A New Kind of Paramedic: 52 FDNY*EMS members become certified rescue medics

[x635 4,066]

A New Kind of Paramedic

52 EMS members become certified rescue medics

No space is too tight, too high or too arduous for a new highly-trained group of paramedics in the EMS Command.

Since January, 52 rescue medics trained in special operations have been saving lives like never before, by treating patients before extrication from confined spaces.

A rescue medic treats a man who fell into a hole on a fuel barge on January 23 at the Brooklyn Navy Yard. Rescue medics spend nearly one month training at the Fire Academy on Randall’s Island. They study everything from collapse rescue to high angle procedures.

“In any job, seconds count,” said Chief of Department Salvatore Cassano. “So the rescue medics’ highly-specialized training enables them to provide extraordinary care more quickly to victims and, therefore, save more lives.”

In January, a team of rescue medics were called to the Brooklyn Navy Yard when a ship worker fell into a hole on a fuel barge. The medics made contact with the victim and worked with SOC firefighters to perform a high-angle rescue in the 18-inch wide hole.

“Their skills were critical that day,” said Chief of EMS Command John Peruggia. “All these members are bringing pre-hospital care to the landscape of an urban battlefield.”

To be certified as a rescue paramedic, EMS members must complete nearly one month of training at the Fire Academy on Randall’s Island. This includes 40 hours studying collapse rescue, 40 hours of confined space rescue, 40 hours in combined trench and high angle procedures, and 24 hours studying ‘crush medicine.’ They also receive advanced Haz-Mat training.

Upon completion of their training, rescue paramedics are able to intubate a victim in a narrow crawl space, work in harnesses and protective masks, rappel from ropes and operate among debris.

“People think you run in a hole and pull someone out, yet it’s so much more complex than that,” said Rescue Paramedic Lenore O’Neill, a seven-year veteran. “I always wanted to get involved in rescue operations. It feels good to make a difference.”

The first rescue paramedic class graduated in late 2006 and members began being dispatched earlier this year from EMS Stations 10, 20, 57, 46 and 23.

The training is funded through a grant provided by U.S. Department of Homeland Security’s 2005 Assistance to Firefighter Program.

[trauma74 111]

I wish all the new rescue medics the best of luck with their new duties. Be safe out there.

[Guest]

This haztac and rescuemedic stuff seems cool and all, the names certainly sound heroic, but I get the impression that the FDNY is offering training that might be used once in a medic's career. Yet they are perfectly comfortable with allowing the medics to do the bare minimum required for medical continuing education, which is the real reason we have paramedics, to help sick people. While I have no statistics to back this up, I would bet there are maybe 3 or 4 instances per year of a patient requiring the skills of a rescuemedic. This seems like a disproportionate amount of effort going into rescue training when you consider there are over a million EMS calls in the same time period. I'd be open to hearing someone prove me wrong, however, I think this whole haztac/rescuemedic program is taking the EMS side of FDNY in the wrong direction.

[JJB531 652]

This haztac and rescuemedic stuff seems cool and all, the names certainly sound heroic, but I get the impression that the FDNY is offering training that might be used once in a medic's career. Yet they are perfectly comfortable with allowing the medics to do the bare minimum required for medical continuing education, which is the real reason we have paramedics, to help sick people. While I have no statistics to back this up, I would bet there are maybe 3 or 4 instances per year of a patient requiring the skills of a rescuemedic. This seems like a disproportionate amount of effort going into rescue training when you consider there are over a million EMS calls in the same time period. I'd be open to hearing someone prove me wrong, however, I think this whole haztac/rescuemedic program is taking the EMS side of FDNY in the wrong direction.

Personally I think if there is only 1 instance each year of a patient requiring the skills of a rescue medic, it is well worth it... in other words even if 1 life is saved as a result of the actions of one of these paramedics, then the program as a whole is a success.... I know if I was the poor schmoe stuck in a hole and needed a medic, I'd sure appreciate it...

[Goose 188]

The biggest issue, at least with the haztac buses, is that they are always run to the bone like your regular bus. So if a hazmat job drops and their tied up on a routine call, there dedicated until they can turnover.

[bob803 1]

I hope they get paid more money. If they do great if they don't they should. FDNY specialized units ie rescue, hazmat make a higher percentage of pay then non specialized units.

[helicopper 1,050]

This haztac and rescuemedic stuff seems cool and all, the names certainly sound heroic, but I get the impression that the FDNY is offering training that might be used once in a medic's career. Yet they are perfectly comfortable with allowing the medics to do the bare minimum required for medical continuing education, which is the real reason we have paramedics, to help sick people. While I have no statistics to back this up, I would bet there are maybe 3 or 4 instances per year of a patient requiring the skills of a rescuemedic. This seems like a disproportionate amount of effort going into rescue training when you consider there are over a million EMS calls in the same time period. I'd be open to hearing someone prove me wrong, however, I think this whole haztac/rescuemedic program is taking the EMS side of FDNY in the wrong direction.

You raise a very valid point and if training for the 99% of other calls is being overlooked, there is a problem. However, a city like NY probably does more confined space rescues in a year than many other STATES do - think about it - tunnel jobs, construction jobs, collapses, etc. To have 52 medics in the City trained for this specialty does not seem unreasonable. If they were trying to train EVERY medic it might be impractical. 52 medics can keep these skills sharp with training while the remaining medics in the City are focusing on the majority of the calls.

You suggest 3-4 per year - I would argue that there are probably 3-4 per month in the five boroughs. It seems like there's a building collapse once a week down there.

The program was funded with grant money - not the city's regular CME budget so what's the problem?

You seem very passionate about the subject - care to elaborate on what you mean about the training problem you see down there?

[ckroll 101]

Save for the crush medicine, it sounds like standard fire service trench/ high angle/confined space. I'm thinking there may be a lot of medics that are already trained to rescue, if not actually called rescue medics. It might be useful to keep lists locally of those who can 'drop in' on a patient.

The issues I see as paramount are teamwork and continuing training. One medic can't rescue, it will take a trained, coordinated team of 4 people to make a rescue medic effective. Keeping skills current will be a huge undertaking. Once a rescue goes vertical, gravity is your constant companion, and there is no room at all for error. It will require a LOT of dedication on and off job for medics to keep that many skills sharp.

I wonder how often, the best course might be to focus on doing the rescue first and treating later? The tragedy would be if rescue were delayed to treat in the field when good or better outcome might be obtained by sticking with rescue basics. I don't know how many of you have packaged a patient in a cave, but it's a nightmare. I can scarcely imagine trying to successfully add ALS skills. That said, more preparation and more training is always a good thing.

How are the teams to be managed and deployed? Will they be available out of region?

[tbendick 27]

As far as the amount of calls that would require ALS treatment of a patient in a Confined Space or other rescue situation, I would say that it is a low number.

However saying that there are a lot of calls that would require someone with the proper training to go in and evaluate the patient but no preform and special ALS care.

There are enough calls and potential to have a demand for the rescue medics. From the trench collapses to all the tunnels under manhattan and more are being built ever day.

[ny10570 745]

I don't get what you mean by the bare minimum of CME training. All of the rescue training and refreshing is in addition to all of the required ALS training. As for CME training the dept sponsored CME for the 5 year program is still being developed but in its current form exceeds the requirement to re-certify.

The lack of calls requiring this level of training is the reason the program has yet to be expanded. I don't know the exact numbers, but since the program began I know of 3 trench collapses, 2 confined space rescues, and 2 building collapses. By those numbers alone thats seems like a significant need.

The interaction between the Rescue Companies and the Rescue Medics is an good example of coordination between EMS and Fire. The medic is not there to effect the rescue. They are just there to evaluate the patient and perform any necessary interventions. Those who know best how to rescue people are still in charge.

There is a problem with the Rescue and HazTac units being unavailable due to traditional EMS runs. The argument is that the daily EMS duties keep their skills up. In light of the risk involved with them being unavailable the number of HazTac units are suppose to be expanded as more members are trained and more Rescue Medics might be added.

Money for these units is part of the bargaining for this contract. Personally I'm against it for several reasons. The big two being the majority of the Hazmat jobs and WMD jobs are going to be discovered by your average front line units and as a service in the event of a massive chemical or biological incident we are all trained to the operations level and will be operating in the warm zone where we will be considered contaminated.

[MGMedic 0]

I work the Manhattan Rescue Medic bus on tour 3. The morning shift has lately been dispatched to 2-3 jobs per tour that are considered rescue. They actually were on the news last friday for treating a construction worker 40 ft. in a hole. I don't think the news mentioned that the reason they were downtown (our area is 116th/1s ave) is that they hurried out of the ED for another construction worker they had brought in and responded to a woman that fell into a cellar opening on the sidewalk (76th/Lexington) right after that.

My point is, these jobs are always going down. It's been hard educating EMS patrol bosses and fire chiefs to remember to special call us. It's not something they are used to, but we're getting there.

We like to think our main reason we are around is to potential assist a fellow rescuer, be they EMS, PD or FD. We operated in the fire building at last year's fatal fire in the bronx for over 90 minutes. Unfortunately it wasn't a successful outcome.

As far as "isn't it better to just treat after bringing them out?" We've all been well lectured by our USAR Medical Director, Dr. Dario Gonzalez, on the medical management of the crush injury. Should we ever have a prolonged extrication/entrapment, depending on all parameters, taking a pt. out before treatment will ultimately be their demise (the chinese call it the smiling death). we've all been well versed on management of acidosis, hyperkalemia, rhabdomyolosis, etc. before extrication is to occur. A few of us also make up the medical specialist group of NYTF-1. It is nice being able to have all this training on hand and the potential to use it on an "everyday" basis instead of when being deployed or drilling.

PS-The article that started this thread is old. We've been out on the street for about an year now.

Edited November 11, 2007 by MGMedic

[JBE 328]

03R is the Rescue Medic bus out of Jacobi. I'm not sure who the other ones are, possibly 31 or 35R in Brooklyn, and 23R in SI.

[MGMedic 0]

03R - Station 20 Bronx

12R - Station 10 Manhattan

49R - Station 46 Queens

35R - Station 57 Brooklyn

23R - Station 23 Staten Island

[JBE 328]

Thanx MG, I thought 12R was in the mix(former 12Z).

And, as always, better to have and not need, than need and not have.

[MGMedic 0]

Hey JBE,

not too familiar with the "fire side" of things, especially dispatching. Are officers out there special calling us? My assumption is that for the most part we just get bunched in with all the EMS resources, so was wondering how it goes down on your side of the mike. Any insight would be helpful, if not interesting. If too involved for this thread, i understand. Maybe a PM?

-Many thanks (we are the old 12Z, still sitting in the same school yard)

[Guest]

I can personsally say I have heard batt. chiefs special call the haz-tac and rescue medics to boxes. so it does happen.

[JBE 328]

I have yet to hear it on my end. But then again, nothing bad happens when I work.