FormerEMSLT297

Why are we even taking him to the ED at all?

Because he is unemployed, and has no health benefits, and no primary care physician, and you can not refuse transport, at least not in NYC on a patient with an confirmed injury.

Now, I know Dust, in a perfect world, the person would go to his primary care physician, but like i said, eutopia is a far far away place.

The problem is the touchy feely, kumbia singing motherf*cker they have for an EMS Commissioner.

"oh people won't have access to healthcare unless we haul every douche bag with a hangnail" :roll:

Yes he is,, however, think of it this way, over 4,000 responses a year for BS, if he lost those responses, his staffing would drop, and then he would lose people, less people, makes him less important (i think that might be his logic, anyway.)

Why would you carry a 35 y/o M patient that accidentally cut his hand with a knife while slicing a bagel and you are taking him to the ED for stitches ????????????

No, carry only when medically necessary.

Now that being said, you should not walk a patient with chest pain or ACS, if they are too big for you to carry, you should get help. Not justify not carrying him/her because of 110 lb partner. Walking an ACS patient is called malfeasance, and you are open to a law suit not to mention just providing lousy patient care.

I see some contradictions in your statement.

If you are going to risk complications, doesn't it make more sense to do so ten minutes from the ER than an hour away? And, if so, doesn't that make urban a more logical deployment for RSI than rural? And, since it is extremely rare for HEMS to be the first ALS on a scene, why would RSI be more valuable to them than to a primary provider? If I haven't gotten that tube by the time you get there in the bird, it's about too late for you to save the day with teh RSI.

I'm not asserting either of those claims myself. I'm just pointing out your contradictions.

Contradictions, O.K. maybe, my point is that if you can bag a person effectively for a 5-10 minute transport time, thats fine, but if you have a longer transport time you run the risk of creating gastric distention which may impede the resp. exchange, also in our area, the helos usually get to the calls within about 10-15 minutes after the call, so they arent very delayed. Ideally if all systems had the QAI and dedicated training to support it, RSI should be standard, but I just don't see the systems being able to support it.

I know of several jurisdictions that allow the EMS supervisors to RSI, others have certain units that are allowed to RSI, but not all of them.

No, RSI should not be standard ... for all of the mentioned reasons, and several others.

Our RSI program requires quarterly evaluations in a clinical setting. That means with an anesthesiologist. Think about taking all of your medics out of the system 4 times a year for a day in the O.R.

RSI definitely has its place in HEMS, Rural settings, and some other specialized units, but in major cities, where the transport tims is an average 10 minutes or so, there are too many complications that can go wrong with RSI.

That being said, if you have a committed Anesthesiologist/medical director, and a good QAI program, then it is something to be considered. But to make it a blanket standard of care, No just no HELL NO.

I save lives for a living/hobby, whatever, and I still qualify for food stamps, public assistance, welfare, (take your pick ).

You can't spell MESS with out E.M.S.

You can't spell PROBLEMS without E.M.S.

Homeless, and hungary Paramedic, will defibrillate you for food.

During medic school, I got paired up with a person, who could not start an IV if their life depended on it.

I have veins that will easily accomodate 14g needles, and this person could not get a 20 into me.

Talk about pain.... but, as someone else said, learn to deal with it... you will have partners that test you.

to quote "these are the times that try mens souls."

No such law from what I know of. I can tell you routinely that in NYC, the Bronx for example, you may live right on the border with Westchester Co. and the closest EMS or Fire unit for that matter will be from Westchester, but, because you live in the Bronx, you get a NYC unit that is actually farther away. That is just the WAY IT IS.

As far as if Michigan has some specific law, I don't know, but as a person who is very familiar with criminal laws, municipal laws, etc. I dont know of anything like what you are suggesting.

Let us know what you find out, I'm curious. No as for a law suit if something goes wrong, i.e. a delay in patient care, one of the elements you would have to prove would be that the jurisdiction involved, knew there was a closer unit, and elected not to call on it.

Former USN/HM2 8404 Combat corpsman here, out for a few years now.

was with 2nd and 4th Marine div. Infantry units

I'm trying not to laugh,,,,, some cities pay a little more, a little less, but i think the average probably is 25 K...

What I hate about the whole adventure minded thing is the PA EMS recruitment video ,,, check this out

www.rollwithit.com

I'll give you one better, how do you know that they are "psych" patients??? they might be overdosed, hypoglycemic, or any number of other metabolic disorders that cause an altered mental state. What about "excited delirium", ? etc.

The truth is you can't know until you have some tests done. All Psych patients should be transported by an EMs unit with police accompanying.

You can do basic tests like blood glucose, and in some places there are chemical restatint policies.

As for them getting violent in the back of your unit... I remember it happening, if they are not restained ,,, GET OUT OF THE UNIT.....!!!! Then what is the worst thing that can happen??? they tear the unit apart and the cops come and tazer him/her. Self perservation is job #1. let the police handle the violent person. Most Police will not transport a violent "psych" patient or even a violent prisoner in a cruiser, the back of the EMS unit is a lot easierr to handle someone that breaks bad. !!!

tksstorm:... instead of running red lights and potentially getting into an accident, for which you will be blamed regardless of what the cops told you. Next time, try covering the rear windows with spare sheets, blankets, or cardboard with tape.

Or you can explain to the suspect that you are "protecting" them and put a blanket over their head.

The other thing is this,, the cops probably, didn't want to have the suspects photo circulated.

It is very hard to seat an "impartial" jury, for a high profile case, when the suspects face has been plastered all over TV, and print media.

The other thing is ,, if they have any eye witnesses, they don't want them to see the suspects photo before they can view a line up. Because it would come out at trial that they say the suspects photo on TV and that would taint the eyewitness testimony.

Thoughts from the Law Enforcement side of the house..

Former

Thanks for all the great replies.

I found some interesting stuff on the Indian River Shores PSD web site, they work 24's with 8 police 8 fire and 8 EMS. Sounds interesting , but I can see problems when you work police for 8 hours are tired , then have to ride EMS or Fire and if it gets busy, you'll be dragging.

I found out taht there are 4 Police Dept. in Minnesota that hire PO/Paramedics, found that interesting,, thanks

Indian River Shores in Florida has this set up. It is a very small, exclusive community, so they get what they pay for.

All of their employees are triple P certs or what we call pyro pig medics. Openings are very rare, hiring is competitive as is pay and benefits.

... (edited for content)

Call volume is low and if I ever had an interest in LE, I would jump all over this job as pay is good and benes are fantastic.

What do you mean by triple P certs ??? (3 paramedic certs ?)

Sounds interesting thanks,, the only comment i would have is if it is so small, might not be the greatest for someone who wants heavy duty LE work,, sounds like a cool job to be able to do all 3,, thanks for the reply.

We have spoken at length about the pros and cons of Fire based EMS, vs. Third service, vs. Hospital based, etc. I know that in some places in the United States, the primary ambulance service is provided by the Police or Sheriffs Dept. I know of 2 in New York for example:

Nassau County NY, the Police Dept. runs the ambulance service, and has something like 24 ALS ambulances. (in addition to the 71 volunteer Fire Depts. that provide ALS/BLS units and Don't ask.)

Greenburgh Police in Westchester Co. NY, also provides ALS ambulance service.

I have heard that there are some sheriffs offices in NY that provide Deputy Sheriffs in Paramedic fly cars, and they do ALS intercept with local volunteer BLS ambulances.

I am interested to see how many Law Enforcement agencies provide primary EMS, I am NOT talking about Helicopter units, or Police cruisers that have AED's and maybe some EMT's doing first response. I just want to hear about ALS providers, or Transport units.

Aslo, if anybody has first hand knowledge of whether this type of system works, better, worse or about the same as more "traditional" EMS providers.

thanks

Former

I can not open the link, it has been removed from the city council agenda ,, can anyone send it to me ?

The Fire Station for sure, everbody knows Fire based systems are the King of EMS

Ahhh, S%$#,, any body got that can of worms AGAIN ?

The term you were looking for is obstruction, not occlusion.

As for what you have done, I'm not 100% clear on all the facts, but its really not a good idea for a student to correct 2 senior people especially in front of family members.

What was the outcome of the patient ??????????????

This topic has been beaten to death, but i'll rehash it in one sentance.

"Very few fire departments run a quality EMS system." an EMS consulting firm circa 1989 NYC. Talking about the prospect of FDNT taking over EMS. (11 + years later, they haven't fixed a thing.

The bottom line is FD's use it to hire more personnel and get more funding, and save FF jobs.

good luck in your search.

To the best of my knowledge you need to be a member of MCDFRS, or an LFRD, in MC to apply,, but I would suggest calling them to confirm that.

Good luck

To quote Nancy Reagan, "Just say no to the DOPE "(your bosses)..

I wouldn't do it,,,, I know i worked for a company that did stuff like that occasionally, and they gave you a company credit card to sleep overnight at a hotel.

Didn't pay you for the down time though. good luck

.... I have had a so called "conflict" only a few times in over 23 years as a medic...

The first one, was right after becoming certified, NYC had Morphine but it was only in protocol for cardiac chest pain and CHF/Pulmonary Edema, so, my partner and I respond to a scene where an 87 y/o f fell and Fx her femur. She was in excruciating pain and would not allow us to put on a traction splint.

I suggested calling medical control and getting a discretionary order for Morphine, my partner said "no, the doc would never go for that".. but i having just come out of training knew that they were moving toward a pain management protocol, and so, my partner didn't argue or try to stop me from calling, he just said i was wasting my time. Well, I called and got the order, and the pt. was a lot more comfortable and we got the traction splint on.

So, that wasn't really a problem.

The second scenario, was an unconscious diabetic. We get there she's cool, pale diaporetic, insulin dependent, so we give her a D-50 and she comes around. My partner then prepares to give her Narcan, I ask him why and (cook book medic) responds "it's in protocol".. to which i say, no it's not, she is now conscious, we don't suspect a narcotic od, WTF, to which he replies, i'm senior it's in protocol im giving it. After the call, I went to see a supervisor, but he was an EMT and not of much help, so, I contacted the Medical directors office, and they held a QA. Those are really the only incidents i remember.

I agree with most of what others posted.

The biggest issue is not being lumped into the FD. Most fire depts. provide very poor EMS service, they are not progressive, they dont take the EMS part seriously, and the EMS side of the house ALWAYS takes a back seat to the FIRE side of the house.

Punishing Firefighters by putting them on Ambulance detail does NOTHING to porivde quality patient care, it just makes the FF resentful of having to do EMS.

Fire based EMS systems do one thing and one thing only, they allow the IAFF to have more members, and they allow FD's to get bigger budgets, and have more people....

They do nothing to provide quality patient care.

My thoughts are my own and do not represent my agency or dept, or company.

In Maryland, Montgomery County offers a I-P bridge course, every other year,

check their web site or call up there, I just checked to try to find the link and could not locate it.

Years ago, when they did an I-P bridge in New York State, one of the only places doing it was Westchester County Hospital Center, and what it involved was basically being registered for the full P class, and having the instructor say "you can skip this part or that part, and only show for these sessions."

But I would call all the local communtiy colleges, PG, AA, Calvert, in addition to UMBC, GW, and NOVA, they would be best able to answer your questions.

The problem is there are no real standard "bridge" courses that I know of, just stuff that individual instructors modify on a case by case basis.

Good luck, let us know how it turns out.