strippel

First, kudos to all (EMS included) involved in the response.

Secondly, my heart goes out to all impacted.

I saw the interview that Rid writes about. They should be well thanked for doing such a good job, after a horrible event.

There also was an interview involving a female EMT from the town rescue squad. She was also articulate, and answered questions professionally.

Lastly, I would like to thank Brian Williams (NBC News) for asking appropriate and serious questions of that EMT. I guess the volunteer fireman in him came out. Especially after hearing all of the stupid, insane, horrible, crappy, juvenile, idiotic, dumb, and yes stupid questions and comments by the press at the first press conference.

I have worked on all three. Braun's are the nicest.

Horton, never really liked them. Too many electrical problems. Too many problems.

AEV's are good. That said, I am good friends with service and sales reps. Currently, we run a fleet of 15 AEVs, beat the crap out of them, and have very few problems.

Braun. Pretty nice. If given the choice, and an unlimited budget, Braun would be my choice. I also know sales reps.

No, I can't get you a better deal.

Everything.

Anything that is needed for patient care can be easily re-appropriated. I was told by a previous boss (current company) that anything in the ER that wouldn't be missed, and could be used on the ambulance is fair game.

In all seriousness, nothing that we don't need, and they don't know we take. Right now, we help ourselves to saline locks and flushes. Our service does not stock nice locks, (we use generic drip sets) and hospital's are far superior. The nurses give them to us, it makes their life easier if the patient is admitted, or needs fluids from a pump.

We also take liberally truck and station cleaning supplies (we have stations at the hospitals).

Our service is independent, yet overseen by competing hospitals. So, technically it's not steeling.

We have a new bariatric ambulance on order, for delivery before summer. It will have one of the above lift systems. Sorry, I don't know which one.

It will be replacing a 1995 Ford F450 with a winch, ramp, and Powerflex litter.

Back in the day (=when EMS was fun) our system was hospital based chase truck ALS (2 medics, maybe a nurse), and community BLS transporting ambulance, with 2 or more EMTs on board.

Call volumes drastically increased. ALS would have to wait for BLS. BLS would have to wait for ALS. To solve the problem, the hospital ALS services got ambulances. When the BLS didn't show, they could transport.

About 10 years ago, call volume increased more, volunteers disappeared, interfacility transport coverage was lacking. Also, non-transporting ALS units do not receive a large portion of Medicare income.

Three of our local hospitals consolidated their ALS services, and 3 BLS services joined in. These were the services that covered the city, and populous suburbs. No more ALS chase.

Since we are overseen by the hospitals, all expenses need to be justified. An ALS ambulance (Medic and EMIT) are far more cost effective than 2 vehicles and from 3 to 7 providers. We now (usually) have enough units to cover our area, and handle the discharges and interfacility transports from the hospitals. Insurance billing and revenue are up. We now do about 28000 911 calls and transports

We still do "chase", but now an ALS ambulance responds to assist a rural BLS unit. If the county is busy, or if the call is the BLS 2nd call their district (and they fail to respond), there is a transporting ambulance on scene to take the patient. Only the supervisor and management staff have a "chase" vehicle, Excursion or Tahoe. We also have 2 BLS QRS (quick response) vehicles. One is staioned in the country, and staffed by volunteers. The other is the fleet service vehicle, and our maintanance officer will back up ambulances when needed.

There are 2 services in our area that provide "chase truck". One is hospital based (the 4th hospital), and the other is community based ALS chase. They both have billing agreements in place with their BLS services, so they can share the Medicare money.

It's not insurmountable, but it will be very difficult for him to get a job with a quality employer.

There is a paramedic around here who screwed up, got a DUI. He started working for a service that is supportive of him. He is not able to drive at all, and must write all calls. Insurance company rules.

Another was slightly luckier. After his DUI, he was able to transfer to the helicopter division of the service.

Both nice guys, both quality providers.

They were both already paramedics, with good work history. Listen to Dust. Make as much of your education as you can.

I have never seen any above 500, but many in the upper 4s, especially when I worked in the ER.

We used to, and still do take bets. Last week, we had a guy who drove into the back of a stopped school bus. He was fully alert and oriented, and even tried to stop for the bus. Thank God it wasn't loaded. He said it shouldn't have been stopped in his lane (bus was waiting to turn left).

He was .382, at 1000 AM.

In PA, you must have an "ambulance station". Which means you must own, rent, or be given use of an actual standing building.

I don't believe there are any more requirements.

That said, three of our stations have multiple garages, office areas, bath and showers, and a cozy area to watch TV and rest.

Our other 3 stations are located in hospitals, so we have all of their amenities. We usually are interested in the discounted cafeteria.

Here they can only refuse if they are 18 yo, emancipated, parent, member of the military, financially independent and not living at home, or pregnant.

We pretty much follow that guideline her in PA.

It pretty interesting, though. Until you ask them to sign a legal document, everyone is related. It didn't take long to realize in the city, everyone is family.

To cover yourself, ask questions that only real family would know. If possible, have the Po show you their ID, or ask about relationships.

Asysin2leads, I have been looking through The Bureau of Labor Statistics web query. Lots of data, not very helpful so far.

EMSN and the newspapers are keeping busy with info.

Anyone in particular?

What'd they do to you? :?

If I'm not mistaken, such threats are prohibited at EMT City.

If you knew any of my co-workers.....

I am starting to look for information for my paramedic school term paper. As of now, I am working with "EMS Safety".

I'm not sure where to go. I have considered vehicle/scene safety, and have found some good info and data. I am also considering violence against EMS providers. Maybe both.

Since much of the data about violence is on government web sites, it will take me a while to go through.

In the meantime, how many of you have been assaulted? I don't mean the diabetic who takes a swing at you with a BS of 10, then wakes up and is pleasant. Or the 90 year old confused ECF resident who swings at you. I am referring to a criminal assault.

If you have been assaulted, and did or considered pressing charges, please let me know.

Thanks

That is something that is specific to every patient, call, location, and system protocol.

At my full time, except for one area, we wouldn't consider a flight. Most of our district is in sight of, or less that 15 minutes by ground to a level II center. If the patient were a child, it is only a short helicopter ride to 3 pediatric trauma centers. The ride by ground is too long.

At my part time, we used to fly almost all "trauma" patients. Not anymore, we now have a level II center nearby. It takes much less time to drive them than to fly.

Well, back from my deposition.

It wasn't good, but could have been much worse. Luckily, I was able to defer to my partner's PCR, and he was in line behind me. Unfortunately, we were both delayed over 90 minutes by the coroner's deposition.

It was thoroughly enjoyable pointing at, and marking "X" on pictures of dead children.

As far as the subpoena, it was a technicality.

Well, today I have to go to court and give a deposition.

I received a subpoena (not fully proper for this county), but legal none the less, and a $25 check.

Over three years ago, there was a horrible fatal accident. Luckily, this case is not in response to the families suing each other. It is the remaining family suing everyone who has ever done service to their vehicle. There are multiple service stations, tire and auto centers, rubber companies, and I think everyone who has ever used a rubber listed as defendants. The family is being represented by a MAJOR bi-costal law firm.

There isn't too much I can say about this, even in the deposition. We were quite busy with one task only. I did not have the joy or writing the PCR.

Last deposition I was at, it was easy. We had one patient, didn't see any others. All questions pertained to the other EMS units, and fire department. I don't think this time I will be so lucky.

I love EMS.

At my full time, we have a John Deere Gator, which was donated to us. We do not much rural area in our first due, so it does not get used much. Usually at large special events.

My part time has a Polaris. Hasn't gotten used much, but last year it got broken in well, 2 days of searching for a missing hunter.

Only a few times.

It is very dangerous, and gets worse with more traffic.

Once and a while, an ambulance or police cruiser will run interference near the hospital. The ER is located on a side street of a major one way road. If the one way road can be safely blocked...

We have to be careful. Frequently, the cruisers are responding with us, and are either just ahead, or just behind us. If the call is more police then EMS, we will shut off the lights and sirens, and them vice-versa. Stealth mode.

That is New Jersey.

New Jersey is different when it comes to EMS.

Ambulances are BLS. There are very few ALS ambulances.

BLS ambulances are either run by municipal governments, or are run Volunteer First Aid Squads, which are "overseen" by the municipal government. Sometimes, municpalities can contract with hospitals or for profit ambulances for service.

Only hospitals can provide ALS, per state law.

ALS "chase" units are staffed by 2 providers, who meet up with the BLS ambulance.

There is currently a political battle in New Jersey. If you know how medicare billing works, it's easy to understand.

Many VFAS and municpal ambulances do not bill. Therefore ALS services who assist them cannot bill. That means there is a lot of uncompensated services being provided by the hospitals.

I would strongly suggest not taking any other college classes while you are in paramedic school.

To use my class as an example, we are in class 16 hours a week, 2 eight hour days. (We then have to finish our 40 hour work week..24 hours of work). We are "supposed" to put in 8-16 hours a week of clinical time. Right now we are only doing truck time, which will total several hundred hours. We will also have about 200 ER hours, plus additional time spent in ICU, Cath Lab, maternity, peds, geriatric, and either family practice, or clinic.

Our class started in August, and should end mid-June.

I can't find the state manndated number of hours, but according to school web sites, it is a minimum of 500-600 hours classroom and lab, and 500 hours clinical. Our program, and others nearby have more hours, and also have 80-120 hour internship after that.

I know they need some education.

Going along with Asys and Rid, even though they aren't rocket scientists. They do pay attention and care about their patients.

I love it when a plan comes together.

Maybe you gave the family the best Christmas present ever.

Nursing facilities.....

Ten days ago, one of our ambulances gets dispatched to a assisted living facility.

Patient was up and about, had a syncopal episode, passed out on the floor. Staff started CPR, without checking a pulse. Patient rapidly became conscious, and told them to stop. Crew arrived, patient was ALS to the hospital, where he stayed for a few days.

This AM, back at the facility. The patient wakes up, tries to get out of bed, his chest hurts. Not cardiac, but from the compressions. He is sore, and had no OTC pain relief prescribed. They call 911, we take him in. He is evaluated, and discharged.

At dinner time, he has another syncopal episode, and passes out. PD arrives (with AED) to find the patient yelling at the staff to stop hurting him. They again did CPR on him with a pulse.

CAO on our arrival, vitals good. A/V sequential pacer (which he has had for a while) seems to be working well. ALS to the hospital again.

CPR done on him twice in less that 2 weeks. I bet his chest really hurts now.

Call the state, and get a copy of the fleet vehicles. NJ (as well as most other states) buys vehicles in large quantity, and picks about 4-6 to be included on a list. That is the "state contract".

It is usually police vehicles (sedans and SUV), pickups, dump trucks, and vans. If there are Chryslers on the list, they are purchased from Warnock on Route 10.

Easier yet, ask your municipality for a used cruiser. Try that out, then spec out an SUV or pickup chassis later.

NJ 2007 Vehicles

2007 Ford Focus 4dr Sedan ZX4 S

Ford Focus 4dr Wgn ZXW SE

2007 Chevrolet Malibu 4DR Sdn LS

2007 Dodge Magnum 4DR Wgn

2007 Chevrolet Impala 4DR Sdn LS

2007 Ford Crown Victoria 4DR Sdn Standard

2007 Jeep Liberty 4dr Sport 2WD

2007 Jeep Liberty 4dr Sport 4WD

2007 Chevrolet Trailblazer 4dr LS 2WD

2007 Jeep Grand Cherokee 4dr Laredo 4WD

2007 Dodge Durango 4dr SXT 2WD

2007 Dodge Durango 4dr SXT 4WD

2007 Chevrolet Suburban 2500 4dr Commercial 2WD

2007 Chevrolet Suburban 2500 4dr Commercial 4WD

NJ Department of Treasury

We are lucky. Ford trucks are on our list, and we get our ambulance chassis for about $7,000 less than the ambulance manufacturer can. We have purchased 2 Expeditions, 1 Tahoe, and 3 Ford chassis through the state contract.

1. Yourself: Wiped

2. Your boyfriend/girlfriend?: wife

3. Your hair: short

4. Your mother? Doris

5. Your Father? Depressing

6. Your Favorite Item: puppy

7. Your dream last night: none

8. Your favorite drink: Yuengling

9. Your dream car: Escalade

10. The room you are in: basement

11. Your Ex: none

12. Your Fears: none

13. What do you want to be in 10 years: retired

14. Who you hung out with tonight? wife

15. What You're Not? awake

16. Muffins: blueberry

17: One of Your Wish List Items: Alaskancruise

18. Time: 0653

19. Last thing you did? coffee

20. What You Are Wearing? shorts

21. Your Favorite Weather: sunny

22. Your Favorite Book: none

23. The last thing you ate: PBsandwich

24. Your Life: tiring

25. Your Mood:calm

26. Your friends: good

27. What are you thinking about right now? mother

28. Your car: Silverado

29. What are you doing at the moment?: Survey!!

30. Your summer: what?

31. Your relationship status: married

32. What is on your tv? what?

33. When is the last time you laughed? yesterday

34. last time you cried? longtime

35. School? AAAAARGH!!!!!

We don't normally do that. We are a city/suburban service with short call times.

If there is a fire/hazmat, we will gladly relieve on scene.

Every now and again, the rural truck will have a late call. Some times they will drive past the station on the way to the hospital. In that case, it has happened.