Alex Woo

Thank you. I understand and I appreciate what everyone has said; good or bad. I've moved pass this; I've heard a lot of things from all angles and I will use what others have said and regroup and come back when I've done all the research possible but then this goes beyond making a dialogue. Like you've said; its cost money and many won't bother with it. So why would I? I am doing as must as I can with NYC REMSCO as I physically can; its not my job to change it; I can only comment and bring suggestions. That being said; NYC Protocols will change someway, somehow; for the sake of the patient, the medic, & the system. If you worked NYC; you would understand my fustration because you would have it too... Until one walks in one's shoes, one can't comment. That is why I started a dialogue to hear what others are going through. I appreciate the service & system but there is no merit for striving to be the best in NYC; if you were in NYC; you would know what I'm talking about. Its an, us versus them, mentality. FDNY EMS isn't as good as they claim to be. This what all non FDNY 911 members have to deal with; FDNY making rules as it comes along. Hospitals won't back you thru the threat of patient steering & selective dispatching. Things FDNY do to make a point is unbelievable to others but for us; its reality. We have no say; non FDNY EMS. The NYC REMSCO liason to NYS Dept of Health has and will always be the Chief of FDNY EMS. Its the way it is... I want change and its come to a point were it must change or it'll break. NYC/FDNY EMS will break come 1/12...

Theses were the references; I see what happened.... Sorry about that.... Reference:1. http://store.emsinnovations.com/p-527-tracheostomy-kit-mini-trach-ii.aspx2. http://www.uptodate.com/patients/content/topic.do?topicKey=~WzGGul1rLjg2rmR3. http://www.medicinenet.com/congestive_heart_failure/page5.htm4. http://www.mayoclinic.com/health/pulmonary-edema/DS00412/DSECTION=treatments-and-drugs5. http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html6. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00007217. http://www.nlm.nih.gov/medlineplus/seizures.html8. http://www.scdhec.gov/health/ems/rsi.pdf9. http://medind.nic.in/iad/t05/i4/iadt05i4p263.pdf page 3 I know what all the medications and procedures I have mentioned. I am fully aware.... I am just tired of the Doctors and Members of REMSCO just sitting around and doing almost nothing on a monthly basis. I want to throw something at them; so a dialogue can start. Maybe then things will change. I want others to see the problems we have in NYC and see something be done. It doesn't have to be anything I've mentioned but if I can provide the spark, then so be it.... NYC EMS is not the best service; we're only recognize because we are the largest and service the most people. Many EMS people come to NYC and visit; ask what we can do and we are not as advanced as they thought. I want NYC EMS to be the leader and the pioneer to EMS change. If I can get NYC EMS up to par with other services; I will but I will lead NYC EMS to be the best EMS service in the nation. I will.... Thank you everyone on this forum. Whether you agree with me or not; you all have helped my cause.... Happy New Year....

Thx Paramagic... If that's the case; let's get rid of all treatment. We'll be Ambulance Drivers... I'm starting a dialogue. I'm just throwing out an idea. I am one person; I believe as Paramedics; don't just tell me the STEMI; give my NTG drip, Heparin, ARB, ACE Inhibitor, Clorigel; these reduce mortality and morbity. We can't; so we need to do the next best think; vasodilation and reduce preload until pt is at the ER, triaged, and a stretcher found. This can take time in NYC. We are always delayed triage and stretcher. So what can we do? Continuing NTG SL q 5mins if Chest Pain persists and patient remains hemodynamically stable. We used to give Nitropaste but they took it out over 1 year ago. As for Albuterol your probably write; Epinephrine, Magnesium, Solu-Medrol are all standing orders. I want continuing Albuterol as an option. Seizures; we can give 2 doses of one Benzo; Valium, Ativan, & Versed. You can't used another Benzo; you must stick for one under SO. I want the medic to continue to give or max out w/o callin; along with alternating between Valium and Ativan... Your right I need science; won't need studys if we mirrored Emergency Medicine.... Diuretics.are the cornerstone in treating APE. We have to be careful of mineral loss. I'm just saying. NYC will conform to change.... I wish EMS/PHC could mirror Emergenncy Medicine. We should follow ACLS, PALS, AMLS, PHTLS, etc. What's the point when we can't do most of what's in the ABC courses. Its a nice to know but you can't do....

Thx Paramagic... If that's the case; let's get rid of all treatment. We'll be Ambulance Drivers... I'm starting a dialogue. I'm just throwing out an idea. I am one person; I believe as Paramedics; don't just tell me the STEMI; give my NTG drip, Heparin, ARB, ACE Inhibitor, Clorigel; these reduce mortality and morbity. We can't; so we need to do the next best think; vasodilation and reduce preload until pt is at the ER, triaged, and a stretcher found. This can take time in NYC. We are always delayed triage and stretcher. So what can we do? Continuing NTG SL q 5mins if Chest Pain persists and patient remains hemodynamically stable. We used to give Nitropaste but they took it out over 1 year ago. As for Albuterol your probably write; Epinephrine, Magnesium, Solu-Medrol are all standing orders. I want continuing Albuterol as an option. Seizures; we can give 2 doses of one Benzo; Valium, Ativan, & Versed. You can't used another Benzo; you must stick for one under SO. I want the medic to continue to give or max out w/o callin; along with alternating between Valium and Ativan... Your right I need science; won't need studys if we mirrored Emergency Medicine.... Diuretics.are the cornerstone in treating APE. We have to be careful of mineral loss. I'm just saying. NYC will conform to change.... I wish EMS/PHC could mirror Emergenncy Medicine. We should follow ACLS, PALS, AMLS, PHTLS, etc. What's the point when we can't do most of what's in the ABC courses. Its a nice to know but you can't do....

Thx medicgirl05.... Can you tell me what county and state you're from? Happy New Year....

It depends; rural, urban, suburban..... I worked in Westchester County, NY $19/hr. I worked in Rockland County, NY $22/hr. I worked in Orange County, NY $19/hr... I worked in various NYC Hospital 911, $23/hr to $29/hr.... As a Manager, I am not disclosing but it's a lot more than $29/hr..... Good luck; finish school first...... Its tough for EMTs and EMT-Ps to find jobs in NYC.....

There needs to be uniforms. Services must have policies reagrding this. I understand the volunteer come from home; it is what is... When a service can be volunteer; then that's what we get. I am not saying it is wrong but I am not saying it is right, neither. If there is no rules then they're not breaking anything. Its up to the VAC to set standards and enforce them. However, they are volunteering time and helping the community. A severely sick or injuried person isn't going to care. They don't care what you can do; just take them to the hospital quickly.... We have all contribute to the stagnant growth of the EMS field; I don't think uniforms are the problem.... There are no specific colors or styles or brands. A uniform must be neat and clean. The service must govern what they want as a uniform....

Thank you Richard B.... If anyone or any organization was to agree and want to assist in this sensitive matter. Many will proof-read before submitting. If I spell something wrong or use improper english; there is no defense. However, I reply from my cell and there is no spell or grammar check in this screen. No excuses; I phrase my question and points improperly; thus causing a snowball of insults. I am fine with all that... I just hope my message, subliminal as it was, gets through to some and hopefully the some; are ones who can do something. I am just one person; I'd hope this forum would have helped my cuase, which I believe is just. However, most don't. That is what makes a person unique. If I cared what others said or felt; I wouldn't be where I am in life.... Thank you all.... Happy New Year..... Also, thank you all who gave me a negative reputation; I see I have a -7. Really do not know what that is. If it was something really that would have affected me; then it would be bad. However, if it was; because I believe something that was not mainstream, I get a negative rating.... Awesome.... I am not offended; this just makes me more hungry for EMS change in NYC, NYS, and the USA..... I will continue to be contraversial; if that is what is necessary; then I will be the contraversial person.... Please really look at the whole picture... I am asking to change a protocol for the benefit of the patient... I've experience the Status Epilepticus; who seized for awhile prior to arrival and due to the thicknees of the walls, I had no cell phone coverage. We got him out of the apt in 25 minutes. We gave him 20mg of Valium; we didn't carry Ativan and 20mg was all we carried. We couldn't get a hold of the MD. He seized all the way to the hospital and seized 30 minutes more; the ER gave hime addt'l 20mg Valium and 8mg Ativan before he stopped. He seized for over 1hr and 15minutes. He ended up in the ICU. This prompt the EMS dept to have the medics carry more Valium and introduced Ativan to the EMS Dept. Before this, I'd asked the EMS Director; we needed to carry more Valium and we needed Ativan. Reason for not carrying more Valium and having Ativan. The closest hosptials are all w/in 10 minutes and Ativan wasn't cheap and it was not EMS compatible. Because we didn't get orders; we had no cell coverage; we were restricted. The General Operating Procedures (GOP); clearly states that if the medic is out of contact with Telemetry; they can only perform Standing Orders and transport. Easy on paper but not practical. The GOP also stated that the protocols are to be used with good clinical judgment. Many will argue that we broke protocol and deserved the restriction, regardless of the reason. I do not want my medics or any medic to have to be place in this or any situation similiar to my experience. I believe that if the medications are standing orders; then to repeat or max out must be in standing orders. Ex. Nitroglycerin, Albuterol, and Benzodiazepine...

Beiber.. OmG!!! You believe what I believe..... Plz see my thread regarding EMT Restructuring and check the EMS Protocol Change thread too.... My idea is a bit aggressive but see how some see it & most insult me on the thread... Its awesome to see how EMS has really regress...... Sorry to be off topic..... I would love to see EMS become a recognized profession by layppl... I want the Paramedic Profession to seperate itself from other EMT certs and become a degree only and advance degrees in discussion... Happy New Year!!!

Thank you.... I'm done banging my head. Its not that I'm not getting what you or others are saying but I was immediately criticized but that's fine. We can agree to disagree. My proposal is an infant propping its head up. My idea hasn't learned to put itself on its belly; it has not learned to sit up; it hasn't pulled itself up onto its feet... I wanted to hear other fellow paramedics' treatment modalities in their respected region. I was insulted because I used abbreviations and that they were abbreviations for texting. Others commented on the grammar; I accepted that & I apologized and rephrase my question. I gave reasons why; I can show proof. I have life experience in NYC EMS; so I understand the system along with its drawbacks. I'm not changing other's protocols. I'm trying to change mine for the good of the patients. I am not asking for something we don't have or have not done before. I'm also certified in Westchester & the Hudson Valley (HV) to work; the protocols there in HV allow for continued administration of NTG w/o calling the MD. We have Thiamine and Lidocaine: which NYC has eliminated. We have RSI and NYC has just benzo's & etomidate. It has Lasix in Standing Order(SO) but in NYC we have to call for it; when 1 year ago it was SO. I'm not proposing to change because others are doing it but in America when MD's argue about something that's not mainstream or FDA approved; they go with studies done overseas. Looking at other's success or method is done all the time; we all do it. Yet, I was insulted because I asked what others do. When ppl cross into one state from another; they are the same person; so why are treatment so different? So, if I ask what others do; its to see how I can incorporate that, to make it better. That's what research is for; finding all variables and eliminate ones that do not belong. Its been beaten down on me in these posts; I shouldn't use this forum for question asking, when I can simply google it. So, I am going to pound my head on the wall; since I'm an idiot. I've been pounding my head for years with the way NYC and NYS has handle its EMS affairs. I promised myself that I will make positive change in EMS & I will. Look at the Red Sox in 2004; they were referred to, as idiots but with hard work; they became the 2004 World Series Champions. Every dog has its day; the day so far belongs to the nay sayers but it due time I will have my day... Thank you and hope your New Year will be prosperous. I do appreciate all the comments...

Because I want change I am retarded.... Change starts with ideas.... I am making an idea... This does not change with one person; it changes with a collection of ppl.... There are many who will be against it but there will be some who'll agree.... I am sorry if you believe my ideas are not valid and there is no science.... I reference the sources; who agree with what I am saying... Medicine is a practice and what paramedics know is just the tip of this iceberg.... So relax... 7. http://www.nlm.nih.gov/medlineplus/seizures.html 8. http://www.scdhec.gov/health/ems/rsi.pdf 9. http://medind.nic.in/iad/t05/i4/iadt05i4p263.pdf Page 3 These were the links that were broken... I apologize for that; I uploaded from my cellphone... These sites are respectable; written by physicians... Not all physicians agree; so your Medical Director might not agree with my Medical Director.... We don't have to agree but we must respect one's idea... I am looking at the big picture,... NYC EMS services millions of ppl; I am lookin out for the best interests for them... My proposal is having options; when communication with telemetry has been a everyday problem for many Paramedics in NYC.... However, I do appreciate all the negative comments. It only makes my quest stronger.... Happy New Year....

Thank you for your input; happy new year....

You all are right. I just wanted to start a discussion. I am no one; I'm just one person. This is not an overnight battle. Its a long time war. I appreciate all the comments, mostly bad. If I'm dumb to question something then I'm stupid for trying. I wanted to hear from others. I am really sorry to have brought it up. I'm in the beginning stages but obviously, I started it all wrong. This is going somewhere it doesn't need to go....

---------------------------- This was one of the emails sent to NYC REMSCO... Ms. Diglio,???? ?? I am emailing you regarding our current ALS Protocols. I want to see more changes; which will benefit the Prehospital Provider, the Region, and foremost the patients. See my proposal.?? ?? 502: Obstructed Airway. I understand why Cricothyriodotomy was taken out. The procedure is time consuming for something that barely provides any air to the choking patient. I worked upstate and we had the Quick Mini Trach Kit 1. It works and its quick.?? ?? 504A: DRUG THERAPY OF MYOCARDIAL ISCHEMIA. Other than the STEMI and the requirement for 12 Lead; this Protocol has been stagnant. I believe that and its a Medical consensus, that NTG is every beneficial medication for ACS 2. I feel that SL NTG should be given every 5 minutes until the Chest Pain has been relieved or until care is transferred to a appropriate health facility without calling Medical Control. Calling can waste valuable time; time is heart.?? ?? 506: Acute Pulmonary Edema. Currently Lasix is a Medical Control Option D. We all believe that Lasix's effectiveness is related to Renal functions. Lasix can take a while before the positive effects occur. However, Lasix is an important part in treatment of CHF 3. Lasix should be back in Standing Orders. In addition, NTG should be given every 5 minutes without calling Medical Control to reduce Cardiac Preload 4.?? ?? 507: Asthma. Currently, ALS Providers must call Medical Control for more Albuterol/Atrovent after 3 Tx's. At the recommend O2 flow rate of 6LPM to produce the inhalable mist; the medication last about 10 minutes. It all depends on flow rate; which is dependant on patient's condition. Asthma (COPD) is an incurable; which causes narrowing of your respiratory airways and can lead to death 5. Regardless of transport time and the proximity of the hospital; the Unit could be extended triage and would need to continue to give the Beta2 Agonists/Bronchodilators while in the Ambulance Triage Area. I believe that continuous Albuterol/Atrovent Tx's should be Standing Orders.?? ?? 508: COPD. Same as 507 rationale.?? ?? 511: Altered Mental Status. Thiamine was taken out. Thiamine is Vitamin B1, virtually no side effects, necessary for sugar breakdown, and helps to correct nerve and cardiac problems for patient's whose diet doesn't contain enough Thiamine 6.?? ?? 513: Seizures. Benzodiazepines are the mainstream medication for prolong seizures. If time is brain; then why do ALS Providers only given 1 dose with 1 repeat; Medical Control must be contacted for continuous Benzo's. We know if seizures last more than 5 minutes; it is classified as Status Epilepticus and this is a medical emergency; brain damage may result 7. If that's the case; then continuous Benzo's need to be Standing Orders.?? ?? GOP; Prehospital Sedation, Page 19. We need to incorporate RSI are part of the Sedation Protocol prior to intubation. It is an intense 10 hour course 8; which can be introduced into the NYS DOH EMT-P curriculum. Patients who need intubation, need to be sedated 9. Complications may arise, where the EMT-P can not intubate but as long as mask ventilations is maintained, the problem is not emergent 9. ?? ?? I've emailed you my ideas on changing the EMT-P to an AAS only with CCEMTP training. I was wondering if you can bring all this, to the next REMSCO/REMAC Meeting. I am available to assist in this change. Thank you for your attention.?? ?? Reference:?? 1. http://store.emsinnovations.com/p-527-tracheostomy-kit-mini-trach-ii.aspx?? 2. http://www.uptodate.com/patients/content/topic.do?topicKey=~WzGGul1rLjg2rmR?? 3. http://www.medicinenet.com/congestive_heart_failure/page5.htm?? 4. http://www.mayoclinic.com/health/pulmonary-edema/DS00412/DSECTION=treatments-and-drugs?? 5. http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html?? 6. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000721?? ? 7. http://www.nlm.nih.gov/medlineplus/seizures.html8. http://www.scdhec.gov/health/ems/rsi.pdf9. http://medind.nic.in/iad/t05/i4/iadt05i4p263.pdf page 3 Regards, Alexander G. Woo

I am not building a case with protocols. It was a like to know for me; so I can see how systems really differ. I like to find out from others; like if I was at an EMS Convention speaking to you. I just wanted to hear it from people in the same field instead of reading it off the computer. I guess I have to do more that apologize and rephrase. As for google; yes I do. If someone asked if I can give a medication or not; can I treat and how. I would answer it regardless of their intentions. I can google it but what would be the point. Everyone on this forum ask others and they probably can google it. Its a regional question I'm asking, which is unique to that region. So, I quess I don't need to ask since I can google it and this forum is not for asking peers anything. I guess I'm learning new things on this forum. Thank you all. Have safe and wonderful New Year...

Thank you all. The people that have commented that my message was done improperly. Obviously, it confused most. I apologize if that offended you. I am sorry that my message was unclear. So, I will re-phrase the question. I have sent several requests for changes to the NYC REMSCO (The governing body for NYC EMS), regarding Protocols for Acute Coronary Syndrome (ACS), Acute Pulmonary Edema (APE), Asthma, Chronic Obstructive Pulmonary Disease (COPD), Seizures (Sz) and Altered Mental Status (AMS). Currently we have to call for more nitroglycerin (NTG) after 3 doses for ACS and APE patients. We have to call for more Albuterol for Asthma and COPD patients; after the standing order (SO) of 3. After 2 doses of Benzodiazepine for Status Epilepticus patients, we must call for more. Thiamine (Vitamin B1) has been removed from AMS protocol. I want the SO to change where the Paramedic can continue to give the medication without calling Medical Control. The reason is that there's only 1 Doctor and 1 Paramedic on Telemetry for the 5 Boroughs (NYC). In my experience working in NYC; I have been on hold for several minutes; there has been times where I waited 10 minutes or longer for the doctor. We learned time is heart and time is brain; so there should be no limit on the Standing Order NTG, Albuterol, and Benzodiazepines. We know that Vitamin B1 helps in breakdown of glucose. It also helps to correct nerve & heart promblems associated with Thiamine defficiancies. We learned the 6 rights of medication administration; this will prevent errors. Travel times can be underestimated depending on the hour and day. In addition, pedestrian and motor vehicle congestion can assist in the travel time being delayed and egress to and from the scene. Also, the triage times can take up to 25 minutes in the ER especially with several hospitals closed in all boroughs which has effected the remaining hospitals. Lastly, care does not cease when you pull up to the Hospital ER bay. I feel my proposal will help the NYC(FDNY) EMS system, the receiving hospitals, the medics, and foremost the patients. Please provide me the treatment for the said conditions, your city, state, & the website for your EMS Advisory Board. Thank you. Happy New Year.

Thank you very much...... Thx Richard B. Its like when there's a big disaster; the cell phones are out and landlines are met w/ busy tones. S.O. needs to be expanded to help pts and the medic.....

Its not about how close a hospital is... Many hospital have closed. We have high rises and where I worked; I worked the Lower East Side; many project bldgs... Many of the time elevators are not working. Also, many of these apts are not clean and full of clutter. Onscene time is usually 20+ minutes; then you have to move the pt to the stetcher; if it took you 10mins to make it to the apt; it'll probably be 10mins to get to ambulance. I never just look at the proximaty of hospitals. You have to look at the egress of the street, bldg, and apt. That alone adds time onscene; time doesn't stop for the patient; they still need Tx. Lastly, with many NYC hospital closed; ER wait/triage time is at an all time high; it was high before the closures. Your responsibilty is not relieved until the pt is on their strtcher. So, if that's the case; I want the S.O. changed, to allow the Medic to continue to give the drg until their's relief, adverse reactions, or relief by equal or higher medical personnel. (The six rights of medication administration) Continued NTG, Albuterol/Atrovent, & Benzodiazepines administration. Please tell me your protocol in regards. The city and state your from. The website to your Advisory Board. This will assist in making the needed changes to NYC EMS. Many thanks. Happy New Year.

Alright. We need to comment on grammatical errors. Please tell me your protocol, your city, your state, & website for your Regional Advisory board. That's what I really need; not on why the medication is good & not good or how it works and can cause side effects. I know all that already. Thank you.... Is this better? That's why EMS won't progrees; nothing has been said to help me out. I'm asking for your treatment and I've told you mine. I want to make EMS care better. I've been fighting for positive change in NYC for years. I need to know how other areas are. That's why I posted this. I rather not hear that what I wrote is not grammatically correct... They're for the most part; acceptable abbreviations....

We can't give NTG drips; all SL. Paste was taken out 2 yrs ago. I've asked for NTG Drip. On all ACS calls; I've given more than 3; due to hemodynamic CP w/ ECG changes. Ntg sl q 5 minutes; until CP is relived, as long as hemodyn stable: until pt is at ER. Pt will receive more than 5 sl ntg; avg time from onscene to hospital is >30mins. That's 6 SL ntg on an avg; if time is heart? As for benzo; stat ep; time is brain. 2 doses of benzo may not be enuff. I've given total 25mg of valium and the ER gave add'l 10mg valium and 8mg ativan. The pt was Sz'ing for over an hour b4 it was stopped by benzo's... I'm asking to not having to call. In NYC 911; there's 1 MD on telemetry w/ 1 EMT-P answering the phone. I've been on hold for the MD for Stat Eps; up to 10 minutes & we're packaging the pt; moving the pt onto the stretcher; mind u Sz'ing w/ no backup. Gave the benzos anyway w/o pernission; by the time the MD was on the line; the pt rec'd add'l 10mg of Valium. My partner and I was restricted for the day but our Medical Director backed us up and pushed the restriction to be lifted... Time is brain and brain; that's what I learned. Plz tell me ur protocol, ur city, state, website for ur Regional Advisory board. That's what I really need; not on why the med is good, not good, or how it works and can cause side effects. I know all that already. Thx....

If you really want to progress in EMS; being a paramedic is a almost a must. Degrees will only help. Many local, regional, state, & federal ems agencies ask for experience and education minimum (Bachelors). Being a supervisor takes time, experience, and dedication. Being a director of a bigger entity will require a degree or/and an advance degree. Get ur AS, BS, MS, or PhD; if you want but get ur edu. Its the most modifiable factor you can control to improve your class, status, and livelihood...

I am petitoning for change in NYC; I've sent emails and letters to NYCREMSCO, the governing body for the 5 Boro's of NYC EMS. I'm asking for several revisons of our ACS, APE, Asthma/COPD, Seizures, & AMS Protocols. I want vast changes but baby steps first. I've been reaching deaf ears when it comes to EMS change. I'm asking for continued (ACS/APE) SL NTG w/o calling Med Control; we can give 3 SL in S.O.. (Asthma/COPD) Continued Albuterol/Atrovent w/o calling; we can give 3 Combi in S.O.. (Sz) Continued Benzo's w/o calling Med Control; we can given 2 doses in S.O.. (AMS) Putting back Thiamine; it was taken out over 1 year ago. What are ur S.O. & Med Control. I want to know the limit on Benzo's, NTG, Neb, & do u have Vit B1? Thanks in advance....

Your rite.... I'm talking bout ppl not titles; that's what makes EMS good or bad.... Happy New Year you all.....

I tho tis wuz a blog... Didn't kno I had 2 use proper grammar. Sorry... Instructor not a professor.... But ur rite.... Betta? U hav 2 reelax..... Plus otha than tha gr8t; your point not taken.... I'm talkin bout becoming an BCLS, ACLS, PALS Instructor not a Teacher or Professor... Plus bein Asian, maff is mi forte... Lol.

Kiwimedic needs to be renamed kiwiemergencymedicaltechnician If we're seperating BLS and ALS... Then it can be kiwimedic...