Richard B the EMT

I was just thinking: has anyone putting a 3 or 12 lead EKG onto a patient ever handed the patient an electrode already attached, telling the patient to put this on their body where you point to on yours (Language barrier being the only reason this might not work)?

I am somewhat unsure this would work, as we come from many countries, and many time zones.

Same cemetery, different night... 2 drunks, coming out of different bars, decided to take a shortcut across the cemetery. One, walking east, fell into an open grave, opened in preparation to a funeral for the next day. He struggled for an hour, unsuccessfully trying to extricate himself. The second drunk fell into the same grave, maybe an hour after that, while walking west. He also struggled to get out. Hearing the second drunk struggling, the first one reached out, tapped the second on the shoulder, and said, "You're not getting out of here." The first drunk suddenly found himself alone in the open grave.

Don't really know the Philly system. JFK, and LaGuardia Airports in New York, and Newark Liberty Airport in New Jersey, are run by the Port Authority of New York and New Jersey. They have Port Authority cross-trained LEOs assigned to ambulances, and these ambulances respond to most, if not all, 9-1-1 calls within the airport perimeter fences. They can, and are, backed by FDNY EMS, or NYC 9-1-1 system, ambulances at LaG or JFK. I presume they are backed by 9-1-1 system ambulances at Newark Liberty. I was told all P.A.N.Y.N.J. P.D. officers are trained as Paramedics with New York/New Jersey dual reciprocity, as they operate on both sides of the Hudson, and the trans Hudson River crossings (Hudson and Lincoln Tunnels, George Washington Bridge, Port Authority Trans Hudson [PATH] trains).

Idiot Sighting: Reported from a US Navy Aircraft Carrier, a pilot told his aircraft's chief mechanic that a particular electrical switch didn't work in the O-F-F position.

I'm going to mention that the Queens County, NY area of New York City has 5 Volunteer Fire Departments, Broad Channel VFD & VAS, Point Breeze VFD (AKA Breezy Point VFD), Rockaway Point VFD & VAS, Roxbury VFD & VAS, and the aforementioned West Hamilton Beach VFD & VAS. All of them are in the same Councilmanic district of NYC, and State Assembly District of New York State. Roxbury, Point Breeze, and Rockaway Point departments are all in the confines of the "Breezy Point Co-Operative", 3 "gated" private communities, with their own security force. Were I to go west to there, I couldn't just drive around, as I'd have to get a pass to access beyond the security booths or gates first. Point Breeze is the only one of the 3 that doesn't run an ambulance, but they have FF/EMTs as members. On the Brooklyn side of Jamaica Bay, there's the Gerritsen Beach VFD & VAS. I am told, but have no actual information, that Richmond County, NY, better known as Staten Island, has 2 VFDs, and that the Bronx, NY, has one. Within New York City, overall, there's at least 30 VAS, as mentioned in someone else's posting, which are covered in Districts 4 and 18 of the New York State Volunteer Ambulance and Rescue Association (I'm a member of D-4, myself). Adding to this, the VFDs with VAS might refer to that part of their operations (the VAS) as Rescue Companies, not ambulance, EMS, VAC (Volunteer Ambulance Corps), or VAS (Volunteer Ambulance Service).

(Sound of Richard B kicking himself)

I'm probably going to kick myself, but what is/are R/M?

As we ALL should.

The woman I mentioned, who wanted us to remove the shoes before walking across her carpet to take care of her asthmatic child, lived in a public housing development. Her family, like many in such situations, must have either scraped the money together, or done time payments, because the place looked quite nice, actually. Going off topic for a moment. It doesn't seem to matter if the family which ownes the nice "stuff" is rich or poor, some have the tendency to be overly protective of the "stuff", more than their families.

Just a thought, here, but anytime anyone signs an RMA/AMA when you as the EMT or Paramedic feel they really should have gone in the ambulance to an ER, follow the old mantra of "document, Document, DOCUMENT"! I have heard of litigation where EMSers were sued because they accepted the RMA/AMA, when what the EMSers warned the patients could happen if they didn't go with them, happened. Admittedly, the lawsuits were unsuccessful, but time was lost, reputations were damaged.

PCP, is this patient a technical boss over you in your medical office capacity? I presume Canadian law to be on the same level as American law, that the medical person (you as the EMT or Paramedic on the scene) is medically in charge, until and/or unless there is a higher medical authority either on the scene, or in consult from the On Line Medical Control. This does not take into account a patient who signs the Refused Medical Assistance/Against Medical Advice paperwork, which is a different situation. Is Entonox also known as "Nitronox", kind of a Nitrous Oxide/Oxygen anelgesic*, which is not (yet) in any New York State protocols, as far as I know? Reviewing here: Took a nasty fall off a snowmobile, complains of head injuries, stiff neck, and tighness in the chest? I'm thinking possible C-Spine involvement, possible Traumatic Brain Injury, M I. Patient wants to RMA/AMA, instead of all spinal immobilization protocols being implimented (I trust you would have), O2 therapy, and patient monitoring enroute to the nearest ER. Seems like you did your best, at the time. Just for information, you've mentioned an hour's travel time to the ER by private vehicle, and presume roughly the same with the on-site ambulance. While a critic of overuse of HEMS (Helicopter EMS), this qualifies, in my book, anyway, as a good time for the Medevac flight. How long to request the "bird", fly it in for pickup, and get to that ER? If and when available, give us the followup prognosis. (*Possible misspelling, I can't get the spell check to work. subject for another string)

In recent articles in both JEMS (via their E-Newsletter), and the New York Times, a company called Emergency Medical Services Company, based out of Greenwood Village, Colorado, has agreed to be "acquired" by private equity firm Clayton Dubilier & Rice, in a buyout of three point two BILLION dollars. The company is supposed to be the biggest provider of "ambulance services". Admittedly, I am probably behind the times, but I thought Laidlow (Laidlaw?) or American Medical Response were the biggest? Also, I've never heard of the group. Has anyone, here in EMT City, heard of them, or worked for them?

I find it interesting, at a meeting, on the 10th, of the NY State Volunteer Ambulance & Rescue Association's local district, including WHBVFD, the past chief, who I have known longer than either of us likes admitting, didn't mention it, nor did anyone else at the meeting.

IMHO, this is one of those situations where the way of addressing the problem became a problem in it's own right.

The link is not working. edited to remove accidental multiple postings.

After the EMS/FDNY "merger", a website came on line, showing a Star Trek "Borg" wearing a fire chief's helmet, captioned, "You will be assimilated". While I seem to not be able to access the picture to reproduce it here, I suspect the person who created the (previous to Septemnber 11, 2001) highly anti-FDNY site is a member of EMT City. He, or she, remains annonymous, by choice.

The shoe/boot cover is a nice, but probably expensive, item. I'll presume most of us have had the devout Jewish patient, who won't violate the religious laws, and "ride" in the ambulance during the Sabbath, Sundown Friday to Sundown Saturday. Aside from calling Hatzoloh Chevra Volunteer Ambulance (the biggest volunteer ambulance I am aware of, with International headquarters in Williamsburg, Brooklyn, NYC NY), all I can do is remind the patient that a "Grand Rabbi", some centuries ago, said that it was all right to break the Sabbath to save a life. For the uninformed, Hatzoloh seems to be equal parts EMS and religious practice.

Service animals guide the visually impaired, as their eyes. They pull their person in their wheelchair, therefore they've become their legs. The animal is trained to pick up fallen items, or items that have been placed on the floor, so they have become the handler's arm and hands. There's even a deaf FBI agent, who is alerted to audio cues by her "hearing ear" dog. The service animals are as much an extension of the human they work for, as any prosthetic device is, of that person's arm or leg. Emotional attachment? Sure, but that comes later, after the team trains together. You must not have eaten hospital food while a patient. LOL

Taking into account that this is more what is my understanding, and might not reflect actuality, try to have a family member of the Muslim woman accompany her, like her husband, brother, sister, or mother. From general EMS training, for a female patient, if possible, have a female tech ride with the patient (I've had NYPD lady officers ride for that reason). In all cases, try to provide cover to the groin area of all patients, and the breasts for women. In "Superman: The Movie", when checking out a rather chesty lady (who was faking injuries from a car crash, to stall a convoy of truck mounted ICBMs, so that Lex Luthor could tamper with them), the security detachment (commanded by Larry "J.R.Ewing" Hagman) formed a circle around her, then was ordered to face outward as a visual shield. Hey, it worked, if only in a movie "for instance". (The movie played on TV this past weekend). I've had instances where I realized, after starting patient evaluations and treatments, that I was in houses where they didn't wear shoes inside, due to religious observances. I would continue the evals and treatments, while apologizing for not removing my boots, as I was under the opinion that such evals and treatments took temporary priority. I never had anyone complain, as most understood where I was coming from. As for the woman wanted us to remove the boots, because they's stain her new carpet, while we tried to access her asthmatic child...

U.S. Department of Justice Civil Rights Division Disability Rights Section Americans with Disabilities Act ADA Business BRIEF: Service Animals Service animals are animals that are individually trained to perform tasks for people with disabilities such as guiding people who are blind, alerting people who are deaf, pulling wheelchairs, alerting and protecting a person who is having a seizure, or performing other special tasks. Service animals are working animals, not pets. Under the Americans with Disabilities Act (ADA), businesses and organizations that serve the public must allow people with disabilities to bring their service animals into all areas of the facility where customers are normally allowed to go. This federal law applies to all businesses open to the public, including restaurants, hotels, taxis and shuttles, grocery and department stores, hospitals and medical offices, theaters, health clubs, parks, and zoos. Caption: Businesses that serve the public must allow people with disabilities to enter with their service animal. Businesses may ask if an animal is a service animal or ask what tasks the animal has been trained to perform, but cannot require special ID cards for the animal or ask about the person's disability. People with disabilities who use service animals cannot be charged extra fees, isolated from other patrons, or treated less favorably than other patrons. However, if a business such as a hotel normally charges guests for damage that they cause, a customer with a disability may be charged for damage caused by his or her service animal. A person with a disability cannot be asked to remove his service animal from the premises unless: (1) the animal is out of control and the animal's owner does not take effective action to control it (for example, a dog that barks repeatedly during a movie) or (2) the animal poses a direct threat to the health or safety of others. In these cases, the business should give the person with the disability the option to obtain goods and services without having the animal on the premises. Businesses that sell or prepare food must allow service animals in public areas even if state or local health codes prohibit animals on the premises. A business is not required to provide care or food for a service animal or provide a special location for it to relieve itself. Allergies and fear of animals are generally not valid reasons for denying access or refusing service to people with service animals. Violators of the ADA can be required to pay money damages and penalties. Caption: Service animals are individually trained to perform tasks for people with disabilities. If you have additional questions concerning the ADA and service animals, please call the Department's ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) or visit the ADA Business Connection at ada.gov. Duplication is encouraged. April 2002 Richard speaking, now. That is the information, directly from the source.

Wow! Sounds like a New York Post headline.

I'm guessing that was supposed to be "Pun"ny? Taking over for Lone Star to battle me with puns? Bring it! but on the "Pun"demonium string.

Be Afraid. Be Very Afraid! Muoohahahahahah!

As stated, NY State DoH requires 2 pillows. Also as stated, they make great ankle splints, and always seem to be in shortage at the supply depot or ER. As the ambulance cots are designed more for function than comfort, I always try to have all patients have one for their heads (not always possible, as indicated).