sympathomedic

Like, well over a decade ago, Empress did a study with State and REMAC approval of the "Maine protocol". Everyone had to take a few hours of class, get a small book and take a test. They gave us check sheets to use when we actually employed the protocol in the field, and they were collected.
Like I said, over a decade ago, but we reduced c-spine immobilizations by 15-24%, and had no bad outcomes. After the study period ended, Empress asked for and was granted permission to continue using the protocol. Many of those folks who were trained have left over the years, though.
Items that would require the board:
Intox, neck and back pain, distracting injury, cannot communicate, acute stress reaction, real mechanism.
Then: pt had to hold fingers apart while EMT pushed them together- pt had to resist.
Pt had to have sensory to toes, and to be able move feet from a laterally rotated to a center-line position while EMT offered resistance.
Lastly, EMT had to (really) palp the entire spine, skull to butt and find no tenderness or anatomical irregualrity.
So the lady who hits her head on the nightstand, and the guy who gets hit from rear at the light, the trip-and-fall, hit by ball etc would all get ruled out for c-spine IF they passed the other items. I have no idea why this did not become the law of the land. I agree with news buff. So many great ideas that we cannot do on our own discretion, because, alas, we are merely technicians.

Like, well over a decade ago, Empress did a study with State and REMAC approval of the "Maine protocol". Everyone had to take a few hours of class, get a small book and take a test. They gave us check sheets to use when we actually employed the protocol in the field, and they were collected.
Like I said, over a decade ago, but we reduced c-spine immobilizations by 15-24%, and had no bad outcomes. After the study period ended, Empress asked for and was granted permission to continue using the protocol. Many of those folks who were trained have left over the years, though.
Items that would require the board:
Intox, neck and back pain, distracting injury, cannot communicate, acute stress reaction, real mechanism.
Then: pt had to hold fingers apart while EMT pushed them together- pt had to resist.
Pt had to have sensory to toes, and to be able move feet from a laterally rotated to a center-line position while EMT offered resistance.
Lastly, EMT had to (really) palp the entire spine, skull to butt and find no tenderness or anatomical irregualrity.
So the lady who hits her head on the nightstand, and the guy who gets hit from rear at the light, the trip-and-fall, hit by ball etc would all get ruled out for c-spine IF they passed the other items. I have no idea why this did not become the law of the land. I agree with news buff. So many great ideas that we cannot do on our own discretion, because, alas, we are merely technicians.

I would say 5 come to my mind:
In the very beginning at Larchmont VAC...
Dan Purcell, who inspired me with encouragment that I was smart enough to be a medic.
Marc Burell, who inpired me by making me think, "Hell, if HE is smart enough to do this, then I MUST be to smart enough to do it."
When I made EMS a carreer...
Bob "Buck" Visconti and Carl "Gunney" Otto who patiently tuned me up during my early years at Empress.
And now now, 30+ years in...
5. Dick Harvey. I look to him and say "HE is still on the road gettin it done, carrying that medicare card in his wallet, so I should stop complaining about sore knees, aching back, heavy gear and multi-floor walk-ups etc and appreciate that I can still to the work."
To the extent that I am any good at all at this craft, and that I am still here, I owe to these guys.
And I can't leave out the skinny, pimple faced kind of a twirpy, nerdy EMT kid I worked with. One day he says."I am going to start an EMS website." Yes, you Seth G.

I am a medic, so I would do BLS first: Oxygen, then position: If lungs are clear, I may lay him down, if he has rales, then I would sit him up and see how he and his SPO2 respond. Then hit the road, all else in route based on your extrication situation-are you roadside or top floor of a 5 flite carry down?
A 12 lead to see if there is an MI going. Being an elderly diabietic he is at increased risk for a silent (No pain) MI.
He appears possibly dehydrated, maybe cancer related. Again, EVERY call comes down to assesment. If signs like poor skin turger, lung sounds, skin color, texture and temp and past Hx such as missed intake and lots of output via diarrhea or vomiting thatn I would be very suspicious of dehydration. He needs an blood glucose test also.
If he becomes cyanotic, or his SPO2 falls he will neet to be intubated. He kind of needs a tube based on what you have already. You may get by with CPAP. Gotta get the lung sounds, but CPAP is becoming the treatment of choice for just about any respiratory distress scenario.
Be intersting to see where this thread goes and what other providers would to.

I am a medic, so I would do BLS first: Oxygen, then position: If lungs are clear, I may lay him down, if he has rales, then I would sit him up and see how he and his SPO2 respond. Then hit the road, all else in route based on your extrication situation-are you roadside or top floor of a 5 flite carry down?
A 12 lead to see if there is an MI going. Being an elderly diabietic he is at increased risk for a silent (No pain) MI.
He appears possibly dehydrated, maybe cancer related. Again, EVERY call comes down to assesment. If signs like poor skin turger, lung sounds, skin color, texture and temp and past Hx such as missed intake and lots of output via diarrhea or vomiting thatn I would be very suspicious of dehydration. He needs an blood glucose test also.
If he becomes cyanotic, or his SPO2 falls he will neet to be intubated. He kind of needs a tube based on what you have already. You may get by with CPAP. Gotta get the lung sounds, but CPAP is becoming the treatment of choice for just about any respiratory distress scenario.
Be intersting to see where this thread goes and what other providers would to.

I totally hear you. Many of us detest the system player patients we come across and we always proudly tout "Patient care FIRST" as a motto. If I hear "seconds count in an emergency" again, I may vomit.
But here we are with some squads being system players, and other squads putting pt care SECOND. I like to think (fantasize) that EMS is better than to let that kind of thing happen. Do the job and ask questions later. I have planted my flag in this system, and I prefer to hold my head high and not hang it in shame.
It is complex. Some agencies are organized in a way that their towns have ZERO to say in how they operate. In others the local gov't does have control but is afraid to excersize it or they have no money to fix the problem. It kinda sucks. You call 911 and you have no choice to accept who the system designates as your responding agency, yet you have no control of the management of that agency. At least in the case of the PD and most but not all of the FD's there is some level of elected official somewhere.
I cannot accept that we, the EMT's medics and others that have the responsibility for this system are either unable (not smart enough) or unwilling (not brave enough) to solve these issues. Makes want to tear off my patches, but there are so many dedicated, proud, hard-working folks of all skill levels and agencies that make the system function as well as it still does.
But getting back to my first post; STOP giving free-bees and taking photo-ops with squads that are not getting it done. Reward the ones that are.

Well, if you are applying for a paid position, then the guys doing the hiring will look for expeience in a paid position. Everyone doing this as a paid person at one time had no experience, yet they somehow broke in, so it can be done. Things like a solid history, good references, positive reputation and a good interview all help. As i said, the VACs and services like them get a lot of applicants for few spots. The commercial services are more likely to hire a new guy.

Brandie new, no exp full time at Empress is about $18.00/hr. Per-diems get more $$$, no benefits. Cortlandt Regional EXP NEEDED $25/hr. Town Of Mamaroneck Amb District EXP NEEDED, about $30/hr (I gotta look at my stubs some day). EVAC I am pretty sure just went to $28.

An anonymous friend of mine who is a police officer tells me of an officer on his job that asked for an "expedite on EMS and the medical examiner!".
I read an article in one of the journals about this subject and it boiled to to the "Expediter" being out of their element, or comfort zone. While I loath unneeded code 3 driving, I do appreciate knowing that I am heading to a scene that is more emergent than the typical not-so-emergent calls that make up 95% (that is a real stat, BTW) of the tour. I may not drive any faster, but I may move a little quicker in getting the gear un-secured and getting to the pt. I may don gloves in route, other little things to prepare for a bad call.

An anonymous friend of mine who is a police officer tells me of an officer on his job that asked for an "expedite on EMS and the medical examiner!".
I read an article in one of the journals about this subject and it boiled to to the "Expediter" being out of their element, or comfort zone. While I loath unneeded code 3 driving, I do appreciate knowing that I am heading to a scene that is more emergent than the typical not-so-emergent calls that make up 95% (that is a real stat, BTW) of the tour. I may not drive any faster, but I may move a little quicker in getting the gear un-secured and getting to the pt. I may don gloves in route, other little things to prepare for a bad call.

I totally hear you. Many of us detest the system player patients we come across and we always proudly tout "Patient care FIRST" as a motto. If I hear "seconds count in an emergency" again, I may vomit.
But here we are with some squads being system players, and other squads putting pt care SECOND. I like to think (fantasize) that EMS is better than to let that kind of thing happen. Do the job and ask questions later. I have planted my flag in this system, and I prefer to hold my head high and not hang it in shame.
It is complex. Some agencies are organized in a way that their towns have ZERO to say in how they operate. In others the local gov't does have control but is afraid to excersize it or they have no money to fix the problem. It kinda sucks. You call 911 and you have no choice to accept who the system designates as your responding agency, yet you have no control of the management of that agency. At least in the case of the PD and most but not all of the FD's there is some level of elected official somewhere.
I cannot accept that we, the EMT's medics and others that have the responsibility for this system are either unable (not smart enough) or unwilling (not brave enough) to solve these issues. Makes want to tear off my patches, but there are so many dedicated, proud, hard-working folks of all skill levels and agencies that make the system function as well as it still does.
But getting back to my first post; STOP giving free-bees and taking photo-ops with squads that are not getting it done. Reward the ones that are.

I totally hear you. Many of us detest the system player patients we come across and we always proudly tout "Patient care FIRST" as a motto. If I hear "seconds count in an emergency" again, I may vomit.
But here we are with some squads being system players, and other squads putting pt care SECOND. I like to think (fantasize) that EMS is better than to let that kind of thing happen. Do the job and ask questions later. I have planted my flag in this system, and I prefer to hold my head high and not hang it in shame.
It is complex. Some agencies are organized in a way that their towns have ZERO to say in how they operate. In others the local gov't does have control but is afraid to excersize it or they have no money to fix the problem. It kinda sucks. You call 911 and you have no choice to accept who the system designates as your responding agency, yet you have no control of the management of that agency. At least in the case of the PD and most but not all of the FD's there is some level of elected official somewhere.
I cannot accept that we, the EMT's medics and others that have the responsibility for this system are either unable (not smart enough) or unwilling (not brave enough) to solve these issues. Makes want to tear off my patches, but there are so many dedicated, proud, hard-working folks of all skill levels and agencies that make the system function as well as it still does.
But getting back to my first post; STOP giving free-bees and taking photo-ops with squads that are not getting it done. Reward the ones that are.

A related topic for this discussion is this: Many squads (Somers and Mohegan come to mind) that have hired paid folks refuse to send them out mutual aid. The arguments I have heard are, "they are too valuable to our community to send out" and "we paid for them, we won't share them with agencies that didn't".
So here is squad A that was having day-long coverage gaps, and now suddenly they hire a crew and they won't let them help someone in squad B land for an hour, a decision that could be truly life- threatening. Also, squad A in theory may have a volunteer crew for their own town- they are a Volunteer service after all.
And you can bet the FD in Town A will happily send the Towns only ladder truck, at about $800,000, to another town- with NO backfill!! $800,000 buys a LOT of $15/hour EMT's. Oh, and I bet the Town A PD sends cars to Town B when they ask. Suddenly the service that no one seems to care about is too valuable to share!
A suggestion: MANY squads get little gifts of my tax money to buy stuff- Larchmont got an bay exhaust system, other squads get CPR machines, building expansions, ambulances etc. How about this: before our government officials borrow money from China to buy the support of local service members, they do some freaking research to see if those agencies are performing, or failing to perform their moral responsibilities, versus protecting turf. And have the balls to say, "NO". Just sayin', but for the record: "As If!"

A related topic for this discussion is this: Many squads (Somers and Mohegan come to mind) that have hired paid folks refuse to send them out mutual aid. The arguments I have heard are, "they are too valuable to our community to send out" and "we paid for them, we won't share them with agencies that didn't".
So here is squad A that was having day-long coverage gaps, and now suddenly they hire a crew and they won't let them help someone in squad B land for an hour, a decision that could be truly life- threatening. Also, squad A in theory may have a volunteer crew for their own town- they are a Volunteer service after all.
And you can bet the FD in Town A will happily send the Towns only ladder truck, at about $800,000, to another town- with NO backfill!! $800,000 buys a LOT of $15/hour EMT's. Oh, and I bet the Town A PD sends cars to Town B when they ask. Suddenly the service that no one seems to care about is too valuable to share!
A suggestion: MANY squads get little gifts of my tax money to buy stuff- Larchmont got an bay exhaust system, other squads get CPR machines, building expansions, ambulances etc. How about this: before our government officials borrow money from China to buy the support of local service members, they do some freaking research to see if those agencies are performing, or failing to perform their moral responsibilities, versus protecting turf. And have the balls to say, "NO". Just sayin', but for the record: "As If!"

A related topic for this discussion is this: Many squads (Somers and Mohegan come to mind) that have hired paid folks refuse to send them out mutual aid. The arguments I have heard are, "they are too valuable to our community to send out" and "we paid for them, we won't share them with agencies that didn't".
So here is squad A that was having day-long coverage gaps, and now suddenly they hire a crew and they won't let them help someone in squad B land for an hour, a decision that could be truly life- threatening. Also, squad A in theory may have a volunteer crew for their own town- they are a Volunteer service after all.
And you can bet the FD in Town A will happily send the Towns only ladder truck, at about $800,000, to another town- with NO backfill!! $800,000 buys a LOT of $15/hour EMT's. Oh, and I bet the Town A PD sends cars to Town B when they ask. Suddenly the service that no one seems to care about is too valuable to share!
A suggestion: MANY squads get little gifts of my tax money to buy stuff- Larchmont got an bay exhaust system, other squads get CPR machines, building expansions, ambulances etc. How about this: before our government officials borrow money from China to buy the support of local service members, they do some freaking research to see if those agencies are performing, or failing to perform their moral responsibilities, versus protecting turf. And have the balls to say, "NO". Just sayin', but for the record: "As If!"

Brandie new, no exp full time at Empress is about $18.00/hr. Per-diems get more $$$, no benefits. Cortlandt Regional EXP NEEDED $25/hr. Town Of Mamaroneck Amb District EXP NEEDED, about $30/hr (I gotta look at my stubs some day). EVAC I am pretty sure just went to $28.

I am trying to think of something witty to say.... I got nothing.
Congradulations, Lt. Mike "NYSPOTY" Bleckeropoulos!

I highly reccomend that you read Thom Dicks book, 'Peoplecare, 2nd edition'. I have seen it on www.emergencystuff.com, and not on Amazon. It changed the way I approached every patient. You should read it. $17.00 or so. Your next patient will appreciate it.

Barry:
I don't want to steer this away from its original intent- which was to discuss the changes brought about by the expiration of the kkk specs.
I find the NFPA to be a massive failure, an example of what occurs when an industry is allowed to self regulate. America has a terrible fire loss rate compared to the other developed counties in the world.(Sweden is best) We have a horrible firefighter death rate in the same comparison. Developments like the FIT device and fire retardant paint have come alongshowing great promise, and the NFPA seems to kind of ho-hum them. We build 1000's of residential homes a day with no sprinklers and no inspections despite that most fireman who die, die in home fires. So I see little proof of the NFPA being effective at its mission of reducing fire loss and loss of firemen's lives. I see it as one disfunctional agency taking the lead from another.
I also doubt that 80% stat. FD's may be on 80% of 911 EMS calls, but I don't think that 80% of peopel transported in ambulances are transported by "firefighters". NYC is a prime and local example. Of course, that has no bearing on the thread, but just saying.

Oh Em Gee, Dan! I was thinking the same thing!
But really, it was time for something better. Too many of us die in ambulance crashes, and many are unbelted in the back.
I do wish the NFPA would stay the hell out of my ambulance. I do not trust that group. They seem to rep the manufacturers, not me. I do not need firemen from Massachussetts with too little fire work to do getting involved in EMS. Prefer to see the AMA not the NFPA.

Recall about 20 years ago, a 'scumbag drug dealer' tried to run over and kill a Mt Vernon cop, and was shot and handcuffed and left in the road. EMS arrived and either directed themselves or were directed by PD to the officer with the knee injury. The dirt bag dealer eventually arrived at the ED, cuffed. Per tesitmony, there were (I have forgotten the #. 12?) cops in the ED and none responded to the MD's request to remove the handcuffs to allow treatment. Thank god the cop-attempted murdering dirtbag bled to death.
WRONG
Turns out he was a West Med Center neonatal surgeon trying to visit his girlfriend and he made a wrong turn off the BRP. His stopping and U-turning on a deserted commercial street attracted the attention of two narcs, in a cadilace and with much facial hair (Point being, the thinking is he did not think they were cops). They tried to stop him and he fled, striking the knee-injured officer. The Doctor was promptly shot to death. The upshot is that the inevitalbe suit was filed and won by the plaintiff. MV I believe actually had to borrow $$ to pay as it exceeded their city insurance max payout.
I appologize to the one member of the EMS crew I know is still doin' the job for dredging this incident up. But I thought it was appropriate for this discussion that no matter how clear the picture is at the time, things are not what they may appear to be. I especially want to express respect for the job of the LEO, and mean no ill intent in bringing up what is surely a painful memory for them.
We are not robots with no feelings and emotions. The job is not always easy. Treat every patient as a human being or don't treat human beings.
After over 25 years of 2000 calls a year and I am not in the unfortunate mindset of the poster above. Please, when my sister, the fully employed 20+ year tax paying paralegal and occasional heroin user OD's, please send another care-giver.

Recall about 20 years ago, a 'scumbag drug dealer' tried to run over and kill a Mt Vernon cop, and was shot and handcuffed and left in the road. EMS arrived and either directed themselves or were directed by PD to the officer with the knee injury. The dirt bag dealer eventually arrived at the ED, cuffed. Per tesitmony, there were (I have forgotten the #. 12?) cops in the ED and none responded to the MD's request to remove the handcuffs to allow treatment. Thank god the cop-attempted murdering dirtbag bled to death.
WRONG
Turns out he was a West Med Center neonatal surgeon trying to visit his girlfriend and he made a wrong turn off the BRP. His stopping and U-turning on a deserted commercial street attracted the attention of two narcs, in a cadilace and with much facial hair (Point being, the thinking is he did not think they were cops). They tried to stop him and he fled, striking the knee-injured officer. The Doctor was promptly shot to death. The upshot is that the inevitalbe suit was filed and won by the plaintiff. MV I believe actually had to borrow $$ to pay as it exceeded their city insurance max payout.
I appologize to the one member of the EMS crew I know is still doin' the job for dredging this incident up. But I thought it was appropriate for this discussion that no matter how clear the picture is at the time, things are not what they may appear to be. I especially want to express respect for the job of the LEO, and mean no ill intent in bringing up what is surely a painful memory for them.
We are not robots with no feelings and emotions. The job is not always easy. Treat every patient as a human being or don't treat human beings.
After over 25 years of 2000 calls a year and I am not in the unfortunate mindset of the poster above. Please, when my sister, the fully employed 20+ year tax paying paralegal and occasional heroin user OD's, please send another care-giver.

Recall about 20 years ago, a 'scumbag drug dealer' tried to run over and kill a Mt Vernon cop, and was shot and handcuffed and left in the road. EMS arrived and either directed themselves or were directed by PD to the officer with the knee injury. The dirt bag dealer eventually arrived at the ED, cuffed. Per tesitmony, there were (I have forgotten the #. 12?) cops in the ED and none responded to the MD's request to remove the handcuffs to allow treatment. Thank god the cop-attempted murdering dirtbag bled to death.
WRONG
Turns out he was a West Med Center neonatal surgeon trying to visit his girlfriend and he made a wrong turn off the BRP. His stopping and U-turning on a deserted commercial street attracted the attention of two narcs, in a cadilace and with much facial hair (Point being, the thinking is he did not think they were cops). They tried to stop him and he fled, striking the knee-injured officer. The Doctor was promptly shot to death. The upshot is that the inevitalbe suit was filed and won by the plaintiff. MV I believe actually had to borrow $$ to pay as it exceeded their city insurance max payout.
I appologize to the one member of the EMS crew I know is still doin' the job for dredging this incident up. But I thought it was appropriate for this discussion that no matter how clear the picture is at the time, things are not what they may appear to be. I especially want to express respect for the job of the LEO, and mean no ill intent in bringing up what is surely a painful memory for them.
We are not robots with no feelings and emotions. The job is not always easy. Treat every patient as a human being or don't treat human beings.
After over 25 years of 2000 calls a year and I am not in the unfortunate mindset of the poster above. Please, when my sister, the fully employed 20+ year tax paying paralegal and occasional heroin user OD's, please send another care-giver.

I thought Suffolk County NY and I am sure State of Massachusetts PD's are using IN Narcan with much success? Maybe it is Suffolk Mass I am hearing of. Guess tht famous scene from "Bringing out the dead" will soon be obsolete!!
http://www.youtube.com/watch?v=CXJ8c0rWJsk here it is for you kids- worked with a 23 year old medic last week who never heard of the movie! Christ!!

Barry:
I don't want to steer this away from its original intent- which was to discuss the changes brought about by the expiration of the kkk specs.
I find the NFPA to be a massive failure, an example of what occurs when an industry is allowed to self regulate. America has a terrible fire loss rate compared to the other developed counties in the world.(Sweden is best) We have a horrible firefighter death rate in the same comparison. Developments like the FIT device and fire retardant paint have come alongshowing great promise, and the NFPA seems to kind of ho-hum them. We build 1000's of residential homes a day with no sprinklers and no inspections despite that most fireman who die, die in home fires. So I see little proof of the NFPA being effective at its mission of reducing fire loss and loss of firemen's lives. I see it as one disfunctional agency taking the lead from another.
I also doubt that 80% stat. FD's may be on 80% of 911 EMS calls, but I don't think that 80% of peopel transported in ambulances are transported by "firefighters". NYC is a prime and local example. Of course, that has no bearing on the thread, but just saying.