Richard B the EMT

2 weeks? one month? I was off my feet for 3 days, by direction, and wearing the brace for 2 months before I went back to work on a paper pushing, modified duty. I wasn't cleared to return to the ambulances for about 6 months! By then, my "cert" had expired, but was able to get into a refresher class quite quickly, and was back in the ambulance 16 months following the date of the injury. Either the surgery has improved to need less recovery time, my doctors were overly cautious, or someone messed with me. In your case, I'll hope the surgical methods improved between my injury in 1997, and today.

There is a difference between funny at the expense of someone else's misfortune, and those who accept the consequences of attempting what we laugh at. The antics of "Super Dave" Osbourne (spelling?) is one example, and Youtube is another. Addressing Youtube, I saw a video there on military humor. One of the items in the video was a soldier being hit by the recoil of a small howitzer (I'm no artillery expert, so as to what size...) being fired. Many who commented on that being included in "Humor" really beat up on the poster, as in that type accident, the impact of the back of the gun being fired, is invariably fatal. Several sportscasters on local NYC area TV news shows play videos of assorted crashes, in cars, on skis, and that baseball player who caught a fly ball as he crashed through a wall. Their catch phrase is usually "...and nobody got hurt". Otherwise, they tell the audience what they are about to see is "disturbing". There is a video of a politician who knew he was going to be arrested immediately after he finished a press conference, for misuse of funds. He was admitting his guilt on camera, while holding a large envelope. As it became apparent that he was finishing up, he opened the envelope, pulled out a pistol, put it in his mouth, and fired, in front of both the audience in attendance, and live to the TV audience. This might be funny to some, but, I presume, emphatically NOT to the majority of the members of EMT City. Would someone in authority please lock this string?

You might want to contact these people, as they run 4x4 Ambulances and Fire Engines. They might be able to advise you. http://www.rockawayp....com/page.php?5 Also, if, as mentioned, the vehicle is only going to be used on a site to bring the patient to a "road" ambulance, there are several "golf cart" conversions available. FDNY uses John Deere brand "Gators", as one example.

I would suggest, if there are any associations of either commercial and/or volunteer EMS departments, to use them to find out where and when there's a trade show, with "demonstrator" ambulances, either in your state, or a nearby state.. The vendor you've previously done business with might be able to advise on this, too. That way, you might get a better idea what is available. Don't refer to a "standard size" box on your type 1, 2, or 3 ambulance. The so called "standard size" may have changed from when you purchased the one being replaced, either direction of larger or smaller, taller or wider. Everything, to a degree, is customized for the customer. On that last, think about what supplies and equipment you are using, and if you want to be able to access them from only outside, only inside, or both. Cabinet and compartment sizes can be needing custom sizing. I know a few departments measured off by a quarter inch, and couldn't close the doors on the compartment they were going to put the Hurst Tool "Jaws" into. Get input from other agencies that have also made similar purchases recently. Sometimes their error will prevent you from repeating it. Look into used. Many departments give up decent stuff, because they want the newest of the new, with all the fancy bells, buzzers and whistles. A few are looking more for display pieces, not actual work-a-day pieces, but it could still work to your benefit, price wise. Think of the geographics of your service district. Are you in spread out countryside, mountain top, densely populated city? Are you prone to flooding, or heavy snows? You already mentioned 4x4 drive as a requirement, so you already know that is going to up the price significantly. Just a few things to consider.

In New York City, Regional Emergency Medical Service Councils (REMSCO) are the local units of the State Emergency Medical Service Council (SEMSCO). If you're a Paramedic, expect to also be doing business with the Regional Emergency Medical Advisory Committee (REMAC). Then, there's NYC OEM and NY State OEM, the Office of Emergency Management. LGCC is LaGuardia Community College, BMCC is Borough of Manhattan Community College, by the way.

Sounds like the HIPAA and PHIPA rules are, if differently worded, both serving the same function. Mobey, see my mantra of "Local Protocols". You're reinforcing it. Good. DocHarris, seems our protocols are the same, if only on this matter. As for the patient not having access to the records, except through filing via the lawyers, remember this one? Mr Jones confronted his doctor, and complained, "I borrowed my file from the nurses station to see what's going on with me, and I'm going to sue you for writing that about me, in my records!" Dr. Smith looked at Mr Jones, and said, "First off, patients are really not supposed to be looking at their records while in the hospital, and second, the initials stand for Shortness Of Breath!" Edited to correct an embarrassing mis-spelling

I need a clarification, here. Situation: An EMS crew, in the ambulance, with no patient, stumbles into a car crash call (unit operating onscene, not otherwise involved), treats, packages, and transports an injury patient from the crash? Said crew never did any call response sheet? If I misinterpreted any of this, please correct me. We call this a "Flag-Down". FDNY EMS policy is, notify EMD of where the call is, so they can "assign" the ambulance to the call, give it a Computer Assisted Dispatch assignment number, and possibly cancel off the assignment any unit previously assigned. It is a call, and appropriate paperwork is supposed to be filled out.

I recall in, I think, Teaneck, New Jersey, an incident. The crew loaded a teenage girl, and then started to finish their onscene patient evaluations. The young lady's father jumped in the front of the ambulance, put it in gear, and drove the ambulance to the hospital.The driver was still doing patient care in the back of the truck. During the ride, he kept asking the crew how to turn on the lights and siren, and they refused him that information. Using their portables, the crew contacted their dispatcher during the ride, and the Teaneck PD was waiting at the ER, and arrested the dad. The man was arrested for Grand Theft Auto (the ambulance), unauthorized use of a vehicle (the obvious), and several counts of kidnapping (the crew, and his own daughter), as well as several moving violations committed during the ride.

You just reminded me of something. My VAC responded to the US Air Flight 1010 crash. While we were waiting at "staging", off the "compound", some freelancer photographer was going door to door on the row of lined up ambulances, looking for a ride into LaGuardia Airport, the scene of the crash. If he got in, it was with some ambulance from behind where we were in the lineup. I don't recall if I saw the guy again. Some years later, in a Crips versus Bloods gang related shooting, with 3 juvenile female ambulatory patients being seen on board my ambulance by myself, my partner, and a Paramedic from another ambulance, we had a quick, somewhat heated discussion with a man claiming to be the father of the 3 girls, insistant that he was going with us, in the back with my partner and the Paramedic. On the direction of the Paramedic, he went along in the back (the Paramedic had a daughter the same age as one of the patients, so she probably felt for the man). (FYI, of the 8 shot with 2 fatalities, nobody was a member of either gang. All, except the fatalities on the scene, were transported to 3 trauma centers nearby, to not back up any one of them.)

The link shown here is Patrick J. Bahnkin, President of Local 2507 (Uniformed EMTs, Paramedics and Fire Inspectors of the FDNY) District Council 37, AFSCME AFLCIO, testifying at the NYC Council's investigation of the bungling of the response by numerous city agencies and the Office of Emergency Management, to the 20 inch blizzard of December 26-27, 2010. FYI, some of the snowfall was still being cleared today, as we get ready for a possible 12 inch snowfall on top of the previous one.

Wait, is that not how we reach OLMC?

I put this akin to the guy shot in the butt. Cops all laughing, until he keeled over from the inbleed, and died from exanguination (spelling?).

As stated, this is going to be under discussion for some years to come, from legitimate commissions to crackpot theorists. Hell, we had the Warren Commission say a single shooter in the book depository, versus the Grassy Knoll and possible 3rd shooter, from 1963. Also, with the confusion of a 20 patient shooting Multi Casualty Incident, who is to say why the crews allowed a political aide, who had at one point is supposed to have been an EMT, if I heard correctly, on board during transport?

1. PROCEDURE 1.1 To establish general guidelines and procedure for the types of equipment that shall be utilized at the scene of an assignment. 2. SCOPE 2.1 This procedure applies to all members of the EMS Command and to Voluntary Hospital ambulance personnel who provide pre-hospital emergency medical care in the New York City 911 system. 3. RESPONSIBILITIES 3.1 All members shall: 3.1.1 Maintain all personal issued equipment in good working order. 3.1.2 Be responsible for checking vehicle and equipment at the beginning and end of their tour. A. Members are responsible for inspecting their assigned vehicle for defects. B. Whenever possible, members shall rectify the defect. When this is not possible, such defects shall be reported to the Supervisor. C. Members shall inspect personal and vehicle patient care equipment and supplies, and take corrective action (including reporting defects to their supervisor) to replenish, as necessary. 3.2 Supervisors shall: 3.2.1 Assist members in replenishing equipment and supplies in order to expedite units going into service. 3.2.2 Verify and correct vehicle equipment and supply deficiencies, when possible. <BR style="PAGE-BREAK-BEFORE: always; mso-special-character: line-break" clear=all> 4. PROCEDURE 4.1 All members shall carry the following equipment to the scene of all assignments: 4.1.1 Fully equipped Technicians' Bag (required for EMT members only) 4.1.2 Stethoscope 4.1.3 Sphygmomanometer with cuff 4.1.4 Bag-valve-mask (with adult and pediatric masks) 4.1.5 Watch with second indicator 4.1.6 Penlight 4.1.7 Oxygen regulator with portable oxygen cylinder 4.1.8 Patient carrying device. 4.2 In addition to the items listed in Section 4.1, EMTs shall carry the AED to the scene of all medical assignments. 4.3 In addition to the items listed in Section 4.1, Paramedics shall carry the medical bag and monitor/defibrillator to the scene of all medical assignments or the trauma kit to the scene of all trauma assignments. 4.4 Paramedics shall carry a telemetry unit to the scene of all assignments in which they have reason to believe that ALS intervention will require contacting On-Line Medical Control. 4.5 Members shall carry any other appropriate equipment that dispatch information indicates may be required (e.g., splints for fractures, etc.). 4.6 Members shall carry any other appropriate equipment indicated by the NYC REMAC ALS and BLS patient-care protocols. 5. RELATED PROCEDURES 5.1 NYC REMAC ALS and BLS Protocols 6. APPENDIX 6.1 Appendix A: Minimum Supplies Carried in a Technician Bag Rev. 09/23/04 BY ORDER OF THE CHIEF OF EMS COMMAND Above is EMT Technicians bab for BLS, below is Paramedic ALS. ITEM STANDARD SUPPLY MINIMUM QUANTITY *Minidrip 3 *Macrodrip 1 *Extension Tubing 2 *NaCl 0.9% 1000 ml bag 1 *NaCl 0.9% 250 ml bag 3 *NaCl 0.9% 50 ml bag 2 *IV Prep kit 2 *Nebulizers 2 Small Disposable Sharps Container 1 Bag valve mask (Complete) Adult size – disposable 1 Bag valve mask (Complete) Pediatric size – disposable 1 *Nasogastric tubes #6, 16, 18 French 1 ea. *Water soluble lubricant 1 Tape - 1" 1 roll Disposable Isolation masks 3 Intubation Kit – Complete 1 *DeLee Suction Device with Vacuum break and filter 1 Medication Insert – Complete 1 Alcohol Preps 10 Saline Locks 4 Intraosseous Needle (IO) kit 1 Needle Cricothyroidotomy/ Needle Decompression kit 1 * Items must be maintained in sterile packaging, until time of use. BY ORDER OF THE CHIEF OF EMS COMMAND

From the FDNY EMS Command Operations guide, circa 2006, and probably updated after. I offer it as a guideline only, Timmy.

Timmy, what was the initial incident to which you responded? Also, for good, bad or indifferent, hindsight is always a bitch, as you will question yourself for some time, no matter how much good you did, as to what you couldn't do. It's human nature to do so. For the time being, concentrate on what went right. On an unrelated, how are you, and your agency, dealing with the flooding I've been hearing about on the news?

Why? Do they flex too much?

Just saying, here, ever thought I live in New York City, I got buddies who are CAP "ground-pounders". Someone usually has to go looking for the transponder when it erroneously gets triggered into signaling a "crashed aircraft". If only asked, some of us got a good story to tell, even from outside EMS experiences. Admittedly, not for stabilization, there is always the stretcher made from two jackets turned inside out, with the tent poles run through the sleeves. I've never used that, but have known of it for more than 38 years.

Weren't many of us discussing this very video on another string, just last month? Debate was raging as to it being real, or a staged incident, as no one could find any mention of a Trooper's death in the state, for the time frame of alleged occurance. Our consensus was, the video was a training film, not actual dash-cam footage.

I just remembered, for the last few years, in New York State, EMTs were no longer allowed to transport patients on IVs. The IV either had to be shut down by qualified personnel, or replaced with a saline lock, otherewise, a Paramedic, Nurse, or other higher trained medical personnel, had to accompany the patient. Previously, EMTs could transport the IV patients, adjust the arm for maintaining the flow, or shutting down the IV if it infiltrated.

The possibility of any calls, even those where no one needed the assistance of FDNY or FDNY EMS, being charged for, is being floated as a possibility in New York City.

I forgot you're in a mountainous area. Bad weather is usually in lower pressure systems, and swelling from that lower pressure can cause pain. Best speak with your ortho doc on that. I live just above sea level, possibly at the magnificent altitude of 10 foot.

January, 1997, I tripped over the edge of the outdoors carpet at the ambulance dock of a hospital, and crashed down onto my left knee. I was in pain, and after another team already at the same hospital with a different patient assisted my partner in bringing in my patient, they returned to me, and assisted me inside. The X-Ray didn't shop anything. Meniscus tears don't show on X-Rays, I'd later find out. The ER Doctor actually refused to sign off on the FDNY paperwork to allow me off the remainder of my tour, actually saying he thought I was faking it, but "FormerEMSLt297", who was previously my partner, then my lieutenant, knew me not to be a malingerer, and put my ambulance off service, and held me at the station. I was not on an ambulance for the remainder of that year. The process was slow, but a few months later (!) I got authorization for an MRI, which did show the tear. In July of that year, I had corrective Arthroscopic Laser Surgery (I think that was what it was called, anyway), and was finally returned to full duty in late December of that year. Since that time, I've re injured the same knee (x2), without requiring surgery, but now have a pre-arthritic condition. Almost anyone with a joint injury can tell when there's going to be a storm, as we feel anywhere from mild discomfort to 6 or higher pain (scale of 10), from the approaching low weather system atmospheric pressure. I'm usually good for that for 72 hours advance warning, so perhaps I should work for the weather bureau (NOT!). As the injury was Line Of Duty Injury (LODI), it was covered by Workman's Compensation. They paid for all medical, pharmaceutical, X-Ray, MRI, and surgical costs, as well as the (POS) leg brace I wore for the next several months.

1) Depending on what type care a patient needs during an IFT, either the skills sets of an EMT or Paramedic might be needed. 2) Earn your skills at EMT level, then use it as basis for getting Paramedic training.

The item has resurfaced, via a link at the JEMS site, re punishment for the Fire Fighters involved. Some are, apparently, going to be fined for a third of their annual income! Faked EMT Certs in Mass.