VillageEMT

Talk sense to a fool and he calls you foolish. Euripides (484 BC - 406 BC), The Bacchae, circa 407 B.C. Nothing EVER changes.

Lithium, BLS ECGs are, unfortunately, rare in the US. In our little village the BLS EMTs are taught to set up both 3 and 12 lead ECGs and to at least know when something doesn't look right so they can alert the ALS. If we are picking up an "ALS assist" enroute from another squad they are sometimes surprized to find a 12 lead strip waiting for they when they get on board. ( They shouldn't be surprized but they should be training their BLS better.) With half-hour plus transports BLS/ALS teamwork is a must. I think that the best approach to many problems is Occam's Razor "the lex parsimoniae" (law of succinctness): entia non sunt multiplicanda praeter necessitatem, which translates to: entities should not be multiplied beyond necessity. (That is, the fewer assumptions an explanation of a phenomenon depends on, the better it is.) (Ref: Wikipedia) Or as we say in Engineering "never assume, in only makes an ASS out of U and ME"

I completely agree with the "never tap your brakes," but I have had many, many tailgaters who will not pass me no matter how slow I go. Around here that can be impossible, two lane roads with ditches on both sides mile after mile. NYS law forbids the use of a handheld phone while driving, EXCEPT for emergency vehicle operators. Also, what if your alone up front and your partner is busy in the back? My first driving instructor taught me to consider the other vehicles as moving obstructions that I had to avoid, not thinking drivers, however stupid. The idea works for me. Maybe. A proper following distance is to allow you to brake or maneuver normally to avoid the vehicle in front of you. This distance cannot compensate for an idiot behind you. If they would hit you if you "tapped the brakes," (see #1 above) then they will hit you on a "normal" stop. When I see a pack of cars tailgating in front of me, I add up the following distance that all of them should have had and add that to my following distance. This pisses off some people behind me but it does create a workable buffer for me. Note: NYS law makes the following vehicle driver responsible for any tailgating accident. The only exception is if the driver of the front vehicle is convicted of DWI or similar offense. BTW, my first driving instructor was a former Chief Driving Instructor for The Sports Car Club of America. Ever done spin training in a Land Rover? Ah, to be "young and foolish" again.

One "cure" for tailgaters is to turn on the rear flood lights. Not nice, maybe not even strictly legal, but effective. Be careful out there!

403, You mentioned the very points that decided us against the Ferno and for the Stryker. We found that the controls were much better on the Stryker and the battery replacement is simpler. Also the Ferno has a nasty pinch point on the side of the frame. The power cots do weigh about 40 pounds more and we notice this the most when one person is trying to bring it into a pt's house alone. One other feature we really like is the rapid wheel up motion when the weight is off the wheels as you load the cot into the ambulance. We had a 500+ lbs pt the other day and having the wheels retract in less than 2 sec. was great. Note: We are a volunteer squad, that means that we all have "day jobs", in this case most of us are engineers. The group that evaluated the two power cots consisted of four senior engineers and a senior test technician with a combined EMS experience of over 105 years. John, Sr Systems Engineer, BAE Systems Somewhere in the world a commercial jet takes off using our electronics - every three seconds.

I'm wondering what problems you have had. We have been using one for about eight months and love it. We have just ordered a second one.

On of our volunteer drivers keep being asked medical questions by the families at the scene, so we got him a t-shirt that had "AMBULANCE DRIVER" printed across the front... in reversed letters, of course.

New York (upstate at least) CFR- Certified First Responder - Cannot transport - the only time we have one is when a 17 yo gets permission to join the squad and plans to upgrade to EMT when they turn 18. Some of the surrounding villages have First Responder Units. EMT - Basic - our squad doesn't have any, see below EMT - D - Basic Defib - Tioga County requires an AHA CPR/AED Cert. at Healthcare Provider level EMT - I - our squad has only one of these, grandfathered in (Hell, he is a Grandfather!) EMT - CC - Critical Care - Almost all of the skills of a P with less phys and pharm training EMT - P NY doesn't use the NR, but the tests are derived from it. If you choose to take the NR test they recognize the NY skills test and give you credit for it.

Sam, NY states right on the cert that it should be laminated upon receipt. The NY cert does no have a photo, but our regional EMS ID does have a photo, our name, agency, cert level, number and expiration date. Some of the hospitals in the area, Upstate NY, require IDs be worn after 9 PM or when the ED has declared an emergency. I routinely wear a photo ID at work anyway, it is required to get in the building. ( I'm an engineer.) I have never had a pt ask for ID but I have been stopped at the ED door, in uniform, and asked for ID. If I remember, I will clip my ID on if I'm not in uniform on a call. It just saves questions on the scene and at the ED. In this day and age I would think a hospital's security very lax if they let just anyone wander into the ED in the middle of the night, in uniform or not. Don't let the attitude of some of the City folks bother you, they just don't understand volunteers. This country was founded by volunteers and much of the good work that goes unnoticed is done by them.

I frequently take patients to an ER that is our Regional Trauma Center and Regional Cardiac/Stroke Center, and they frequently have patients coming out their ears. It is also the ER where most of our clinical training time is done, so we get to see how they work. I don't know the standard of care in OK, but in upstate NY 2 hours on a LB by a patient who has been diagnosed as having no spinal injury would raise a lot of questions. If they do have a spinal injury, why would it take that long to start treatment? Wouldn't delay lead to the risk of worsening the injury? (Note: The questions are retorical and the answers obvious.) A backboard is not intended for long term care. It is an expedient to get a pt to the ER. Busy or not, a reasonably good standard of care would be to get the patient off the back board as soon as practical. Also the original poster stated that there were only a few non-critical pts in the ER in question, so patient load is not a factor here. This was, at best, sloppy care.

"Approximately 2 hours later, we returned with a different patient, and decided to check up on the previous patient. Still in the ER, crying in pain, no x-rays, nauseous from pain, and still on a backboard." I'm just curious about something that seems to have been overlooked in this discussion. When you returned to the ER 2 hours later the patient was still on the back board. In my area this would be extremely unusual, particularly considering that the doctor did not think there was a fracture. I can understand an honest disagreement about diagnosis, but to have a patient lay on a back board for 2 hours without a very pressing reason would, at the very least, be considered uncaring, if not downright abusive treatment.

Tioga county increased its requirement a couple of years ago to 168 hours of classroom time plus 10 hours of clinical time in the ED or 10 calls with transport (we only do emergency calls, not inter-facility transfer). I could keep up with the class at that rate, but I don't think I would even want to try a four week class. It just takes time to absorb all that you need to know and practice it over and over again. And I'm not exactly a slow learner, see below. Find a course that is in the four to six month range with as much hands on labs time as possible and you might be useful in an emergency and not just a "gofor". John F., BSc, CP, IGI, CFIA, CC, EMT-D Bachelor of Science – Mathematics, Computer Science, History Commercial Pilot Instrument Ground Instructor Certified Flight Instructor – Airplane Certified Clockmaker Emergency Medical Technician – Defibrillation Sr. Systems Engineer - Commercial Electronics - Aircraft systems

"6 months." :shock: My Basic course was four months (168 hours of class & 10 hours clinical)! The NYS Critical Care EMT is 10 months. EMT-P is two years, no ifs, ands or buts. Why don't they just admit that they are running a BLS service?

Here a Basic can "assist" the pt with their own nitro only if their BP is above 120. ASA for Basics has been proposed in our region and may happen this year. Now for "on topic:" We haven't started using the new protocols yet. They will be implemented this fall as part of our CPR recert. Our LifePac 12s and 500s will be changed over to 360 joules at that time. Stats for the "old way"... last year, seven CPRs, one save. There were about a dozen "near misses" that made it to the ED in time with a lot of help from ALS. It is so nice to work with a guy who has been an EMT for 35 years and can get an IV into an obese diabetic on the first try almost every time, or the second try every time.

Now that is scary. I'm only a Basic and I can set up a 12-lead EKG and read the more common indications from it. It is not something that is taught in the Basic class but my Squad expects a high level of "assisting the ALS provider." When there are only two of you in the back with a serious cardiac pt and a half hour ride to the ED the need to know what is going on with your pt is more important than the title on your certificate. BTW The Masters program I took at NYU required a 50 to 100 page thesis (primary sources or original research only, no secondary sources) with a formal oral defense similar to a PhD dissertation and defense. Educational standards vary a great deal from place to place.

Where to start... nsmedic393 - if you had read the signature line it is 520 so far this year, it will be 1800 by the end of the year. That is how we pushed the village board into getting the two paid Paras we have. That was a big push from the VOLUNTEERS to get the two PAID PARAS and we have to fight for the budget every year. The southern NY - PA border has been a depressed area for decades and we are just now gaining some jobs back. One of the larger cities here went from a population of 80,000 thirty years ago to 50,000 today. So, no, if we don't do it the village will not be hiring paid replacements, the call will just go unanswered. hfdff422 - There is nothing status quo about our squad. We were one of the first in upstate NY to go to 12 lead ecg. We were one of the Pilot Program squads with CPAP. We had narcs before many of the paid departments around us. One of the drivers in this is our distance from any hospital. When you have to care for your patient for an hour instead of ten minutes you need the best equipment and skills you can get, that is where our money goes. When we see a need in our patient community we work hard to fill it. Our limitation is money, not the status quo. In reality we can move faster than many paid departments since we don't have their bureaucracy to fight. weasel 108 - I read the first part of your comment, it was the last part that I quoted, and that was objectionable. We don't do this just to volunteer, we do it because there is a need and we are the only ones filling that need. There is no tooth fairy that is going to leave a paid EMS squad under our pillow, just the cold reality of life.

WHAT?? :shock: !! "That tells me your service is putting the public's lives at risk,just for you to be a volunteer." I don't know where you come from but this is an incredibly ignorant and demeaning statement to all of the people in this country who put in many hours of volunteer time and work a full time job as well. I am a Sr. Engineer and work full time. Tonight I will spend three hours at the station in one of our monthly classes. There have been more than a few nights where I have been on one call after another from 6 PM until 5 AM and then had to go into work. Do I have to be a volunteer EMT? No, but if not me who will do it? There are volunteers because there is no money to pay a paid staff. Maybe your area can afford a paid dept, good for you. But in many parts of this country volunteers are the only Fire and EMS personnel. It has only been the last few years that the village has managed to pay for two Paras for weekday daytime duty. Their drivers are still volunteers as are all of the night and weekend crews. The system works well but it can be a strain at times, particularly in the face of such ignorance as yours.

From a rural volunteer prospective: When I took the EMT-D course the county had just expanded it to 168 classroom hours plus 10 hours of clinical time or 10 transports. No one in the class thought that there were enough days to cram in all that a Basic needs to know in a rural county. ALS is frequently a "maybe, if available, luxury" for many of the squads in the county. We wish it was otherwise for our patients sake, but the money and people are just not there. We keep up on the latest methods and training is a big part of our volunteer time. You take a different view of EMS when your shortest transport will be 25 minutes and may be an hour or more in bad weather. It would be nice to have EMT-Ps on every call but it isn't going to happen any time soon. Right now we are down two ALS providers and are waiting for two of our people to finish the nine month EMT-CC course. Yes, nine months for a Critical Care EMT. The only Para course that we recognize runs almost two years and there are far too few people who can afford that time while holding down a full time job. So, we "do it" with what we have and encourage anyone fool enough to want to try it to go to class. I grew up with an ex-Army RN for a mother and remember her quizzing doctors when ever I was sick. What a wonderful world it would be if we could just clone a dozen of her for our squad. I wishes were horses...

The only time we take the cot in on arrival is when we know the patient and that they will be going to the hospital. One of the nice things about a small town is that you get to know your patients and their houses. With all of these old Victorians, houses not people, the stair chair gets a lot of use. Sometimes a "disembodied voice" (usually "the voice of experience") will come on the radio and ask dispatch to retone for lifting assistance even before we get to the scene. :shock: Once "the voice" asked for the Rescue truck! Cot hell, we needed a chain saw to get the patient out of the house. :shock: :shock:

Now, for that I would be happy to be an Ambulance Driver!

The regional org., Susquehanna Regional Emergency Medical Services System, ( what a mouthful ) puts the title "Emergency Vehicle Operator" on the ID badges of squad members who drive and don't have an EMT certification ( other than AHA CPR/Defib ). Even with that our past Sargent would keep getting asked medical questions by the pt's family. We got him a "T" shirt that has "AMBULANCE DRIVER" across the front in big bold letters, reversed, of course. ;-)

craig, In New York State Albuterol is an optional BLS medication for previously diagnosed asthma pts if your squad writes a SOP and gets its Medical Director to sign off and you are trained to administer it. In the Susquehanna Region there is a local BLS protocol for it for COPD. https://www.srems.com/default.htm

On my first CPR call our crew chief was a young but very good AEMT-CC and he could not figure out what was causing all the trouble with ventilating the pt. We got the pt to the ER in about 25 minutes (fast for the distance and the snow and fog enroute) and they worked on him for another 20 minutes before giving up. It turned out that the pt had a spontaneous bilateral pneumothorax. Even the ER doctor didn't see it at first. He decompressed one side as a last shoot to try to do something but it was to little, too late. The doctor told our crew chief that there was no way he could have found it in the back of an ambulance, but he still felt bad about it for quite a while. The AEMT-CC is working on his Paramedic now and I hope to work with him again soon.

Vacuum split is our favorite. I've had a few awkward situations lately where nothing else would do to job.

Since I am all alone in the 40's, just barely though, I give you this little thought... I was born a hundred thousand years ago, And there ain't nothing in this world that I don't know. I was with Noah on the ark, Before him, with God in the dark, There ain't nothing in this world that I don't know. Of course it's not true, but it keeps the kids from asking me my age all the time. :wink: