Dragoon

I applied a few in the military. The injuries there were significant. At the same time I also applied several compression dressings to limbs with major injury where a tourniquet would've been applied if not for the compression dressings. (Note: I wasn’t a corpsman aka medic, just a grunt with good training.) Since going to the civilian side I've applied three. The first patient was to an elderly female who was knocked down by a flatbed tractor-trailer that was backing up. Her legs were run over by the rear wheels of the trailer. Both legs were crushed. They looked like raw chicken legs that had been pulverized with a sledgehammer and felt like a tube sock full of marbles. Both legs were dressed with trauma dressings, splinted and elevated. There was no spurting blood; just continuous bleeding where skin was avulsed or at open fractures. She had begun to bleed through the dressings and I decided to apply a tourniquet to each leg. One was placed two inches distal knee and the other was about three inches proximal to the knee because her knee was twisted medially. Both tourniquets were improvised with cravats. I wrapped the cravats wide, twice around the leg and used a pen to twist and tighten. The intent was to stem the flow of bleeding. The second time was for a bicycle deliveryman who was struck by a garbage truck and still underneath it. After the vehicle was secured, my partner and I crawled underneath the garbage truck to remove him. My partner immobilized his head as I assessed the patient. A rapid trauma exam revealed a conscious, Chinese speaking male with an amputation of the right leg distal to the knee. The leg was still attached by some muscle and skin. I decided that because of the amount of blood that was on the pavement and the location (under a truck) he was getting a tourniquet right then and there. It met 2c4's criteria for application. I wasn't going to play around under a truck with limited space trying to apply a direct pressure dressing and bandage. I'm sure if I did attempt it that the quality would have been sub-par. So I applied the tourniquet above the knee because the amputation was just distal to the knee. Again two inches above. This time I had a commercial tourniquet, the C.A.T. Application was extremely easy and I twisted again until I believed the bleeding had stopped. After the patent was extricated and in the back of the ambulance we were able to properly dress and bandage both stumps and perform a more detailed physical exam. Each time was a different situation where a tourniquet was applied. After they were applied to the first patient, we did apply another trauma dressing to the ones already in place. On arrival at the hospital the injuries had not bleed through the additional dressings. The second patient never bleed through his dressings. On follow up with him the surgeon told me the tourniquet was left in place and the patient was taken to the OR with it. Application of tourniquet is flexible but you need to be educated on how to use it in addition to when.

I think for the most part that everyone agrees that scene time should be minimized. I'm all for advancing the prehospital care that we provide but part of that is knowing where to stop and when to get the wheels turning for more definitive care as mentioned previously. The "golden hour" is nothing more than a cookie cutter applied to kinematics of trauma. It's BS. Each patient is unique and your scene size-up combined with rapid patient assessment should be indicators of how long you can stay onscene. Now what do we do with all the texts that mention the "golden hour": burn 'em, use them to build cabins like lincoln logs?

Hearing "load and go" makes me want to vomit. Practitioners get that in their head and it's what they focus on. I see it a lot from EMTs to paramedics, from the green newbie to the crusty old guy or gal. They make patient contact, throw them on the stretcher, get some v/s and go. Maybe an assessment is completed and they are then off. What have they done for the patient other than drive? During my EMT course we learned how to conduct a rapid trauma assessment. I think we all remember that and how to do it. You practice it enough times until it becomes muscle memory ("Slow is smooth, smooth is fast.") and when you get onscene it's not going to take more than 2 to 3 minutes to do it. Knowing what you can do for a critical patient is the key. ABCs as mentioned and discussed. I hate to use numbers but 10-12 minutes as Kiwi mentioned is ideal. You can complete a good assessment and start critical interventions in that time. The big thing is not to keep screwing around with things: i.e repeated tube attempts or failed lines. That also doesn't mean splinting every broken finger and bandaging all the moderate and minor lacerations. On the way to the hospital reassess and maybe if you have the time splint that broken bone and bandage that laceration. Some of the best traumas I've worked have resulted in me yelling "STOP!" and kicking people out of my bus or off the immediate scene so that my partner and I can do an assessment. Usually they are the ones yelling "LET'S GO! HURRY UP!". One of us starts at the head, the other at the feet and we meet at some point. Never have I ever been onscene for more than 15 minutes with a critical trauma patient. And you know what? We get to the hospital with a fully assessed patient and can give a good report to the staff. Now is that a matter of education or experience? And how do we teach that way of thinking?

Before I saw who posted this, I had only seen some of the top of the picture and I thought the inside of that bus looked familiar. You would have gotten extra points for inverting the stretcher with the equipment strapped to it. Though that is right up there with silly stringing the cab of certain crew in the "Boogie Down" some time ago.

If the city were to go to a true third service you'd eliminate a few hundred of employees who are on the "promotional" list to go to the suppression side. Not a bad thing. There are still quite a few around to include Richard who wore the old green pants. I think they'd love to go back. I'd be more inclined to join if they became third service instead of the bastard child.

Already being discussed. http://www.emtcity.com/index.php/topic/17449-news-feed-suspension-ends-for-nyc-emts-in-bagel-shop-incident-jemscom/

Opportunity only knocks once. Temptation leans on the doorbell. USMC Recruiting Station Berkley: We piss off more hippies by 9am than you do all day. (If hippies were up before noon.) I♣Hippies

Here are two videos that compare the standard and alternate issue boots with what was originally issued and an individual off the shelf purchase. This video compares the weight. This video compares the flexibility.

Universal call taker or UCT - where PD takes the call and info and then forwards it to the "appropriate" agency. No more specialized call receiving operators. PD operators will do it all: first aid instructions, complaints, etc. The same system that suppression is currently using that they are having so many problems with: no info, bad addresses. A conditions boss I spoke with said that it was supposed to make its way to EMS this summer but so far it hasn't. Though I have noticed a delay in being dispatched from the time the call is entered to when we are dispatched. About 2-4 minutes and its not because of no unit available or units being preempted.

Chief Sickles (sp?) I believe is gone from Queens, not sure where he is though. He is still a miserable boss making life difficult for the crews who are trying to do the right by picking up jobs that are close to them. I saw him a few months ago on a midnight tour at a simple fire in mid-town. He buffed it. My partner was so upset when he found out Sickles was there that he said he would have slashed the tires and gone out of service mechanical rather than do the standby. And Sickles made everything hard too: changed vehicle staging twice, had us relocate where we were setup twice, trumped the division captain a few times. I really think he was f'ing with us. The best thing to happen was when the conditions boss sat down on the stair chair and said "He wants to do it all, he can. No need for me." As far as the statistics go I've heard that all of the breakdowns that Richard mentioned are available but FDNY won't release it. Apparently the numbers without skewing and manipulating are quite scary and show considerable holes and flaws in the system. I do believe that on the slowest of days we are doing somewhere of around 3,000 patient contacts. Richard, you might know the answer to this; do they still plan on implementing the universal call taker into EMS? If they do the chaos that will ensue is going to be wild.

The missile MVA was about two years ago on the Bruckner expressway late at night. I don't remember all the details but it was a fender bender. Officer asked the tractor trailer driver for the paperwork and what he was hauling; answer, tomahawk missiles. I think it was two or four. The missiles were inert (no warheads or propellent). Bomb squad, ESU and fire were called. I think the Bruckner was shut down for about an hour till everyone had a warm and fuzzy that there were not going to be any big booms. That night at least.

Heck NO! That place is way to upscale for EMS hooligans. The Subway Inn or Port 41 is where it is going to happen. That or the last car of the F train to Coney Island with an oversized boom box (must have dual tape decks) and concealed beverages . Any other place is unacceptable.

Now just say it as one word.

It sucks that FDNY EMS has such a bad rap. I've never had a problem with Dr. Freese. He has done more to advance and progress NYC*EMS in the last two years than any of the other physicians at the office of medical affairs. About every six months there are revisions and advancements to the protocols that benefit us and it is a result of Dr. Freese. We all know that NYC is not great but is has gotten better in part because of him. We have some real pompus a**hole physicians that treat us like crap (80249 for anyone in NYC) when we call for orders or consults that we have to deal with but I've never had a problem with him. He is also an attending emergency room physician at St. Vincent's Medical Center in Manhattan which has it's own EMS department that handles 911 in the city. I hope that A/TC EMS gets the best doc but try not to knock the guy just because he has FDNY in resume.

I'm not going to get into a pissing match here about the education and experience issue. Maybe I could have made my opinion clearer in that you need an education to do this job. A 120 hour EMT class doesn't cut it. This is medicine, not first aid, not shuttle service to the hospital. Get some health science courses and take your paramedic course. In the 10 to 14 months that it runs you will get your field experience. If you can't put the book learning together with the practical application then your preceptor shouldn't be signing off on your ride-a-longs. You do not need three years to learn how to do proper BLS. What are you going to learn there that you won't on ride-a-longs? We've already had the thread that mentioned slamming narcan, equals poor patient care. And if the shooter returns then the scene was not safe. To borrow from Dust, FAIL. No disrespecting EMT's. I am one. I'm just believe that how we operate sucks. Most of the time we do things is because that's the way it's always been done. (I sure wish I could find the "monkey smack around" thread.) JMHO. By the way, I'm in NYC*EMS too.