FormerEMSLT297

SF Dept Of Hospitals of DOH I thought used to have one of the best EMS systems in the country. See what happens when you turn stuff over to the FD ......

Maybe if I get really motivated, I'll do my MA/MS Thesis on fixing the NJ EMS system, and specifically on how many ALS level patientd DO NOT receive an ALS unit pre-hospitally. Maybe,,, If i ever get off my A$$, and step up. At the very least I'll have plenty of material to work with LOL.

I do not think that EMTT.org is related to CONTOMS,, as I stated previously CONTOMS is taught by the DOD thru the Uniformed Services Health Sciences (if foget what USHS stands for), but they are based out of Navy Med @ Bethesda and WRAMC in NW DC, and their instructors are Military medicine operators, not part of a private corporation. Keep in mind as has been stated in numerous other TEMS posts on this site and others. A 5, 10, or 15 day course can not prepare you to be a TEMS operator, This class is meant to augment a FULL police academy and or a Full SWAT training program, the 5,10 or 15 day TEMS course barely sratches the surface and I would hesitate making entry into a hostile area with someone who was not a sworn member and trained SWAT operator. I'm not trying to discorauge you from emtt.org, but as i said, it barely scratches the surface.

If you are a TEMS provider, why dont you have your own weapons???? I think CONTOMS is being reguvenated and will be running a class soon,, you need a letter of sponsership from a LE agency.. I believe the cost will be somewhere in the area of $800-1000, not sure yet, as soon as I find out info. I will post it here. CONTOMS is a DOD program and is taught in the MD,DC area.

I seems to me from skimming the article and Dr. B's repsone, that he is really questioning the efficacy of using helicopters for interfacility transfers.... Not so much for scene work especially when the patient is critically injured,, is that the impression that you all are getting, or did i miss something ???

Guys and Gals, Do Not get me wrong, I do not blame the Hosptials, I blame the corrupt NJ legislature that allows ONLY HOSPITAL based EMS systems to provide ALS,,,, that is who is to blame. And as for "proving this" ,,,, yes, pick up any NJ paper and read about the lack of ALS providers, the decisions that Medics have to make, about which call do i take vs. which I do not, etc. I know it ias hard to truely MEASURE an EMS system (response times are crap) but Isn't the best EMS system meand having ALS to all or as high a percentage of patients that need it as possible. I'm not advocating a CA, FL, or any other nightmare situation, just that by simply ALLOWING providers other than Hospitals to have ALS units would increase the amount of ALS units. Now, if you ant to do a state wide protocol, or coubnty wide or something, that may be something to look at ... Ohh and you can not tell me that Hospital based systems are fool proof. I worked in several that had some SEVERE issues. Patient shopping, slow responses becuase the Medics doubled as ER techs, Taking insured patients to their ER while taking uninsured or just plan undesireable patients to Municpal ER's. Please spare me the BS that because the are Hospital based, there is somehow better QA/QI, the truth is some Medical Directors (be it FD, Hosp, Pvt, or 3rd service, or PD) are ENGAGED, and others are not... nothing to do with the type of service that you work for.

One of the first things you can to to "fix' NJ is to change the law. I am by no means an advocate for a fire based EMS system, I tyhink everyone here knows my views, but a system that only allows ALS providers to work out of hospital based systems is crap too. The hospital, because of medicad reimbursment cant get enough money to turn a profit, so they drop an ALS unit here or there. Alllowing Paid FD,'s 3rd service municiplaities to run ALS units, or allowing the volunteer companies (FAS) to hire paid ALS people, would greatly enhance to ALS coverage... I think this can be accomplished fairly simply, What NJ state legislator does not want MORE ALS coverage. It's a win win situation, change the law so that any agency with a Medical Director and support and or sponsership from a municipal government can run ALS units. Give me one good reason why Hospitals in NJ should have a monopoly on ALS units when patients are dying on the streets because of the shortage of medics. This is crap. Also FAS members, local FD's, PD,;'s municipalities should publicize the S&*$ out of the fact that this monopoly exists to the detriment of the general public. Win the crowd and you may effect change.

Opss sorry the link is now up, you can apply directly thru www.nps.gov/uspp Application process will be open only till end or June so hurry. In addition to having vacancies in DC area, We also have field offices in New York City, and San Fransisco CA, so if you are interested in straight Police work you have other geographical options. Aviation unit is only in the DC area though.

The United States Park Police in Washington, DC is currently hiring Police Officers, Starting Salary is $48,000 after the Academy $50,000 with increases to a top salary of $87,000. If you are interested in being a PO or if you are interested in being a Flight Paramedic and Tactical SWAT Medic and are currently an NREMT-P, or can obtain NREMT-P, and you have a work history that involves a high volume EMS system you may qualify, after completing probation, for the Position of Aviation Rescue Technician/Paramedic. to register for the upcoming test, go to www.usajobs.opm.gov then click on series search, enter series 0083, and look for the USPP announcement for further info about the USPP go to www.nps.gov/uspp If you have any specific questions pm me, this is not a guaranteed offer of employment, simply a note about what type of non-traditional flight programs that are out there. PS we fly 2 Bell 412's hoist equipped a/c and 1 206L3. WE do a combination SAR, Medevac, LE, and homeland security missions. www.alea.org go to the photo library and scroll down to USPP.

I almost guarantee I know what happened. First I'm almost certian that the units GPS was not working correctly, why else would they come up recommended. I worked in Comm years ago, as a Disp, and Floor Lieutenant, before the days of AVL/GPS. Each unit has somethign called a home atom, this corresponds with an NYPD Pct. and sector, near where your area is. If the unit was from SI and lets say they belong in the 123E precinct. All you need is for the person loggin the info into the computer to erroneuously type 023E, and puff, according to the computer they are in Mn, and on the upper East side close to the call. Now, When I was in NYC*EMS, before ANY disp was allowed to transfer a call from MN to SI or send a unit from SI to MN they needed to get permission from the Floor LT. The system BROKE DOWN. I do not know wh yin this day and age, 2 Disp (SI and MN) did not catch this, the floor LT, and Tour Commander did not catch this, the SI unit did not speak up and say heah WTF, and why didnt they come up on the Mn Central freq, and say were coming from SI anyone closer. Also all Sta. LT's now have computers and can monitor calls and units status, so why didnt the SI Station boss notice his unit going to MN and why didnt the MN boss notice the SI unit responding to a MN job..... There is a ton of fault to go around, I can see pulling a Queens unit into MN or a BX unit into Harlem, or a BK unit into lower MN, but this was just STUPID. Plin and simple......

Thats just priceless,,, I think someone in HR @ AMR will be leaving soon.

Was I the onlty one to catch the time line,,,, his sister was shot 6 years ago..... you're going to have to give me a little more updated stats than that..... Talk aboue day late and dollar short... boy

I worked with a lot of NPS Rangers in the past, and they are a very professional group. Ranger training is not equal to PJ training, or even close, but they do have a lot of great traning, here is a sample: After Hire as an NPS Law Enforcement Ranger you go to FLETC for 18-21 weeks of initial LE training (The number keep changing 18, 19, 20) Then you go to a large "busy" park for Field Training which lasts an additional 8-12 weeks. Then you are cut loose on your own as an LE. If you need to be cross trained, there is NREMT, some Basic some I-99 and even some Medics" They also offer a several GREAT Technical rescue courses: the basic is 1 week, then they have additional "Advanced Rigger' classes. In addition to that they have all kinds of structural and wildland firefighting classes, some great tracking courses, and other things like that. In closing, the basic LE ranger can be cut loose after FLETC and field training, and then go back for additional traning when it becomes available, and depending where you work in the park dictates what kind of training you get. If you are a front country ranger, you get more LE, and if you are a back country ranger, you might get more wildlife management classes. Ohh,, and Kevin Moses is an LE Ranger and a climbing rqanger, and he is one of the teachers of the NPS Tech Rescue Course, He is a very professional guy, and I learned alot when i went to one of the courses several years ago. Google NPS 51 i think that is the directive of "EMS operations for national parks" I worked seasonally in a park in NY many years ago, and ironically, we all had NYS EMT cards, and after several years they told us we had to get NR, since NYS did not recognize NR, and none of us wanted to pay to get certified just for a PT job, @ $10.00 per hour, we all quit, I dont know what the resolution was cause i never went back. They had some bizarre rules but the overall level of care and equipment was fine. Many NPS parks run a large EMS contingent with a MD, and several medics, they even have ambulances on tracks like a snow cat.

No, the union involved is DC-37 Local 2507 and 3621 AFCSME,, they represent all NYC employees who are not cops, FF and Sanitation workers. This disgrace has ebbn going on for YEARS, and years.. one of thereasons i left. The hostile takeover of NYC-EMS, by FDNY was nothing more than an attempt by Mayor Guiliani to save firefighter jobs, and prevent closing firehouses. What mayor is popular when he does that??? So, we give them some advanced first aid training, and send them to all the medical calls, and poooff,, they cant close firehousese cause call volume is up. The Best is that the former union preisdent of FDNY, Thomas Von Essen, was appointed as FDNY Commissioner under Mayor G, and he SOLD his guys down the river, and basically forced it down their throats. Mayor G, who ran the first time underthe I'll make EMS its own third service and SAVE if from HHC, (Health and Hosp), ran the second time and forgot all the things he promised our union, and sold NYC-EMS personnel, and FDNY, down the RIVER.

Dust will probably want to kill me but, volunteer somewhere in a 9-1-1 system. that will get you exp. in "real calls" or as someone else said there is always the transport service. You did however in no way "waste your time" if you do not find anythingon the BLS level , finish medic school and you will. EMT's area dime a dozen, but medics are harder to come by. Good luck

I was wondering what med. they gave him,,, what is maxalon,,, I never heard of it,, and I dont have my PDR or Tabers nearby.

Ohh,, this won't open up a can of worms..... I can see some crew asking a patient with what they believe is a minor illness, and family members over hear to payment request, then if the patient ends up dying later,, LOOK OUT.. Grieving family member: "They were more worried about getting paid then helping my ...(insert title here) ..booo hoooo hoo,,,,, I do think that it is a GREAT IDEA to cut down on the I have a clinic appointment rides,,,, but it is wrought with problems......

As a former Navy Corpsman attached to the FMF, IO understood the rules on arming medical support to be as follows: A medic/Corpsman cuold carry ANY non-crewe served weapon as long as it was for personal protection. I carried both pistols and M-16/M-4 rifles, when I was deployed. But I could not carry a 240G or M-2. Many corpsman I worked with chose not to carry a rifle becaue they felt it: 1. slowed them down and 2. if they really needed it, they ciould use an inuured marines rifle. I liked to carry idf because it made me look more like a marine AND LESS LIKE AN OFFICER or Corpsman (READ TARGET). I also put me med bag in a regular ALICE or small frame pack for the same reason. Just my 2 cents from the FMF guy

If you're lucky maybe the mayor will be there and say something like "this is a great entry level job, for people who want to get real jobs like FF, Police or RN's/MD's... " That is the gist of what Mayor Koch said at my graduation..... Basically EMT is a stepping stone not a career. The graduation, unless it has changed, which i dont think it has,, is BS. and held at the Fort Totten Toxic Waste site. I mean EMS Academy.... LOL I was embrassed to bring family there.

I think that the question that needs to be answered is ,,,, Did they do this intentionally as some of you belive, or was this just a mistake as others have suggested? I mean did they hear the medics on the radio and still pull off, or did they mistake the banging on the door (let me in) for the take off to the hospital. If it was intentional BURN them,, there is no excuse. If it was a mistake, then they deserve a second chance. Retraining and education is part of the QA/QAI process, which is confidential. In addition to the retraining, no one on this board knows what will happen to them administratively. They may in fact when all is said and done get suspended, written up whatever...

we use www.emscharts.com it is great.

Objective and Subjective both go in under Assessment. Under this method mine would read like this: C: I have chest pain. Pt. is 45 y/o C/o substernal chest pain radiating to left arm and jaw. H: Pt. states the onset was while pushing a heavy wheel barrel up his sloped driveway, he describes the pain aas "pressure or squeezing" He has never had a previous episode of C/O, he takes no meds, and has no allergies to foods or medication. A: R/O M.I. Pt. found sitting clutching his chest, patient cool, pale, diaporetic to touch + JVD, Neg. pedal edema. B/P 150/90 P 120 EKG S-tach w/o ectopy R Resp. 20 L/S clear and equal bilaterally. Rx: Pt. placed on high con O2 via NRB, 1 NTG 1/150 gr. S/L without relief, Pt. admin. 2nd NTG 1/150 Gr. S/L with relief. TX: Pt. seemd to improve during transport, his pain level went from an 8 to a 3. His color improved, and his VA were B/P 138/88 P 94 R 18.

I concur. With about 400 patients seen in a year, I would say that maybe 20, or about 5 % needed RSI. And thats just off the top of my head, and may even be a little high. Might be closer to 12 .... brain not working now, sorry. And that is with a fiarly liberal RSI policy that relies on clinical assemsnt and provider judgement, in addition to injuries and S/S.

Where was I going ? I know that medic students can start IV's in the field under the direct supervision of a preceptor. The paper seemed to allude to the fact that since he was a student it was ok for him to start IV's. Well, not while working as acharge medic if he is NOT CERTIFIED... Thats what i meant. I have NO problem with students doing skills, as long as they are signed off by an IC to do them, and a preceptor is watching. Thats how they LEARN.

Gezzz,, I thouhg this stuff just happened in NYC between FDNY and ESU. LOL RSI.??? Thats just stupid. I work in a system where not all ground providers are RSI, so if i showe up at a call, and the pt is in another unit from my service or another service. I open the door, say hello, and maybe something like "heah I can RSI if you think it is needed". when the response is "No, we're going to the LZ " my reply is "OK see YAAAAAAAAAA." I think the sheriff said it best. "troubling or disturbing" to quote Rodney King " CANT WE ALL JUST GET ALONG ???""