Flasurfbum

Well, it certainly has been a while since I have been around.

Ironically, the other day, as I was riding backwards on Engine 23, I thought about Rob, and how I haven't talked to him in quite some time, and how I needed to get in contact with him, let him know how I was, and find out about him.

This kinda stings, because I never did.

As one of the "firemonkeys" that often enraged him, I also learned from him, and am a better provider for it.

Thanks buddy for lighting the fire (and then throwing gasoline on it to amuse yourself) under my ass to make me a better medic. I'll see ya on the otherside.

Does the pt still have pain?

I hate bicyclists on the road, especially when they have no consideration for vehicles especially the ambulance.

Ding ding ding!!

I love the ones the obey the 3ft rule... they ride 3 ft from a curb, and expect traffic to stay 3ft away from them, AND avoid getting in a head on collision.

Whatever happened to natural selection?

Thanks everyone!

Although I am a Fireman, and working for a FD based EMS system, I don't forget why I do this, and I treat my pt, not the monitor, a protocol, or make decisions that are not in the best interest of my pt.

AK, I think we have worked in the same areas, and may have crossed paths.

Are you in Brevard atm?

I'm in Satellite until Sunday.

Eeps you'll be in bicycle radius from me (Which is 5 miles from my front door). Remember Florida is a 3foot state and don't be like some drivers and try to push me off the road. :: chuckles:: ( Being that one of the local trucks tried to do that again recently. After I took time to drop off that thank you book from my kids too. :: pouts:: )

I drove in Jersey, Fla is a piece o cake!

How far is Hillsborough from Pinellas county?

Right next to each other.

Pinellas county is across the bay from Hillsborough. Now for the big question from the person in Hillsborough: What part of Hillsborough?

Right now, no idea.

5 weeks of orienting at HCFR HQ on Hanna Ave, then onto a Rescue to be evaluated as a 3rd.

I am hoping for Rescue 14 or 74, by USF, but we will see....

Congrats!!

Which county do I need to avoid or move from?

Hillsborough.

You still down here?

Assess and secure airway via most appropriate device

Establish IV access

20mg Lasix

0.4mg NTG SL q5min, up to 3 times.

Call medical control.

Often times we will get orders for 1in NTG paste, SL NTG PRN, PRN orders for Etomidate, Versed and intubation, PRN orders for CPAP if we haven't used it already, and occasionally 20mg more Lasix.

God Bless NJ MICU.....

After doing my time in Hell (aka NJ), I got hired with a County Fire Dept in Fla, starting June 21st.

I know many look down upon Fla Fire Depts, and those that work for them, but this is a huge chance for me to actually be a medic, a fireman, and actually use my judgement during patient care, not a Dr many miles away, who I talk to over the phone.

For once I am agreeeing with a firefighter. (SHOCK) Especially considering the original post sounds like somehting a firefighter would do.

I might be a fireman, but I am also a pt advocate.

What the hell are these things the kids are wearing on their wrists? Had one that was wearing at least fifty of these Silly Bands on each arm, in addition to a number of "cause" bracelets. I cut them all off, instantly pissed off. But my first aid for 'emo bandz', is telling them to knot them back together and call them "battle scarred bandz". So, I hereby coin that phrase, but feel free to use it in order to calm them down. HA HA lolz

Obviously, someone is lacking the skills needed in order to communicate with their pts.....

How are you able to retain your certification in the State of NJ?

Does NJ OEMS know of your conviction?

Welcome from Cape/Atlantic MICU.

It is not hard to transfer to another state as long as you are nationally certified. All you do is obtain job in that state and take any state test they may require or it may be as simple as paying a fee.

No offense, but you obviously have never dealt with Jersey.

So it would be easier to transfer to another state as an EMT then it would as a paramedic (depending on which state?) I'm most likely looking at New York or New Jersey if I were to move.

If you plan on coming to Jersey, bring patience, and lots of it.

You need your NREMTP, and then you need a project to sponsor you. You get that, and since you are coming from Fla, they will place you in the MICU as a 3rd "Medic in Training", despite the face you already have Fla and NREMT-P. You will be doing a minimum of 100 hrs as a MIT, paid, but not to the full Medic level, and higher then EMT pay.

You then wait, and wait and wait for the State to get, process, and send back your paperwork. You then get assigned a "T" or Temp number. You have 6 month "Trial" period where you can work as a 2nd, but not do certain things, like RSI or work with another T#.

If your project wants to keep you, you drop the "T" before your number, and you are then MICP 3###.

The pay and experience are pretty damn good up here (STAY AWAY FROM MONOC UNDER ALL CIRCUMSTANCES!!!!), but unless you work for UMDNJ, you will have crappy retirement and hospital benefits.

Why, might I ask, are you so set on coming up here?

I completed my Medic in Fla in Sept of 08, moved up here, and didn't even get approved to become a MIT until Dec of 08, and wasn't assigned my T# until Feb of 09.

I am now trying as hard as I can to get a FF/Medic job in Fla.

Look at the Carolinas, or anywhere that has their EMS squared away.

I am not going to even touch the BLS/ALS wars that happen, the idiocy of the furst grade counsil, the lack of MICUs, the restrictions placed on medics..... you get the point.

Do it for a year or two, get the best experince almost anywhere, and run.

Have and questions, feel to PM me, I am still in Hell.

Errr, Jersey.

AJ, NJ MICP #3247

I like this concept. Definitely NOT for the everyday medic.

Toward the Sound of Shooting

Arlington County, Va., rescue task force represents a new medical response model to active shooter incidents

* E. Reed Smith, MD, Blake Iselin, FF/EMT-III, Assistant Chief W. Scott McKay

* December 2009 JEMS Vol. 34 No. 12

* 2009 Dec 1

In November 2008, a group of 10 well-trained terrorists with good communications systems and a well-coordinated plan essentially held Mumbai, the largest city in India, paralyzed for more than 24 hours. Although the coordination and scale of the Mumbai attack went beyond what we’ve seen in the U.S., active shooter scenarios aren’t foreign to us.

An "active shooter incident" is commonly defined as an incident in which one or more people use deadly force on other people and continue to do so while having unrestricted access to additional victims. Almost every year, several of these incidents happen throughout the country, injuring and killing innocent civilians. They range in size, scale and publicity, with the most infamous being the killings at Columbine High School (12 killed, 23 wounded) and Virginia Tech University (32 killed, 17 wounded). On Nov. 5, an Army major went on a shooting rampage at Ft. Hood, Texas, killing 13 and wounding 30 others.

In the past decade, the EMS community has spent a lot of time and effort training to increase awareness, detection and response capability for weapons of mass destruction. But we’ve failed to address what could possibly be the greatest threat for mass casualty—the well-armed, well-supplied lone gunman who is willing to or intends to die in the act of killing and injuring others, including fire and EMS responders.

Other first responder groups have addressed this issue. After the Columbine High School shooting in 1999, police agencies across the country addressed what appeared to be failures in their tactical response to active shooter scenarios. They developed proactive response plans, which established a standard that’s now commonplace. Prior to Columbine, the police model was to cordon off the area and wait for the arrival of a SWAT team to engage the threat. In most circumstances, this process allowed the shooter to continue to be active inside the perimeter and led to a significant delay in getting victims to medical care.

In a paradigm shift following Columbine, police departments moved to an aggressive response in which police immediately pursue, establish contact with and neutralize the shooter; the idea is that the sooner the shooter can be contained, captured or neutralized, the fewer the casualties.

To meet this objective, first responding patrol officers organize and deploy in three- or four-person teams as soon as they arrive on scene; they move quickly through unsecured areas, bypassing the dead, wounded and panicked citizens with the goal of engaging and eliminating the active threat. They’re now trained to "move toward the sound of shooting."

In contrast, fire/EMS hasn’t followed suit. The current standard fire/EMS response to the active shooter is to stage in a secure location until police mitigate the threat and secure the area to create a scene safe for fire/EMS operations. But there’s a basic problem with this response: While waiting for a secure scene, those injured inside the building aren’t receiving care and are dying from their injuries.

In our agency in Arlington County, Va., we recognized this weakness in our EMS response during after-action briefings for a large active shooter drill in which EMS assets were staged for more than an hour before police declared the scene safe for medical operations. Subsequently, in conjunction with the Arlington County Police Department, members of the Arlington County Fire Department developed a new EMS response to active shooter incidents—the Rescue Task Force (RTF)—that takes the current military medicine model of Tactical Combat Casualty Care (TCCC) and applies it to civilian EMS.

The goal of this response is to get medical resources to the patient’s side within minutes of being wounded while continuing to mitigate provider risk. Although our tactical medics were already familiar with TCCC, we felt this small group was limited by their primary role of working directly with our SWAT team and would likely be delayed in their deployment to the scene. The Rescue Task Force, similar to the police response to active shooters, must be implemented almost immediately. So, in order to fully implement the concept, we trained all of our paramedics in TCCC and the operational aspects of the RTF.

The Basics of TCCC

Tactical Combat Casualty Care represents significant advancement in prehospital battlefield care. After the Battle of Mogadishu in 1993 (represented in the movie and book Black Hawk Down ), U.S. Navy Capt. Frank Butler, USN MC; Lt. Col. John Hagman, USA MC; and Ensign George Butler, USN MC, wrote a landmark paper that defined the concept of TCCC and changed the paradigm of how medical care was applied on the modern battlefield. Taking into consideration the limitations due to the austere conditions inherent in combat, TCCC essentially defines a set of principles and medical practices aimed at decreasing preventable deaths at the point of wounding. It defines what needs to be done immediately and in what order.

TCCC is evidence based and well supported by combat data. The Wound Data and Munitions Effectiveness Team study (1967–1969) examined combat wounds from the Vietnam War and found that approximately 20% of all soldiers killed in action died from extremity hemorrhage, tension pneumothorax or airway obstruction, all of which are readily treatable in the field without extensive equipment or medical support. Similar findings were reported in a 1984 study: 9% killed in action from exsanguination from extremity wounds, 5% killed in action from tension pneumothorax and 1% from airway obstruction. Although these wounds are all readily treatable, they’re very time sensitive. Any delay in treatment will increase the risk of mortality; thus, the best chance for survival after ballistic wounding is with a response configuration that puts medical care at the patient’s side within seconds or minutes. "Far-forward" placement of medical assets is therefore essential. The success of such aggressive application of medical care has been proven in the U.S.’ current conflicts, with survival rates of 90% in Operation Iraqi Freedom and Operation Enduring Freedom.

The overriding principal in TCCC is to perform the correct intervention at the correct time in order to stabilize and prevent death from the readily treatable injuries. For the civilian provider, this approach requires a shift in thinking. Airway control is not the first priority. Not only are exsanguinating extremity wounds far more common than airway injury, but a person can bleed to death from a large arterial wound in two to three minutes, while it may take four to five minutes to die from a compromised airway. Therefore, in TCCC, life-threatening bleeding is addressed first, followed closely by airway control. Open chest wounds and tension pneumothorax are of concern as well, but they generally don’t cause mortality for 10–15 minutes, so they’re addressed third. In TCCC, the traditional ABC mnemonic (for airway, breathing, circulation) is replaced by CAB (for circulation, airway, breathing).

Because supplies and resources are limited in combat and austere environments, medical treatment and stabilization must be done expediently with minimal supplies. Tourniquets are emphasized and prioritized as a quick and effective method to control extremity hemorrhage. This practice is based on retrospective medical data that refutes the prevalent civilian EMS doctrine regarding their use and complications. Multiple studies and case reports from Iraq, Afghanistan and Israel have shown the safety of tourniquet use, especially when they can be discontinued within one to two hours. Although patient evacuation may be delayed hours or even days in a military combat zone, in civilian active shooter scenarios, patient evacuation is usually performed within 60–120 minutes and definitive medical care is often easily accessible after evacuation. Thus, for any exsanguinating hemorrhage, tourniquets can be applied immediately and quickly de-escalated once the patient is evacuated to a higher level of care.

For non-exsanguinating hemorrhage, mechanical pressure dressings with wound packing are used. Some wounds, including those in the femoral triangle or in the neck, are not amenable to tourniquets. These wounds are controlled using hemostatic agents, such as Celox, QuikClot ACS and HemCon, in conjunction with direct pressure. These agents enhance the coagulation cascade and increase clotting through local mechanisms in the wound itself. Although the initial versions of the hemostatic granules had morbidity from the exothermic reaction with blood in the wound, the newer versions of these chemicals have addressed and resolved this complication.

For airway control, nasopharyngeal airways are emphasized over oropharyngeal or endotracheal intubation; nasal airways are fast, stable and effective in all unconscious or altered mental status patients, regardless of the presence of a gag reflex. Intubation is de-emphasized because it requires extra equipment and loss of situational awareness. If more definitive airway control is needed, blind insertion devices and cricothyrotomy are the procedures of choice. For breathing, re-establishing chest wall integrity with an adhesive occlusive chest seal and early management of tension pneumothorax is emphasized. Because tension pneumothorax can be difficult to recognize in the uncontrolled setting, aggressive and proactive use of needle chest decompression is used in patients with thoracic injury and respiratory distress.

Translation to Civilian Care

After examining the weapons used by active shooters, the patterns of morbidity/mortality, and the medically austere conditions in which active shootings have taken place, it became clear to our department that civilian active shooter scenarios presented similar conditions and injuries as in combat.

The approach to redefining our medical response to these scenarios is based on the same concept used by firefighters involved in an interior attack on a structure fire: The risk is mitigated by proper equipment, training and tactics. Understanding that time to care is the key to saving lives, EMS personnel must get into the scene of an active shooter as quickly as possible to provide rapid stabilization. It’s no longer acceptable to stage and wait for the affected area to be cleared by the police; doing so defeats all principals of TCCC and can result in a number of preventable deaths.

The RTF is essentially a simple response model made up of multiple four-person teams that move forward into the unsecured scene along secured corridors to provide stabilizing care and evacuation of the injured. Each team consists of two police patrol officers to provide front and rear security, and two medics to stabilize patients using TCCC principles and equipment. In addition to the security of the escorting officers, these medics are outfitted in ballistic vests and helmets to further mitigate the risk of operating in this environment. Based on daily staffing in Arlington County, a total of seven RTFs can be formed at any time, each equipped to carry enough supplies to treat up to 14 victims, depending on their injuries.

Using input from military and medical subject matter experts and considering the operational limitations of the RTF mission, reliable, well-constructed and user-friendly medical and personal protective equipment was chosen and purchased with grant funds secured from the Metropolitan Medical Response System. The following is a list of what was chosen for the RTF:

Personal Protective Equipment

>> Level IIIA Hornet Tactical Vest from Protective Products International with Level IIIA biceps protectors

> Lightweight with a large amount of overall chest and back coverage

> MOLLE webbing across chest for easy attachment of equipment carriers

> Adjustable in size to fit all medics in the department

> Identification with large Arlington County Fire Department patch on front and biceps protectors,

as well as ‘RESCUE TASK FORCE’ on back (see p. 50)

>> Level IIIA Special Operations Helmet

> Lightweight with high-cut back for greater range of motion

> Four-point harness to prevent helmet from sliding over eyes during patient care

Medical Equipment

>> TQS Medical Emergency Tourniquet (MET)

> Open loop system with solid construction

> One-handed operation

>> H Bandage from H&H Associates

> Firmly secured pressure device and solid construction allows for greater amounts of

pressure and easier application

>> Bolin chest seal occlusive dressing

> Strong gel-based adhesive allows for easy fixation and stability during transport

>> QuikClot ACS hemostatic agent

> New formulation of the Zeolite with decreased exothermic properties

> Small gauze pouch design eliminates powder issues and can be used as

wound packing

>> 14 gauge 3" needles for chest decompression

> Current recommendation of Committee for TCCC for use of longer needle

Response Team in Action

If an active shooter incident occurs in Arlington County, the first four or five responding police officers quickly form an initial contact team and enter the building; this is the standard police response. This contact team moves quickly to the sound of the shooter, bypassing wounded victims and other threats in an attempt to eliminate the most immediate threat. In doing so, they essentially clear a corridor into the building and relay important reconnaissance information back to command. Although these officers don’t provide direct assistance to the wounded, they identify the need and call for the RTF.

Once this need is identified and communicated to police command, the RTF is formed with two police officers providing security for two medics as they move into the building down the corridor secured by the initial contact teams. Although directly under police command, the RTF is essentially a unified command asset. Once inside the building, the RTF police officers are directed through the incident commander to move the medics to the injured victims identified by the initial contact teams.

RTF communication functions on two different radio zones: 1) the RTF police officers communicate with police command, giving such information as location of the team within the building and receiving updates on location of the injured, the contact teams and possible threats; 2) the RTF medics communicate with fire command to report the number of victims and injuries. This dual communication allows for accountability and effective use of the teams as well as for planning and management of both the external casualty collection point and additional EMS resources.

The first one or two RTF teams that enter the building move deep inside to stabilize as many victims as possible before any one victim is evacuated. As victims are reached, the RTF police officers provide security in place while the medics treat the victims. Using the concepts of TCCC, they stabilize only the immediately life-threatening wounds on each patient they encounter, but leave these patients where they are found and move on.

The number of victims that can be stabilized by these initial RTF teams is limited only by the amount of supplies carried in. Once out of supplies, teams start moving back out of the building, evacuating patients they’ve treated. At the same time, additional RTF teams are formed as personnel become available; these teams are brought in with the primary mission of evacuating the remaining stabilized victims. They can also be tasked to move further into the building in a "stabilizing but not evacuating" mode to take over for the initial RTF teams that have run out of supplies and begun evacuation.

A supply depot is set up near the entry point to the area of operations to allow for quick re-supply and turnaround for RTF teams. If needed, an internal casualty collection point will be set up near a secure entry point, where casualties can be grouped to allow for faster and more efficient evacuation by non-RTF EMS personnel. All patients are eventually evacuated to an external casualty collection point well outside the building in a secure location where traditional EMS care is initiated.

Skills & Drills

Since RTF inception, we’ve conducted monthly training on the application of care according to TCCC principles, the new personal protective and medical equipment, and RTF operational considerations. Every paramedic in the county, regardless of assignment to engine company or medic unit, is capable of functioning on the Rescue Task Force. For police, the RTF represented a paradigm shift as well; thus, training sessions to teach the concept, the role of security and movement for the medics, and operational details of command and control were held for all patrol and command officers.

Several successful drills have since been conducted to reinforce the concept, training and command/control. The largest of these drills was a full-scale, multi-jurisdictional simulation of a multi-victim high school shooting similar to the Columbine incident. Using a local high school, multiple victims with moulaged ballistic and blast injuries were spread over a large area, simulating a scenario in which shooters moved indiscriminately throughout the school. Additional fixed threats, such as improvised explosive devices (IEDs) that required integration of bomb mitigation squads and limitation of ingress/egress, were also added.

In this drill, the RTF proved feasible and effective. The initial police contact teams requested the RTF within 10 minutes of entering the building; four RTF teams were deployed into the building, and within 30 minutes, all 44 victims had been stabilized and evacuated to the external casualty collection point. This drill reinforced the fact that, using the RTF concept, a large number of severely wounded patients scattered through a large building could be effectively and efficiently treated and evacuated before law enforcement cleared the entire building. In comparison, using the traditional EMS response in a similar drill that year, the first patient contact wasn’t until more than 90 minutes into the drill, and overall, it took more than 2.5 hours to clear the building of patients. Without question, after 2.5 hours, many would have succumbed to their injuries.

Virginia Tech Lessons

The response to the shootings at Virginia Tech University on April 16, 2007, demonstrated the effectiveness of rapid medical intervention via forward placement of medical personnel. Because of prior shootings on that campus, both of the local SWAT teams near Virginia Tech were active, and each had a tactical medic assigned and present with the team. Thus, when the call went out, both teams were formed up, nearby and ready to respond. The teams were inside the building within 12 minutes of the first 9-1-1 calls.

These medics quickly set up an internal casualty collection point and began triaging and stabilizing the injured as they were moved there by officers. Those treated and stabilized with probable life-saving interventions included a young man with a femoral artery injury that was controlled with a tourniquet and a young woman who had a tension pneumothorax relieved by needle chest decompression.

The entire building was declared clear by the tactical teams after 29 minutes, and only then did the rest of the local medical response enter in full force. In this case, although small and limited, the forward medical component was able to apply stabilizing and life-saving interventions near the point of wounded.

Overall, this was an improvement over other incident responses, but two points should be clarified. First, the availability of SWAT teams that day was by chance, only due to the prior activation of the team. On any other day, neither team would have been formed up and available to respond with a tactical medic within 12 minutes. Second, patrol and tactical officers were still required to evacuate the injured to an internal collection point and then out of the building. Essentially, this process left fewer officers available to perform a secondary search for additional shooters, explosives or other threats.

Conclusion

The Rescue Task Force, using the proven military medical concepts of tactical combat casualty care, is a proactive response to a real threat that every fire/EMS department in this country faces. As recent events have shown, the threat of coordinated small arms attacks in public places is not only real but likely in the current global economic and political environment. Prehospital medical response must change the current model of waiting for a secure scene, even though this may involve assuming a higher level of risk. Risk is nothing new for us; every day, we risk our lives to save people from dangerous situations, doing it with a safety net of protocols, training and equipment. The Rescue Task Force concept does the same, using a safety net to move fire/EMS to a new standard. JEMS

E. Reed Smith, MD, is the medical director for Arlington County (Va.) Fire Department and its Rescue Task Force. Contact him at rsmith@arlingtonva.us.

Blake Iselin is a firefighter/paramedic with ACFD. Contact him at biselin@arlingtonva.us.

Scott McKay is the assistant chief for ACFD. Contact him at wmckay@arlingtonva.us.

Umm... I was talking about the stretcher shoulder harness. I thought he was too.

I'm confused...

Woops.

Thought he was talking about the shoulder straps WE have, not the ones on the cot.

Percs and posting.... not a good mix.

All new ambulances being purchased by AtlantiCare Regional Medical Center have 5 point harnesses on the bench seat. They are far from impractical. Design tweaking needed?

Sure.

But they WORK.

I was involved in an on duty MVC, while treating a pt.

I will not be delving far into this topic.

I am alive, banged, bruised, sore but lucky to be alive.

If you are new, been here a while, or a crusty ol medic, heres a few things to reinforce.

Secure your equipment. If it can get loose and fly, it will.

No RL&S unless they are dying.

Secure yourself!

I would LOVE to see a mandate for all new ambulances to have attendent seat harnesses. I am not fond of playing pinball, when I am the pinball.

Be safe guys. This has been a very sobering experience.

How is their BLS training and QI process?

From what I have been told by an oldtimer or two, a South Jersey MICU project was based on KCM1, down to the equipment and all.

As for its valididty....

However, much of the same happens here in Jersey. We go on ALS level calls only (in theory ), and can get cancelled by BLS en route, or before pt contact.

Its once we make pt contact that all similarities seem to disappear.

http://www.newson6.com/global/story.asp?s=11255583#

Is anyone sensing a pattern with this guy? Maybe he just happens to find all of the people who like to resist.

Doc, you haven't had a run of a particular type of patient?

Sometimes you attract all the codes, MIs, ODs, psychs, etc?

If it were any other Trooper that this had happened to, I think that this would barely have made the news, let alone attract our attention.

My concerns are that the Trooper starts really thinking "how will this look in the media" before he acts, rather then relying on his training to keep him, his partner(s), and the public safe, and a perp will take advantage of it.

So you agree that the actions of the officer were premature.

To be a nice as everyone wishes he was. The man disobeyed a lawful order, multiple times.

Best look again, Level 2 is voice "control" the officer in quest was not IN CONTROL of himself let alone the situation, as in the first interaction with Paramedic White AND turning his back of the Individual that he was questioning ... a POLICE FAIL in of itself.

Level 2 was not working, so 3 was employed by the Troopers partner. The subject resisted, and a quick escalation to level 4 was attained. The subject was subdued with no further incident.

Well, I must have missed that part but not observing a chase and in the recording the stopped individual state quite clearly he was assisting with construction.

Thats fine and dandy, but the trooper clear and calmly stated that they would be dine in just a minute, and the hold on just a minute, well be outta here soon. Apparantly, waiting to a LEOs instructions were not in this guys list of things to do.

The accosted individual also clearly stated he was going to his Uncles Home, the women in the background gave him verbal permission to enter, if this individual was allowed to walk by there would have been NO issue at all, this was an escalation by the police in the first place, a simple case of a control freak. A little street Medic applied sense if one has a threat one never wants have to watch 2 directions let buddy walk by whats the harm really.

You don't let anyone thats NOT a LEO close to the scene. When I am working, NO ONE gets behind me that isn't a cop, FF, or EMS Professional. No one.

Yup my 13 year old daughter can and has, it does not require anywhere near this violent of an action ... gravity is your friend.

I had one. It required a good amount of force to deploy. A flip like that was normal to deploy it.

Wrong again look at the tape, he was backing up afraid he was going to be (he was right) I observed a strike when the "violent offender" was falling while trying to be restrained, in fact baton action lead to a further loss of control, this is a textbook case of NOT how to arrest someone.

I observed someone trying to get away from a LEO trying to effect an arrest.

Well this is where I would adamantly disagree its not generic comments towards ALL LEO (s) these comments are directed towards just one bad apple, a shame really when there are so many good LEO out there.

The book according to whom ? (see above Continuum of Force again I located it for those to read it in its entirety)

The continued support by the supervisory staff will be their undoing they are very rapidly loosing the respect of the public by failing to police their own.

To your own Force Chart.

Care to rationalize that reproduced statement ?

Then the officers Tipton explanation of one strike then taking the person to the ground, the victim was in a choke hold and his hands were behind his back, falling to the ground, the victim even states this, Tipton's explanation ON INTERVIEW was chronological incorrect.

cheers

I believe in Surfing vernacular SHRED DOOD.

Was he a little quick in hooking the guy up?

Yea, a little.

He did follow the use of force chart. The guy refused the officers verbal commands. He was firm, polite, and explained the police would be leaving soon. (IIRC, they had chased a suspect and the suspect had stopped at that particular location.) Having people walk through while the LEOs are conducting an investigation/during a crime is not good. You don't know who they are, why they are there, what they are doing, etc.

Anyone actually used an expandable baton?

You HAVE to flip them violently out to expand them. The guy started to resist when he was cuffed by the second officer, one strike was applied, the guy brought to the ground, cuffed, and the situation over.

I see a LOT of anti cop attitude. Why, I don't know.

Other then hooking him up a little quick, he did everything else by the book.

If a paid EMT or Medic refused to take a job, there would be calling for their job. What is the difference?

Thats why we have gloves, gowns, masks and glasses on the bus. Wear them.

Why should the citizens of that community suffer because of her ignorance and ineptitude?

Refusing to enter a shooting scene before PD clears it is one thing.

Refusing to enter a burning structure without the proper gear, training, and team is one thing.

Refusing to go on flu like symptoms call because you have not been vaccinated is completely another.

I wonder how many years prior she got the flu vaccine?

Yet another shining star in Jersey's volunteer EMS System.....

Beach Haven First Aid Squad captain says members should be among first to get swine flu vaccine

By DONNA WEAVER, Staff Writer | Posted: Tuesday, October 27, 2009 | 0 comments

BEACH HAVEN - The captain of the Beach Haven First Aid Squad says she and her colleagues should not have to wait two days to receive the swine flu vaccine, but instead should be among the first to receive it.

Deborah Whitcraft, a former mayor and outspoken public figure, added that as a resident of Beach Haven and a taxpayer who funds the Long Beach Island Health Department, she should be able to receive a vaccination at the clinics.

Whitcraft said the department told her she could not make an appointment to receive the swine flu vaccine at the clinics today and Wednesday. Tim Hilferty, the department's director, said Whitcraft and other emergency personnel can receive the vaccine Thursday at Southern Regional High School.

But that's not soon enough for Whitcraft. She said she answers more than 200 first aid calls per year along a 10-mile stretch of Long Beach Island and that she will not be so quick to take calls anymore after being denied a vaccination.

"If there are flu symptoms on a call, I just won't answer the call," the 10-year volunteer said.

Hilferty said that because of the limited supply of vaccine, the department and the Ocean County Health Department had to establish two sub-tiers of priority cases. The local and county departments are waiting for more vaccine to arrive every day, Hilferty said.

Whitcraft said that is all the more reason to vaccinate emergency medical personnel immediately.

"We started with pregnant women and young children. It was determined that those populations we were seeing were having the most complications from the flu. This is the population that is most vulnerable," Hilferty said.

LBI Health Department employees are not even vaccinated yet, he added.

Whitcraft referred to areas around the country that are using their vaccinations on emergency medical workers.

According to a report in the Chicago Sun Times earlier this month, the Chicago Department of Public Health's first shipment of about 16,000 doses of vaccine will be distributed primarily to hospital employees who have direct contact with patients and the Chicago Fire Department's emergency medical workers.

The Seattle Post-Intelligencer reported that the vaccine began arriving in King County earlier this month and that health care workers were the first to get it. They were selected because they are most likely to get sick and to pass the illness on, the report said.

"We'll certainly open it up to the next population as soon as vaccinations are available. We're ready and willing to vaccinate everyone. It's not our objective to deny anyone the shot," Hilferty said.

The clinics offered over the next two days by the Long Beach Island Health Department are by appointment only.

The Advisory Committee on Immunization Practices recommends that when vaccine is first available, programs and providers administer the vaccine to five target groups: pregnant women, people who live with or provide care for infants less than 6-months-old, health care and emergency medical services personnel, people 6 months to 24 years old and people 25 to 64 years old who have medical conditions that put them at higher risk of influenza-related complications.

These five target groups comprise an estimated 159 million people in the United States, according to the federal Centers for Disease Control and Prevention.

"We cover 20 of the 18 miles of LBI, and we are the first to deal with these people. We've already had one swine flu case in Holgate," Whitcraft said.

Words fail me.