Richard B the EMT

So? Get that response "MOOOOOOOOOOving!"

Sorry, couldn't resist!

When the patient/family member(s)/bystanders refer to me as a Paramedic, Nurse, or Doctor, I thank them for my "promotion" and wisecrack on how I wish the promotion would appear in my paycheck.

Oh, by the way, I gave a non-riding member of my defunct Vollie Ambulance a generic ID card calling him a JAFO. He still has it, over 10 years later, even with him now knowing what JAFO means.

The fact that the ambulance was proceeding slowly, with no lights and siren displaying, speaks more somberly to the deadly event reported. The news item stated the fireworks show had been canceled out of respect to the 2 deceased. In my book, your decision was the only correct one.

My mother and I are sighted members of the Queens/Long Island (NY) chapter of the National Federation of the Blind.

The wife of the chapter president asked me for information on EMS responsibilities towards "Seeing Eye" dogs, now more commonly known as "Service" or "Guide" dogs.

I know, under local protocols (read as New York City and New York State), that the dog must be transported with their "master/mistress" if said person requires our EMS intervention.

I also remember, from several years ago, an article on this, in either EMS magazine, or JEMS, but so far, I am unable to find it, to pull it/them up with the search engines I use.

Could you, the members of EMT City, pull up articles from any EMS "trade" magazines that you have, even those from outside the United States, that I may relay the information to this friend of mine? Post the articles, with the link, in this string.

As always, thank you in advance for any assistance you can offer.

Richard B, the EMT.

1) Once again, we seem to have run into the "Legal Duty to Act"/"Moral Duty to Act" situation. This will be addressed under local protocols, and if no legal duty to act exists under those protocols, it is up to the morals, or lack of the same, of the individual as to doing anything.

2) Just wearing a T-shirt with the local department logo on it doesn't qualify an individual as an actual, trained, off duty member of that department. If the wearing of an FDNY or NYPD logo hat or T-shirt was an indication, fully a quarter of the #2 Train passengers are members of these departments. We know otherwise. If you come on an individual who seems to be affecting some kind of rescue and wearing logo-ware, under local protocols here in NYC/NYS, they are required, BY LAW, to produce Identification on request. If they refuse, or are unable to produce any ID, when the uniformed on duty LEOs get there, they can be enlisted to remove said individual from the scene.

3) If the "on duty uniformed" person, in this case, the lifeguard/"friend" ordered you away from a patient, apparently not recognizing you, perhaps this individual was so hyped up with the call, that they didn't realize it was you. I can not say for certain, I was not on the scene. If you can, approach that individual, when both of you are off duty and removed by both time and distance from the scene of the call, and ask what happened that the person ordered you away, when per what I think I'm reading here, you are higher medical authority, and, judging by MY protocols here in NYC/NYS, could have run the scene.

4) Check with local protocols, also, on the possibility that by following the lower trained person's order for you to leave, if you might be in violation of "Patient Abandonment" policies and protocols. Of course, this would be done on a quiet, low level, as you don't want trouble for yourself.

Due to schedule changes, and a just fixed computer, I have not been visiting EMT City, and was unaware of the deployment.

I must invoke the words of Saint Philip of Esterhaus, and really mean them this time, for both the Dust Devil, all in his unit, and all the military personnel assigned now and in the future in Iraq, Afghanistan, and anywhere they hate us just for the crime of being us:

"Hey! Let's be particularly careful to the extreme out there!"

Someone commented on the cucumber up the rectum? Anybody heard the EMS urban legend of the Gerbil up someone's rectum? Story has been around at least 30 years.

Somewhere in the ether of EMT City, I had a posting on "trail-gaters" following the ambulances down crowded highways. Most times, the cars are not in any way connected with the patient aboard.

I have also told relatives/friends to start out to the hospital prior to my leaving the scene, and not to follow the ambulance, if at all, when I expect to be running at L&S ("Code 3," "hot") when I do leave the scene.

I don't know if the NYS Vehicle and Traffic Laws actually has such wording, but I was once told (unverified!) if someone following the ambulance when the ambulance is running at "Emergency Status" is involved in an accident, the Ambulance Motor Vehicle Operator (notice I didn't say "Ambulance Driver") is responsible, somehow.

What I do know, NYS VTL states anyone following an Emergency Vehicle, at less than a specified 200 feet following distance, is subject to a ticket.

As for nobody owning a car in NYC, you've never been in rush hour traffic on the Franklin Delano Roosevelt Drive ("the FDR"), the LIE (Long Island Expressway), the GCP (Grand Central Parkway), the 'Wyck, the Deegan, the BQE (Brooklyn-Queens Expressway) "Trench", the Interboro/Jackie Robinson Parkway, and (dear to my heart) the "Belt". I've left a few of the major highways, expressways, and parkways out of this list, but others living in or near NYC will let youse guys know!

1. Despite plans to dissect them one by one, SEMAC gave wholesale approval to the new CPR Guidelines 2005. You might have seen the February memo from State EMS Bureau Director Ed Wronski (www.health.state.ny.us/nysdoh/ems/bemsupdates.htm) warning that State written exams will continue using the 2000 AHA Guidelines until such time as SEMAC and SEMSCO review the new material. All that stands in the way now is the process of changing exam questions to incorporate the new material. The Bureau projects this could be completed by the fall. Gasp!

2. If you’ve reviewed the new CPR Guidelines, you no doubt saw recommendations that Emergency Medical Dispatchers and EMS providers give aspirin to patients with suspected acute coronary syndromes. Whadda you know, the SEMAC approved CFR and all levels of EMT to administer 162 milligrams of chewable aspirin to any patient with suspected acute coronary syndrome provided there is no history of aspirin allergy and no recent history of GI bleeding. The Education and Training Committee is working on a classroom component, so don’t rush over to CVS and stock your ambulance with baby aspirin just yet. A revised version of the BLS protocol for Adult Cardiac Related Problem should hit the streets once all the i's and dotted and t’s crossed.

3. Just in from the department of no surprises: not all AED manufacturers have updates available for users to upgrade their machines to the new CPR Guidelines. The Bureau plans to write each AED manufacturer inquiring about availability of upgrades. They’ll share responses with the EMS community. Hard to believe that an electronic medical device can’t be upgraded to keep with the times, but at least the Bureau’s findings will tell us which vendors we might want to do business with in the future.

4. While we’re on the subject of acute coronary syndromes, here’s a ditty that might give you angina. A SEMSCO tabled SEMAC motion that EMT-Basics be trained to acquire 12-lead EKGs (if approved by their Region and Service Medical Director) went out to various committees for consideration of potential impact and implementation concerns. Members of the Council’s Finance committee calculated fiscal impact of the decision would range from $90 to $150 million dollars initially, followed by some $10 million annual upkeep costs for statewide implementation. More concerning (if you’re still conscious) is an estimated $6 million cost to equip the remaining hospitals in the state to receive 12 leads from the field. Without that little drop in the bucket, the whole program would be for naught. I guess you might say, “further study is needed” on this motion. If you’re still clutching your chest, you’d better go ahead and pop 2 baby aspirin.

5. Stumbled into a meth lab lately? If so, you hopefully had a copy of the Bureau’s recently distributed brochure tucked in your pocket. A 2005 NYS law requires EMS services to educate their personnel on recognition of illegal meth labs. The educational brochure distributed by the Bureau can be downloaded at www.oasas.state.ny.us/meth/index.htm.

6. The Pilot recert program will not expire this June, if the legislature passes a proposed extension. Current bills call for an extension through 2011, although the Bureau had intended to recommend the program be made permanent. Given that nearly one quarter of New York’s EMS providers participate in the Pilot Recertification program, it certainly is not going away.

7. The Easter Bunny may be delivering burn kits for every NYS ambulance courtesy of the State Hospital Preparedness folks. The Bureau notified County EMS Coordinators last month to expect shipments shortly. Here’s what’s in the snazzy, soft, water resistant carry case: 1 thin thermal reflective blanket, 4 pair uni-sized gloves, 4 surgical face masks, 2 clean (not sterile) burn sheets, 6 assorted nonstick, multilayer gauze burn towels, 4 rolls assorted sterile roller gauze, and 2 rolls 1 inch tape. Before you get on the blower to invite your County EMS Coordinator out for lunch, note that there are only enough kits to equip ambulances. The Bureau is hoping to include an educational module and PowerPoint with the shipments.

8. Plans for Vital Signs 2006 this October 20 through 22 in Syracuse are moving along. Scope it out at www.vitalsignsconference.com. While you’re there, check out the NYS EMS Council Awards link for information on Annual Awards presented at the Conference Banquet. Consider nominating a deserving colleague for their exceptional EMS contributions.

9. Gad zooks. We may be done rebuilding Iraq before a revised spinal immobilization protocol appears. The ball is now back in the physicians court after it became apparent that there’d be a dramatic increase in field immobilizations under the proposed revision. Consider yourself lucky to be getting a new burn kit and leave it at that.

10. The NTSB (National Transportation Safety Board) issued a report on air medical operations in January, revising it on March 6, 2006. You need only look to your EMS brothers and sisters killed in the line of duty during 2005 (www.nemsms.org) to know that urgent safety changes are needed for aeromedical transport. While the industry has work to do, users (yup, that means you) share responsibility for crashes by participating in or allowing a practice of “helicopter shopping” and inappropriate use. Surf to www.ntsb.gov/publictn/2006/SIR0601.htm for a summary or full copy of the NTSB report. On the same subject, the SEMAC Air Medical Services TAG proposed a series of standards be issued as a Bureau Policy Statement for Air Medical Services in NY. Suggestions to tighten the recommendations were offered along with the possibility of developing Air Medical Services Regulations in NY (based on the proposed policy statement). Further discussion and possible approval is expected in May.

11. Seen a bunch of Hare Traction splints and Thomas Half Rings up for auction on eBay? All for naught, says the Bureau. A Fall 2005 memo from Director Wronski regarding approval of the Sager traction splint for immobilization of proximal third femur fractures has resulted in a brouhaha of sorts, despite a second memo clarifying the first. Note that current protocol allows traction devices only for mid-shaft femur breaks. SEMAC did not change this. What they did was add approval for straight in-line traction splints to immobilize proximal third femur breaks. SAGER is the only such device presently on the US market. Keep your Hare, your Thomas Half Ring, and whatever other traction gizmo you might have. Just don’t use ‘em on anything other than mid-shaft femur fractures!

12. Interested in getting your hot little hands on a copy of the revised QI manual? You’ll have to wait until Christmas, most likely. The Evaluations Committee projects having the revised manual and a PowerPoint presentation ready by year end. Hey, at least you won’t have to rack your brain for stocking stuffer ideas.

13. Next time you see a bus or taxi bearing down on you, it’s unlikely you’ll be field resuscitated with PolyHeme®, the red blood cell substitute manufactured from human blood by Northfield Labs in Illinois (www.northfieldlabs.com). A February 22 Wall Street Journal article blasted Northfield for hiding results of a 2000 study where 10 of 81 cardiac surgery patients given PolyHeme® suffered heart attacks versus none of 71 patients given blood. Northfield Labs disputes the Wall Street Journal claims, and while some prehospital studies using PolyHeme® continue, the Albany Medical College trial previously approved by SEMAC appears to be on hold for the moment.

14. The Bureau provided the Finance Committee with a template for use by Regional EMS Councils to request training funds not presently provided through Council, Program Agency, or Course Sponsor contracts. Award of monies (which come from unspent training dollars) is subject to availability of funds and DOH discretion.

15. Here’s a legal pearl for you troublemakers out there: REMACs have authority to limit the practice of BLS providers. In a recent downstate region dispute, parties argued that REMAC control over field provider practice is limited to ALS providers. Not so, said a State legal opinion. NYS laws and regulations make no differentiation between levels of care in the authority of a REMAC to limit a provider’s practice. That said, REMACs have no ability to revoke certifications, effectively limiting their influence over BLS providers to physician controlled local protocols like albuterol.

16. On February 7, 2006, the State Health Department issued a revised Pandemic Influenza Plan with EMS included. You might want to pop onto the DOH web site and take a peek before flu season arrives (surf to: www.health.state.ny.us/diseases/communicable/influenza/pandemic/index.htm). Specific prehospital care guidance is included. EMS agencies are advised to reinforce infection control practices, promote flu vaccination of EMS providers, and review proper use of PPE. Each EMS agency should also have plans in place to rapidly immunize workers and key ancillary staff as well as to distribute antiviral medications should DOH make them available. EMS also places high on the list of priority groups for immunization and antiviral meds. County Health Departments are urged to establish close communications with the EMS Coordinators and EMS services. Blah blah blah aptly summarizes the rest of the 406 page document.

17. The EMSC (EMS for Children) federal grant to New York was extended through February 2009. Under the approved extension, EMSC will become a permanent NYS program, expand the role of the EMSC Advisory committee, increase prehospital pediatric equipment, and (hopefully) begin designating pediatric receiving facilities. Hooray for kids!

18. The Systems Committee may be trying to usurp the Spinal Immobilization Protocol with their sixth redraft of a new CON (Certificate of Need) policy statement designed to replace 93-09 and 93-10. A few more terms need better definition and additional subgroups have been duly appointed. Discussion will likely continue at the May meetings.

19. As a result of a Bureau meeting with State Education officials, the Education and Training Committee appointed a TAG to investigate clinical skills performance issues. You may recall the State Ed notified hospitals last fall that certified EMS providers cannot perform ALS skills falling within the scope of practice of a licensed profession in a hospital setting unless those skills are carried out as part of an original or refresher EMS certification course. This could spell trouble for ALS provider skill retention programs, air medical hospital contracts, and other existing programs. It appears that a mechanism can be put in place to allow existing programs to continue – the TAG will flush out these details.

20. Instructors around the state remain hot under their collars about a relatively new DOH policy prohibiting them from taking a peek at their student’s state written exams. DOH is considering ways by which CICs could become more involved in the exam development and validation process. Stay tuned.

21. If you rank yourself as a trivia geek, here are some statewide stats to fill you up from 2005 year end: 1100 ambulance services, 115 ALS-FR services, and 721 BLS-FR services (that DOH knows of). Services by level of care: 405 BLS, 133 Intermediate, 188 Critical Care, and 484 Paramedic. Total Certified Vehicles = 5553 consisting of 4017 ambulances and 1536 other (which would include EASVs, helicopters, etc). Sweet.

22. Remaining 2006 SEMAC and SEMSCO meetings are schedules for May 23 and 24, September 14 and 15, and December 12 and 13.

These notes respectfully prepared by Mike McEvoy, PhD, RN, CCRN, REMT-P who was the 2005 Chair of the State EMS Council where he represents the NYS Association of Fire Chiefs. Mike remains on the Council as a wise old past-chair, kinda like an old Fire Chief. Mike is EMS Coordinator for Saratoga County, a paramedic for Clifton Park-Halfmoon Ambulance Corps, a firefighter and chief medical officer for West Crescent Fire Department. At Albany Medical Center, Mike works as a clinical specialist in the Cardiac Surgical ICUs, Chairs the Resuscitation Committee, and teaches pulmonary and critical care medicine at Albany Medical College. Contact Mike at McEvoyMike@aol.com. If you want a personal copy of these “unofficial” SEMSCO minutes delivered directly to your email account, surf to the Saratoga County EMS Council at www.saratogaems.org and click on the “NYS EMS News” tab (at the top of the page). There, you’ll find a list server dedicated exclusively to circulating these notes. Past copies of NYS EMS News are parked there as well.

What follows is not witnessed by me, and falls under the label of "EMS Urban Legend".

Nursing home call for an "Unconscious". The Fire Department First Responder Engine, and EMS BLS and ALS teams arrive simultaneously to find the patient in a wheelchair, in rigor, full dependent lividity, cool to the touch. Patient reportedly was in the chair from 0930 hours, wheeled to lunch and didn't eat, and it's now 1600 hours (local time). The patient in the chair was parked all day across the hallway from the Nursing Station!

Before anyone asks, that was 3 jetliners (Eastern Flight 66, US Air Flight 1010, and American Airlines Flight 587), and a single engine 4-seater that did a forced landing on the beach (carburetor froze, permanently stalling the engine), with no loss of life, and the police seizing it's cargo of illegal recreational pharmaceuticals.

I started when I was 19, with a Volunteer (charity/unpaid) service. I then progressed thru 5 private, proprietary services, and finally got the municipal EMS job when I was 32.

I'm now just shy of 52 years old, on the municipal EMS job (first NYC Health and Hospitals Corporation, then under the management of the FDNY) for almost 21 years.

I'm physically battered by "the job", and emotionally battered by too many DOAs, and 3 major, one minor plane crashes along the way.

This is not a job for weaklings, and in my current physical status, I'd probably not get hired. However, if an older person (35 and up) feels that they can hack it, go for it!

It is an unfortunate thing that some crews are never told that they had been exposed to something hazardous until the next day, either chemical or contagion.

Similar lines: A hospital put up a new wing, and was using chemical sealants. Someone from the work crew walked by the ER, saw the patients, ER crew, and some ambulance teams with them, and damn near had a CVA on the spot. He ordered everyone out, and when the hospital administrators came over, realized everyone was at risk from fumes, they closed the ER for 24 hours, moved the ER people to a designated safe area until they cleared out the case load, then reopened in the designated safe area for a week.

I've had one partner for 7 years, coinciding with a string of several other partners. All partnering seems to have no rhyme or reason, as I'd have a partner for a couple months, then they'd be moved to either another unit, another tour, another unit on another tour, or even moved to another station. The general reason is labeled "Needs Of The Service."

As for placement in Manhattan, the Bronx, Brooklyn, Queens, or Staten Island, they used to have "dream sheets" in which you'd list in order of preference where you wanted top work. Didn't mean you'd get it, because of that aforementioned line of the needs of the service, but it could be promising.

We have cars, but some of us don't want to give up a parking space, especially in some sections of the city.

Having said that, we also have a good bus and subway system, which, due to lack of parking by FDNY Headquarters, I've been using to go to work.

I also note, I don't know how to get to Fort Totten by public transportation, and don't want to find out!

In mentioning the "Expect the unexpected,"

When you expect the unexpected, you'll never be disappointed!

I just posted on another string, on the subject of scene safety with intox and EDP patients, in which I said,

When in doubt, EMS back out,

Let the LEOs sort it out.

Let them secure, and then let your

team transport the patient towards a cure!

It got me to thinking about poetry of, and for, EMS. Hence, the creation of this string.

I propose anyone post here little bits of EMS "Folk Wisdom", or witty mnemonic training phrases. Remember, about a decade ago (probably more), a group of Instructor/Coordinators (EMT/Paramedic teachers) actually recorded an album of EMS related "Country/Western" songs (whoever borrowed my copy, please return it, no questions asked?)

While we may not make an album off of anyone's writings here, we can amuse ourselves, and perhaps help some of the newbies "get" the training better into their heads.

Which reminds me: Does anyone remember the words to "Fifty Ways to Kill Your Patient", to Paul Simon's "50 Ways to Leave Your Lover"?

Regarding scene safety with drunks or EDPs:

When in doubt, EMS back out,

Let the LEOs sort it out.

Let them secure, and then let your

team transport the patient towards a cure!

(Hey! He's a poet, and didn't know it!)

I got in without knowing anybody that could pull strings, but that was during the New York City Health and Hospitals Corporation EMS days, prior to the Fire Department New York EMS days.

Yes, they don't hire for long periods, then suddenly have a large number of large classes.

They have hiring after taking folks off of EMS to go to the "Fire Suppression" side. I've lost some good partners that way.

There are also those hired to replace those who leave to go to the NYPD and other Law Enforcement agencies. Another way I've lost good partners.

One that I don't recall reading in this string is those who get promoted to Lieutenant, the lowest of supervisors in the organization (perhaps I need glasses, with apologies to anyone who did post that). That also has cost me partners.

(I am on the promotion list for Lieutenant, at list position 194. Wish me luck, folks, perhaps I'll be called by the end of the summer.)

Almost forgot: Youse guys know me, but I am not in a position to help anyone get into the FDNY EMS, or even just the FDNY. I'm just a working "grunt".

As always, for hiring information, click on the link http://www.nyc.gov/html/fdny/html/home2.shtml , and work through to hiring. It's in there!

We have new people here, now. Anyone else want to comment, or add their vote to the survey?

Somewhere on the "City", I posted a true tale of a paramedic who fired a defib in the air, giving himself a shock that knocked him down.

When everyone ran up to him and asked WTF happened, he said, "I was doing this..." and shocked himself again!

When the others picked him off the floor, he allegedly told his partner, "That would have killed a lesser man!"

Following that, as his last name was Anderson, he had the nickname of "Sparky."

I quote #3 quite often.

Under NYS law, a child may so be left at a hospital, Firehouse, or Police station, so at least the child will be safe. The mother cannot be questioned beyond what already has been mentioned.

HOWEVER...

The current FDNY Commish used to run Child Services, which itself is under fire for reasons I'm not going to go into. The commish wants the firefighters and the FDNY EMS crews to hold the mother for the cops, in total violation of State law.

Again, proof of my belief, if it makes sense, it's against the law in NYC.

As I see it...

If using a C-Collar, spinal long board will be used.

I'm in an area where backup is usually not too far away. Run out of long boards? Request another unit to either drop one off, or assume patient care as THEY put the patient onto their long-board.

If and when a KED or the Iron Duck Extrication Appliance (IDEA) is used (FDNY EMS uses both), the patient so immobilized will also be on a long-board, and a C-Collar on under the KED or IDEA, under my mantra of LOCAL PROTOCOLS.

The patient who really needs immobilization but refuses it? Document DOCUMENT DOCUMENTthe Refused Medical Assistance, but they might still sue you and/or your agency.

If the patient is out of the vehicle (presuming a car accident), you might want to do a "standing take-down", where you hold a standing patient in immobilization, put a c-collar on them, and place a spinal long board behind them, and lower both patient and board, as a single unit, to the laying down position, then secure the patient to the board.

Yes, that last takes practice to do well, but I feel it is easy to learn.

"Spider Straps?" I presume that these are the straps that come over the patient's shoulders to join up with the uppermost of the torso straps. Rumor has it the FDNY EMS is going to go to these type patient safety straps (not calling them patient restraints, might have a battle of the phrases I really do NOT wish to get into).

How many times have we heard the dispatcher putting an alert tone over the air, following it with "Unit ****, you're transmitting a signal", when somebody is accidentally transmitting. If they're transmitting, they can't hear the "stop transmitting" request.