FDNY EMS Chief Relieved of Command?

[efdcapt115 1,511]

I repped PEMO and want him and ny90210 just to know, it's not a vote taking sides. It's just a vote for a man who had an honorable career cut short by injury (hope you don't mind me saying that Joe) and what I'm reading is a post from a man who was 100 percent pro on the job, a man with a lot of humility, who compliments so many posters opinions, I just want to point that out to the board. At the same time, aside from a few probably overly tired moments when nyzipcoder got off his area of expertise (EDIT: I speak from experience in that department), he's usually a level headed facts driven poster.

So.....

Stay well both of you.

Edited January 7, 2011 by efdcapt115

[NWFDMedic 58]

I need to address a previous comment. NY10570 I was one of those "dumbed down" EMT Supervisors (Lieut) in the NYC EMS system and had absolutely no issues with supervising both EMTs and Paramedics on a daily basis and actually enjoyed it. I found that there was extreme cooperation from both levels of personnel and knew my job was to enforce procedure and review what was within my scope of training. The issues arise when medics carry a "mightier than thou" attitude because of their level of training and forget that without BLS there is NO ALS and also forget where they came from, they were once one of those "dumbed down" EMTs. Don't throw stones when you live in a glass house. Lets talk dumbed down. Being a medic is not Roy and Johnny. It is flow sheet medicine. If you do A and see B then do D not C. There are even pocket protocol charts and I-Phone apps. Not that there is anything wrong with it but don't knock one area of a system because of a swollen ego. If swelling has become an issue some IM epi or benadryl might help but I am working out of my area to suggest that. Stay dry and safe in the snow today and remember we are all there for the same thing: the patient.

First, it's SQ epi, not IM. Then again, I guess an EMT Supervisor wouldn't know that about paramedic treatment modalities.

Seriously though, do you honestly think that paramedicine is flow sheet treatment? Sure there are protocols, just like every other type of medicine. However, protocols are only guidelines and paramedics should be expected to use good clinical judgment to treat each patient that presents to them and, at times, to operate outside of the box in the best interest of the patient.

I think an EMT supervisor would work quite well in certain systems and I'm sure there are some great ones. In fact, there are a good number of EMT's that I work with that I would rather have as a command officer than many medics at a significant incident. Not only are they equipped with the tools to handle the situation better, I would rather have the limited supply of medics treating patients if I have a competent EMT to run the scene.

[JBE 328]

Sidetracked, thread derailed. Can we get back on topic please?? NWFD, play nice.

[efdcapt115 1,511]

Sidetracked, thread derailed. Can we get back on topic please?? NWFD, play nice.

Sorry. I'm the sidetracking guilty party.

[Rescue97 6]

Except, as I understand it, they don't fall into the same chain of command. Do they? There is an EMS Lt. or Capt. at many runs we respond to, but as far as I know, they do not hold rank over firefighters. They hold authority at the incident as personnel with the higher degree of training....although some of the ems officers are EMT's and they oversee Medics. How does that work? What I'm really looking for is some insight into the EMS command system.

Even tho a Ems Lt or a fire Lt would never step on toes they are equal in rank regardless of what side there on. the FDNY is FDNY fire and FDNY EMS, both under the same umbrella. They both overall have to answer to the same chief, even tho there are both somewhat seperated the ranks are the same. Respect is given to one enother and both sides. I have never seen disrespect from either officer to office or firefighter to EMT's/Medics.

[prucha25 76]

First, it's SQ epi, not IM. Then again, I guess an EMT Supervisor wouldn't know that about paramedic treatment modalities.

Seriously though, do you honestly think that paramedicine is flow sheet treatment? Sure there are protocols, just like every other type of medicine. However, protocols are only guidelines and paramedics should be expected to use good clinical judgment to treat each patient that presents to them and, at times, to operate outside of the box in the best interest of the patient.

I think an EMT supervisor would work quite well in certain systems and I'm sure there are some great ones. In fact, there are a good number of EMT's that I work with that I would rather have as a command officer than many medics at a significant incident. Not only are they equipped with the tools to handle the situation better, I would rather have the limited supply of medics treating patients if I have a competent EMT to run the scene.

As I have been explained multiple times, and through multiple different medical directors. Neither an EMT or a EMT-P is allowed to deviate from their set protocols unless authorized by their medical director. Any Deviation from that and you are not only putting your job on the line but that of the Doctor who oversees whatever agency you are working for. EMT's and Medics DO have to follow their protocols because we are NOT Doctors. Doctors have years and years of school and a ton more clinical training then we do. Protocols are not " Guidelines" in the eyes of EMT's and Paramedics they should be seen as law. I've been explained that in tricky situations, or if you want to think out of the box you need to authorize it through telemetry. Whilst I know a lot of exceptionally talented and gifted Paramedics who I would trust with my life, the nature of our job dictates we obey our protocols and when in doubt call telemetry. Also it's been proven that an over abundence of medics on any given( MCI, Cardiac Arrest, APE, etc) call is more detrimental to a patient because people forget the order in which you're supposed to operate. ( BLS then ALS).

I can tell you first hand that in the field whether the boss has a Yellow patch or a White patch doesn't matter. As long as they are competent at organizing additional resources ( giving a notification, updating the ALS, requesting FD, etc) the patch doesn't matter. I've met plenty of bosses who are medics who aren't as great organizers as some EMTS, and vice versa. At the end of the day the boss isn't there to do patient care. They are there to make sure the job as a whole is getting done correctly.

Edited January 8, 2011 by prucha25

[ny10570 745]

Guess I don't generally see the necessity of the EMS supervisor directing patient care. Fires, rescue ops and haz-mat calls tend to be multi-unit events requiring coordinated tactics involving multiple personnel to successfully mitigate an outcome. Most EMS calls require one person be in charge of one patients medical care. I'm admittedly not familiar with the specific job description of an FDNY EMS Supervisor, but in most cases EMS supervisors oversee multiple units and coordinate non-emergency stuff and once in a while supervise multi unit calls, directing units but not direct EMS patient care. Supervisors also run interference as a representative of the agency between providers and facility personnel or unhappy family members.

I've never been a Paramedic and probably never will be, but I've supervised medics both under my immediate supervision and from further up, and too my knowledge not once have I had an issue where my lack of paramedicine training somehow had a negative effect on the incident or patient care. The only time it would have helped would be in cases where I was involved in direct patient care, not supervising anything but the patient.

Far be it for me to say how FDNY should do it, certainly not my thought. No doubt that an organization that large must have tons of bright people looking at bettering the system for everyone (no doubt everyone has an opinion, something medics and firefighters are rarely short on) but I'm often interested in the "why" of how people do things when they seem to be out of character from what I know. What is it that FDNY Supervisors do in the field?

Supervisors are automatically assigned to several call types and actively encouraged to take a proactive role in patient care. They are also delegated responsibilities in determining hospital destination and RMA approval. As part of our 5 year recert program they now handle a substantially portion of our training. We have only 4 or 5 physicians for 3,000 emts and paramedics, making officers are responsible for identifying dangerous practices that require intervention and possible retraining. There is nothing that says an EMT cannot be an excellent supervisor. However your marginal and poor supervisors are much less of a problem when they know the job they're trying to manage and your excellent supervisors can become better involved and facilitate better patient care.

[ny10570 745]

I need to address a previous comment. NY10570 I was one of those "dumbed down" EMT Supervisors (Lieut) in the NYC EMS system and had absolutely no issues with supervising both EMTs and Paramedics on a daily basis and actually enjoyed it. I found that there was extreme cooperation from both levels of personnel and knew my job was to enforce procedure and review what was within my scope of training. The issues arise when medics carry a "mightier than thou" attitude because of their level of training and forget that without BLS there is NO ALS and also forget where they came from, they were once one of those "dumbed down" EMTs. Don't throw stones when you live in a glass house. Lets talk dumbed down. Being a medic is not Roy and Johnny. It is flow sheet medicine. If you do A and see B then do D not C. There are even pocket protocol charts and I-Phone apps. Not that there is anything wrong with it but don't knock one area of a system because of a swollen ego. If swelling has become an issue some IM epi or benadryl might help but I am working out of my area to suggest that. Stay dry and safe in the snow today and remember we are all there for the same thing: the patient.

You don't know me so you can drop the whole ego maniacal medic line. I never once said there were no phenomenal EMT supervisors. While I'm at it there are medic supervisors with time in the field that I wouldn't let touch a week old corpse let alone a living patient. The job is better for the higher standard. The half assed Lt exam and ensuing training does nothing to select or create real leaders. Its about time they started asking for more than a GED and knowledge of the ops guide to run the largest EMS system in the country.

Edited January 8, 2011 by ny10570

[ny10570 745]

Psst nwfd ... They bailed on SQ epi in favor of IM due to the decreased skin perfusion during anaphylaxis. Otherwise I couldn't agree more but have given up trying to explain that A + B doesn't always equal C. Its the difference between EMT-I and Paramedic that some people just don't get. Clinical judgment still has a place.

Prucha, we cannot operate outside of our scope of practice however operating in more than one protocol and at times outside of protocol is an absolute necessity. To operate outside of protocol but within your scope of practice is why we specifically have the ability to call for discretionary orders. Before pain management and EDP sedation became protocol it was done by aggressive medics with consent from the doc.

Edited January 8, 2011 by ny10570

[antiquefirelt 994]

As part of our 5 year recert program they now handle a substantially portion of our training. We have only 4 or 5 physicians for 3,000 emts and paramedics, making officers are responsible for identifying dangerous practices that require intervention and possible retraining.

Ah this certainly says a lot for requiring the higher level for promotion. Our system puts medics in training roles for most ALS classes and others are used for BLS training, of course on a far smaller scale, making training delivery far easier. I'll admit that the biggest issue we've had is with non-ranking medics QAing senior or higher ranking personnel, a hazard when not enough medics promote. I also agree that raising the bar, especially when you have a deep pool to choose from should only better the system. Sadly, no matter how the requirements stack up, the larger the number of personnel the more often you'll promote duds and overlook great leaders, or as most optimists would say, the more often you'll get it right!

[PEMO3 523]

You don't know me so you can drop the whole ego maniacal medic line. I never once said there were no phenomenal EMT supervisors. While I'm at it there are medic supervisors with time in the field that I wouldn't let touch a week old corpse let alone a living patient. The job is better for the higher standard. The half assed Lt exam and ensuing training does nothing to select or create real leaders. Its about time they started asking for more than a GED and knowledge of the ops guide to run the largest EMS system in the country.

First let me start by offering an apology for my definite in appropriate comment. Unfortunately, I was not near a computer after EFDCAPT's response set me straight to do this sooner. I allowed my emotions over the demotion of a person I respected for no apparent reason other than a politician covering his rear allowed me to read into certain threads and respond with a knee jerk reaction which is something that I pride myself on not doing. My only point was that an EMT can supervise just as effectively and sometime even better than a medic.

Stay safe.

[prucha25 76]

Psst nwfd ... They bailed on SQ epi in favor of IM due to the decreased skin perfusion during anaphylaxis. Otherwise I couldn't agree more but have given up trying to explain that A + B doesn't always equal C. Its the difference between EMT-I and Paramedic that some people just don't get. Clinical judgment still has a place.

Prucha, we cannot operate outside of our scope of practice however operating in more than one protocol and at times outside of protocol is an absolute necessity. To operate outside of protocol but within your scope of practice is why we specifically have the ability to call for discretionary orders. Before pain management and EDP sedation became protocol it was done by aggressive medics with consent from the doc.

To which I couldn't agree more. However saying protocols are only guidelines( which I know you did not but NWFD did) WILL get people in trouble. It takes clinical judgment not to be a robot and be a be a GOOD EMT or Paramedic, however operating within our scope or practice is a must to not get jammed up. A good EMT or Medic will be a good detective and realize just because a patient presents with something doesn't mean it can't be X,Y, or Z. However as you pointed out those protocols which came out eventually( EDP sedation) happened because people CALLED telemetry and didn't just do it on their own. My concern is not with letting our people do more, but with people doing more with no guidance from a Doctor. Our jobs take a good deal of detective work, and ingenuity in stressful situations, however we are not allowed to just go out and do things without approval.

[Goose 188]

To which I couldn't agree more. However saying protocols are only guidelines( which I know you did not but NWFD did) WILL get people in trouble. It takes clinical judgment not to be a robot and be a be a GOOD EMT or Paramedic, however operating within our scope or practice is a must to not get jammed up. A good EMT or Medic will be a good detective and realize just because a patient presents with something doesn't mean it can't be X,Y, or Z. However as you pointed out those protocols which came out eventually( EDP sedation) happened because people CALLED telemetry and didn't just do it on their own. My concern is not with letting our people do more, but with people doing more with no guidance from a Doctor. Our jobs take a good deal of detective work, and ingenuity in stressful situations, however we are not allowed to just go out and do things without approval.

Everything a paramedic does is under medical control, be it off-line or on-line. That's why there is a regional credentialing process, to ensure that 1) you know the protocols and procedures and 2) ensure the REMAC physicians that you not only know the protocol but can carry out the protocols in a safe and effective manor (among other things).

This is what Westchester says about this (straight from the introduction section):

Protocols are treatment algorithms that should be used in conjunction with GOOD CLINICAL JUDGMENT. Protocols should be considered as the “models” by which all patients should be treated. Protocols are guidelines for non-physicians to administer emergency care in specific situations. Since patients do not always fit into a rigid formula approach, situations may occur which do not fit into these protocols. For patients who DO NOT fit into a rigid formula approach, or where there is no existing protocol and a clear need for Advanced Life Support exists, the paramedic shall initiate appropriate therapy and contact OLMC in order to differentiate the most emergent clinical problem and define the most suitable therapy. At that time, the OLMC physician shall order the most appropriate treatment within the paramedic’s scope of practice as defined by their level of training, certification, AND the Westchester Regional Paramedic Protocols.

Anyone can be a cookie-cutter paramedic (or cookie-cutter anything, for that matter). But to make a blanket statement and equate carrying out an ALS treatment modality to making a betty crocker cake is ignorant, to say the least. I know a lot of being a paramedic today is supportive care, but there really is something to say for being a tactful/thoughtful clinician as opposed to someone who just pushes drugs because they can (cookie cutter medic).

In reference to the supervision issues, i never personally had an issue with any conditions boss. I only ran into a handful, always seemed to catch the same ones when i was in the bronx - had a few medics and EMTs. Really had no issue with any of them. They were always helpful, friendly and never busted my stones or questioned my care. Even had one go to bat for me when an engine company left us hanging on an arrest on the 13th floor of the projects. Actually, i kind of liked having them around.

That said, you can't measure a boss by what patch he wears on his shoulder. You have to measure him or her by the man or woman they are and their ability or inability to manage the men and women of the job and the issue of the day. In the case of EMS, everyone is part of the clinical picture - everyone brings something to the table. Sort of like a fire department - engines, trucks, rescues. We've got CFRs, EMTs, Medics and bosses - all specialized units in our own regard who hopefully can build off the other and get the job done. Hopefully that makes sense...i know a lot of the people here are fire people, if it doesn't i apologize i know nothing about the fire department!

Edited January 8, 2011 by Goose

[cffd50 0]

i work ems in the bronx and the job of the bosses is to follow and make sure the protocol is being followed properly. u dont have to be a medic to do that. and believe me, ive seen medics who shouldnt even be allowed to to give oxygen. i think its unfair to not allow emts to be promoted to boses...theres alot of great emts who would be terrific bosses. better than most medics would

[FDNY 10-75 640]

theres alot of great emts who would be terrific bosses. better than most medics would

This is the case in many EMS systems...

Bloomy should be impeached. Theres a lot more to being mayor than having money.

[efdcapt115 1,511]

First let me start by offering an apology for my definite in appropriate comment. Unfortunately, I was not near a computer after EFDCAPT's response set me straight to do this sooner. I allowed my emotions over the demotion of a person I respected for no apparent reason other than a politician covering his rear allowed me to read into certain threads and respond with a knee jerk reaction which is something that I pride myself on not doing. My only point was that an EMT can supervise just as effectively and sometime even better than a medic.

Stay safe.

If I did something positive, in this case, with this Brother, it's only returning the favor.

Have a nice weekend fellas.

[ny10570 745]

Thanks for that vote of confidence efdcapt. I appreciate it.

PEMO3, thank you. I don't think anyone with any sense takes anything said here to heart. Faceless conversations about passionate topics are bound to illicit knee jerk comments. I have been guilty of more than my fair share.

I absolutely agree the patch means nothing so far as an ability to lead. However I to believe that for the good of the service paramedic bosses is the right step.

Back to the topic of chief Perrugia's scapegoating. The latest rumor out of the knitting circle is he will not lose his rank and is going to be reassigned to a different post. Adding the start to the chief of EMS post enabled this.