEV only had access to 20 more E series chassis.

Guess we'll just have to wait and see.

Heard from someone who works for AEV that Ford has ceased production of the Econoline (E Series) chassis completely. He said they have something like 20 left to build, then no more.

Anyone else heard this, or have thoughts?

I certainly hope that more people don't lean towards monster chassis like the Int'l. Those things are a menace to EMS.

Check out this thread for the skinny on BFD apparatus. They have an ancient fleet, apparently with few plans to get new stuff beyond this rescue and one engine.

They are indeed running 93's and 94's as front line rigs.

http://emtbravonewengland.com/index.php?topic=2.0

BVFDJC,

Edited for the sake of your sanity? Too bad everyone copied your post before you could pull it. C'mon kid. Don't you get it yet? Stuff just ain't free. Be nice, but...it just ain't.

You mentioned the Bill of Rights. First the Bill of Rights is from federal government, not state. Last time I looked on the side of an ambulance, it wasn't a federal service coming to my aid. Second, there isn't much in that there document about EMS. People didn't much care about EMS until oh...1966. Oh, and what fun it would be if this was a state system. Oh wait...that is socialism where the government provides everything for everyone.

Buddy, I feel your pain. You seem passionate about this rant you are on. Passion is good. I can remember being your age and jumping up and down about things. I once convinced my dad that his buying a car with a/c would ruin the planet. Being a good dad, and a cool dad, he caved. I have since realized my folly. As a junior (meaning younger) of this board, watch, listen, look around prior to rants. Said behavior also is VERY helpful as a new guy in the fire service. VERY helpful. Also, please don't take this post as me trying to slam you. I am not. If I were, I would have been much more blunt and mean. Trying to offer some advice, cause I have been where you are. As we say, been there done that.

Ok, let me get this right...

BVFDJC, you really think this is "utterly unethical?" Come on dude. Do you think it is unethical for this? Does the water department charge your parents for using water? How about electrical services? At the landfill, do you have to pay a tipping fee? Not everything is covered by your beloved tax dollar. Where do you think the money for services will come from? With tax cuts, the money is not there. You have to make it up somewhere else. Billing does this. It is not unethical to bill people for value added services. You may not like it, fine. But using words like "utterly unethical". C'mon.

There are fire departments all over the state billing for transporting patients. Now, as I understand it, they have to set up a separate ambulance corporation to do it, but it is the guys from the FD in the ambulance.

I can see that being a somewhat tricky extrication. An hour does not seem all that crazy...

I worked out of these for many year up at Eastern Paramedics in Syracuse, NY. BY FAR the best made, best laid out ambulance for city (2 person crew) work. Everything was within hands reach, very stable, low center of gravity. We switched to the cursed Wheeled Coach moduvan in 1994 or so, and they just plain sucked. You can do EMS in anything, but the Braun slope side was the cat's hind end.

Broken Thermometer Causes 100 to Respond to Mercury Spill

1/2/2007 8:47:16 AM

WSYR-9

CARMEL, N.Y. (AP) - It was quite a New Year's Eve at the home of Richard Berger in Carmel - in Putnam County. Someone in the house broke a rectal thermometer and the family called 911 around 10:30 to report the small mercury spill.

Several dozen volunteers from the Carmel Fire Department responded to the house on Brookview Drive.

Fire Chief Darryl Johnson says mercury is a hazardous material that can cause stomach problems if inhaled.

Men wearing protective gear used wet sponges to clean up the puddle.

It was packaged and brought to the Carmel firehouse where the county health department will dispose of it today.

The Berger family was not hurt.

HAZ MAT back to the firehouse?

I was wondering what the staffing patterns for the City of Peekskill are? I see on the website that there are 24 paid guys and 200 (holy crap) volunteers. Do the paid guys staff an engine and cover the stills and such, or are they spread out differently?

Thanks!!!