FDNY*EMS What If's

[BurnNurse]

The Two medic system was in place as on site medical control believe it or not, it has to do with the way the controlled substances were distributed back when dirt was new, The two medic system worked because there was very few medic units and the idea was to have both medics in the back with the patient while the emts drove the buses, we also had PRU's but not enough transporting BLS units to back them up. The system has gone through many changes but keeps coming back to the beginning, As far as doubling the ALS capability, you still need two medics in a cardiac arrest and I would like it if i had a little bedside back up when the poo-poo hits the rotary oscillator, I have worked in a fly car system and a one medic one emt system , and the two medic system , I like them all for various reasons. BUT NYC may benefit from a combination of the two and maybe a return of the PRU ( Paramedic Response Unit.) The other thing is FDNY still as far as i know has paramedic interns or Jr. Medics , who can not be on there own until they complete 960 hrs with a senior medic ...similar to FTO. at least we were trying to get that title back then, don't know what happened ....

[Dustdevil]

As far as doubling the ALS capability, you still need two medics in a cardiac arrest

Two medics is a luxury in most systems. Most ALS systems run 1 basic/1 medic teams. I never found it that much easier to work a code with another medic than with a good EMT who knew how to hang an IV. Once the tube is in, there's only one ALS job anyhow. I certainly wouldn't say it was something I "need."

As far as I know, there is only one tiered system in Texas with both basic and ALS units instead of all ALS. That's Austin. Somehow they make it work well enough to get good reviews by the experts, but they still have a lot of problems with it.

Seems to me that if EMTs never work with medics, their professional growth is severely limited. Also seems like it would cause a deep divide between the two levels and increase the whole "just a basic" vs. "paragod" animosity.

[Richard B the EMT]

The way the FDNY EMS is structured, depending on the call type, certain calls get Paramedics, others EMTs, some automatically get both.

As we know, callers to the 9-1-1 system (gasp!) lie, to get an ambulance there quicker, so dependent on who gets on the scene first, can cancel the other if they are not needed. If the caller states to 9-1-1 the patient is in active seizure, and my BLS gets there to find the patient standing there with packed travel bag in hand, saying "What? I'm having a seizure as we speak," I'm canceling the ALS, keeping them available.

Tangent, here: in NYC, there is currently no structure to penalize "false alarms" of this type.

[Asysin2leads]

Well, lol, no "official" way to penalize false alarms, wink wink nudge nudge.

[Richard B the EMT]

Well, lol, no "official" way to penalize false alarms, wink wink nudge nudge.

As any patient, even the most frequent of ETOH abusing frequent fliers, can complain about treatment,or lack of same, I don't think we should go there!

[10-52-EDP]

I THINK STICKING A MEDIC WIT AN EMT IS NOT REALLY A GOOD IDEA

MOSTLY BECAUSE IT WOULD BE HAVIC

-THE MEDIC WILL ALWAYS FEEL LIKE HE/SHE IS IN CONTROL

-THE EMS ACADEMY WOULD HAVE TO BE LONGER FOR EMT'S

TO SEEK EXTRA TRAINING

-DISPATCH WOULD HAVE TO TRIAGE CALLS A WHOLE LOT DIFFERENTLY

-AND ON TOP OF THAT THERE ARE MORE EMT'S THEN THERE ARE PARAMEDICS IN THE SERVICE SO THERE WOULD BE A HIRING FRENZY AND THE NEWBIE PARAMEDICS WILL PUT A STRAIN ON THE DEPARTMENTS BUDGET SALARY WISE

-PLUS ITS GONNA COST FOR MORE ALS EQUIPMENT

[Dustdevil]

-THE MEDIC WILL ALWAYS FEEL LIKE HE/SHE IS IN CONTROL

It's not a "feeling." It's a fact. Besides, there is usually going to be a senior person on a crew of two EMTs too. There's always a pecking order, regardless of training levels. It's not about egos. It's about what is best for our patients.

-THE EMS ACADEMY WOULD HAVE TO BE LONGER FOR EMT'S

TO SEEK EXTRA TRAINING

What extra training would they need?

-DISPATCH WOULD HAVE TO TRIAGE CALLS A WHOLE LOT DIFFERENTLY

No they wouldn't. Triage is triage. Medical priorities don't change according to the level of training of the responders. The only difference would be that they would no longer have to spend that extra time trying to decide which level of responder to send. And it would totally eliminate the need for sending two units, or intercepts.

-AND ON TOP OF THAT THERE ARE MORE EMT'S THEN THERE ARE PARAMEDICS IN THE SERVICE SO THERE WOULD BE A HIRING FRENZY AND THE NEWBIE PARAMEDICS WILL PUT A STRAIN ON THE DEPARTMENTS BUDGET SALARY WISE

You may have a point there. What is the breakdown? How many ALS vs. BLS units on the road at any given time?

-PLUS ITS GONNA COST FOR MORE ALS EQUIPMENT

With some of the highest taxes in the nation, they should be able to find the money to protect their citizens. I bet you can think of quite a few things the city could pull money out of in order to fund EMS.

WHY ARE YOU SHOUTING??

[Guest]

I THINK STICKING A MEDIC WIT AN EMT IS NOT REALLY A GOOD IDEA

MOSTLY BECAUSE IT WOULD BE HAVIC

-THE MEDIC WILL ALWAYS FEEL LIKE HE/SHE IS IN CONTROL

-THE EMS ACADEMY WOULD HAVE TO BE LONGER FOR EMT'S

TO SEEK EXTRA TRAINING

-DISPATCH WOULD HAVE TO TRIAGE CALLS A WHOLE LOT DIFFERENTLY

-AND ON TOP OF THAT THERE ARE MORE EMT'S THEN THERE ARE PARAMEDICS IN THE SERVICE SO THERE WOULD BE A HIRING FRENZY AND THE NEWBIE PARAMEDICS WILL PUT A STRAIN ON THE DEPARTMENTS BUDGET SALARY WISE

-PLUS ITS GONNA COST FOR MORE ALS EQUIPMENT

Too bad really, our Dept. is mostly Medic/emt or double medic units. We don't seem to have any problems , however as an EMT my scope here is more expanded.

[Asysin2leads]

EDP, don't take this the wrong way, but you're a moron when it comes to the whole ALS vs. BLS thing. First off, as my esteemed colleague from Texas pointed out, a paramedic IS in charge, ALWAYS (in lieu of a physician) when it comes to patient care decisions. If the Mensa medic thing went through, it would be a real case of medic says, EMT does, without question, because if they didn't, it would be disobeying a direct order, which would result in charges, termination, flogging, etc.

Secondly, exactly what is the problem with EMS spending money on ALS equipment? I mean, are you one of the holdouts for flying ambulances? Before you post next time, do a couple of steps, such as taking a deep breath, THINKING, maybe actually reading up on what the hell you are talking about, turning your caps lock off, and THEN trying to put together something that is somewhere near a coherent sentence. Okay? Thanks .

[bandaidpatrol]

I THINK STICKING A MEDIC WIT AN EMT IS NOT REALLY A GOOD IDEA

MOSTLY BECAUSE IT WOULD BE HAVIC

HA HA HA... A Probie! :roll:

First.. It's HAVOC.

Second.. I've seen very few EMS teams that were Medic/Medic. That's a waste of manpower. My whole career, I was the medic, and my EMT drove. In fact all of the units were Medic/EMT, unless they were EMT/EMT.