All the wrong facts

The Riverhead Police Accident Investigation Division have released thier findings on the Collision that Killed 2 EMS Workers.

The findings are that the accident was caused by REMSCO insisting on minimum response times from volunteers.


Come on now. This had nothing to do with wanting to get an ambulance on scene within a reasonable amount of time. They were transporting the patient to the hospital at the time. I'm not going to debate what caused the accident, but at least base your statements in the facts, unless you can show me how your time from scene to the hospital affects your scene response time. Let's not pervert the tragedy that happened in Riverhead by attacking a policy you disagree with when the two have nothing to do with each other. Shame on you.

What is the problem with expecting an ambulance to be on the scene within a reasonable amount of time? It's been said before, but maybe it's worth repeating; if the volunteers can't handle it, maybe we need to try a new system (no I'm not saying it is guaranteed to work, but if our current system doesn't work we need to change it). Why is everyone afraid of quality improvement (ie tracking response times to calls)? I'm tired of everyone saying that the information will be used in an inappropriate manner. If you are not doing anything wrong, there should be no need to worry. Don't give me the old line about 1st responders being on the scene in a certain amount of time. 1st repsonders cannot transport to the hospital and are therefore useless in transporting the pt to definitive care. It does a trauma pt or a critical medical pt no good to sit on the scene with a 1st responder with no ambulance. These pts need to be in the hospital where they can recieve proper care. Welcome to the 21st century. Our communities deserve quality care. We need to provide that care or get out of the way and let some who can do it take over.

[Turk182.2]

The Riverhead Police Accident Investigation Division have released thier findings on the Collision that Killed 2 EMS Workers.

The findings are that the accident was caused by REMSCO insisting on minimum response times from volunteers.


Come on now. This had nothing to do with wanting to get an ambulance on scene within a reasonable amount of time. They were transporting the patient to the hospital at the time. I'm not going to debate what caused the accident, but at least base your statements in the facts, unless you can show me how your time from scene to the hospital affects your scene response time. Let's not pervert the tragedy that happened in Riverhead by attacking a policy you disagree with when the two have nothing to do with each other. Shame on you.

What is the problem with expecting an ambulance to be on the scene within a reasonable amount of time? It's been said before, but maybe it's worth repeating; if the volunteers can't handle it, maybe we need to try a new system (no I'm not saying it is guaranteed to work, but if our current system doesn't work we need to change it). Why is everyone afraid of quality improvement (ie tracking response times to calls)? I'm tired of everyone saying that the information will be used in an inappropriate manner. If you are not doing anything wrong, there should be no need to worry. Don't give me the old line about 1st responders being on the scene in a certain amount of time. 1st repsonders cannot transport to the hospital and are therefore useless in transporting the pt to definitive care. It does a trauma pt or a critical medical pt no good to sit on the scene with a 1st responder with no ambulance. These pts need to be in the hospital where they can recieve proper care. Welcome to the 21st century. Our communities deserve quality care. We need to provide that care or get out of the way and let some who can do it take over.

Right on!

[ProEMT]

Preach the truth brother, a sane voice in the wilderness is heard from

[BadNewsBear]

From what I understand the driver of the semi pulled over towards the right side of the road and the amb driver thought he was pulling over based on the fact that he was lights and siren. Reasonable thought in the heat of the moment. Does anyone know if the driver of the semi had his left directional on as he pulled towards the right? This was truly an MVA that should be labeled as an accident.

[clay cole AEMT-CC]

WRONG WRONG WRONG! Pulled over on not pulled over, the drive of the ambulance MUST be able to control the vehicle and use DUE DILLIGANCE (which means to be able to stop for those in Riverhead and South Country) in case the drive of the truck does something unexpected (which should have been expected)




Nothing accidental about it! Negligence!

Clay

[pay.]

well, I guess you'd better build more hospitals on the north fork and out east-or by choppers for all the depts. If getting to the hospital, and that's what YOU said was important ,than we near hospitals shouls have more allowance to get to a call? It only takes 6-10 minutes to get to port jeff from my dept. What does someone in Cutchogue do? A paramedic first responder by the way can provide almost all the crucial care needed on scene while 99% of the cases can afford to wait. If you REALLY want to improve efficiency and safety-educate the public about not using the ambulance as a friggin taxi for shit like sprained fingers(with 2 adults and 3 cars in the driveway!)Try educating the public about pulling over....SAVE LIVES..stop whining. Timing abulance 21s on scene will be misunderstood by the public.

[turk182.2]

well, I guess you'd better build more hospitals on the north fork and out east-or by choppers for all the depts. If getting to the hospital, and that's what YOU said was important ,than we near hospitals shouls have more allowance to get to a call? It only takes 6-10 minutes to get to port jeff from my dept. What does someone in Cutchogue do? A paramedic first responder by the way can provide almost all the crucial care needed on scene while 99% of the cases can afford to wait. If you REALLY want to improve efficiency and safety-educate the public about not using the ambulance as a friggin taxi for shit like sprained fingers(with 2 adults and 3 cars in the driveway!)Try educating the public about pulling over....SAVE LIVES..stop whining. Timing abulance 21s on scene will be misunderstood by the public.

Since when can a paramedic first responder provide all of the crucial care on the scene? I didn't know that they could do an open thoracotomy on a traumatic arrest, or put a chest tube in an unstable pt with a hemothorax. Can they do a percutaneous cric on a pt with a difficult airway? How 'bout transvenous pacing on an unstable cardiac pt who doesn't capture with transcutaneous pacing? Come to think of it I haven't seen too many do a pericardial centesis on a pt with pericardial tamponade. Is BiPAP in the protocols for CHF/COPD pts? Don't get me wrong, I think that they do a bang up job, but they are limited in what they can do.

The unstable pt needs to be gotten to the hospital, period. Building more hospitals and buying everyone helicopters (which is what I think you were saying in your broken English) obviously isn't the answer. Yes, a pt in Cutchogue will have to wait longer to get to the hospital than a pt in Port Jeff will, simple physics. The pt needs to be gotten to the hospital as expeditiously as possible, this means reducing the time from the 911 call to 21 at the hospital. There is nothing we can realistically do to reduce our on-scene and 18 times. The only time left is your response time, which can be reduced, saving the pts valuable time. It's great that we have people (Medics, CCs) that can do things on the scene to save lives in certain cases (shocking pts in Vfib or VTach). These people are people who probably would not make it to the hospital alive if they were not shocked early, on the scene. So, yes in these cases a paramedic 1st repsonder can do great things. However, there are also the cases I pointed out above where it is more important for the pt to get to the hospital than to sit on the scene waiting 30 minutes with a paramedic wondering where the ambulance is.

Educating the public about using the ambulance as a taxi won't increase efficiency. In most districts (notice I'm not saying all districts), most (again not all) calls come in one at a time. In the busier districts this is not true obviously. This is why priority dispatchig is a good idea. If we are going to educate the public, why not educate as to what the 21 on scene time means. I think they may just be smart enough to get it. They may not like the fact that it is taking some ambulances to get to a call in an hour, but I think they will understand what it means. It would also help the public and our relationship with them if we recorded times based on the call and not the corps. A pt living in ambulance district A may wait over an hour for an ambulance because company A and company B couldn't get out, but company C is on the road in 2 minutes (once they finally get the call). The the members of company C it looks like they did a great job (which they did), but to the pt it looks like it took company C over an hour to get to the call. If we track the calls, those in the districts that are able to handle their calls can show that it was not them, but another company that caused the delay. I hope this makes sense, I know it's a little wordy.

I've rambled on long enough.

[Lets Go Paid]

The Riverhead Police Accident Investigation Division have released thier findings on the Collision that Killed 2 EMS Workers.

The findings are that the accident was caused by REMSCO insisting on minimum response times from volunteers.

Clay Cole, AEMT-CC= ASSHOLE!

[Turk182.2]

The Riverhead Police Accident Investigation Division have released thier findings on the Collision that Killed 2 EMS Workers.

The findings are that the accident was caused by REMSCO insisting on minimum response times from volunteers.

Clay Cole, AEMT-CC= ASSHOLE!

Oh come. Let's not turn a good debate into petty name calling. If you don't have something useful to say, keep it to yourself.

The Riverhead Police Accident Investigation Division have released thier findings on the Collision that Killed 2 EMS Workers.

The findings are that the accident was caused by REMSCO insisting on minimum response times from volunteers.

Clay Cole, AEMT-CC= ASSHOLE!

Oh come. Let's not turn a good debate into petty name calling. If you don't have something useful to say, keep it to yourself.

Anyone who believes REMSCO was responsible for that accident deserves to be called a name. Just another stupid vollie who does not know what he is talking about..BAN THE VOLLIES.

[reality.]

In over 99% of calls, none of those procedures is necessary-less than 1% of patients are truly Unstable, although if you knew protocol, you'd know we dont use cups anymore. Response times do not equate with time of call to arrival at hospital!!!The hospital may be 5 or 25 miles away. If they're that "critical"-use aviation. 10year olds who sprain their knee at dance class shouldn't be using the time and all the others may be "treated" by the paramedic until transport. They are not Mds, but again ,a CC can keep over 99% of our patients until 21 at the ER. No one needs to do surgery on the ground - you guys make yourselves a bit too important. The same drugs and aed are applied on scene as in ER. Not too many chests are cracked open except on TV.

[:)]

Although I agree with "Reality" on a lot of your points, bear in mind that we STILL do utilize the CUPS scale, it was deemphasized in the state curricula, not removed entirely. In many systems in NYS the CUPS scale is remarkably helpful at determining the accuracy of Emergency Medical Dispatch PSAPs through correlational studies and scatterplot graphs.

Thanks

[Turk 182.2]

In over 99% of calls, none of those procedures is necessary-less than 1% of patients are truly Unstable, although if you knew protocol, you'd know we dont use cups anymore. Response times do not equate with time of call to arrival at hospital!!!The hospital may be 5 or 25 miles away. If they're that "critical"-use aviation. 10year olds who sprain their knee at dance class shouldn't be using the time and all the others may be "treated" by the paramedic until transport. They are not Mds, but again ,a CC can keep over 99% of our patients until 21 at the ER. No one needs to do surgery on the ground - you guys make yourselves a bit too important. The same drugs and aed are applied on scene as in ER. Not too many chests are cracked open except on TV.

1% sounds like a low number, but let's put it in perspective. I don't know the exact number, but let's say that SCEMS responds to 100,000 calls per year. If 1% of these pts need one of those procedures, or one of the many that have not been mentioned, that mean there are 1000 pts per year that need them. So, you may not see every critical pt, but they are out there and need to be taking care of in an expeditious manner (in the ER, cath lab or OR). In the limited population that you see as an individual provider there may not be many critical pts but when you look at the population overall there are quite a few. You can say that 1000 is not that many in the grand scheme of things, but if you or a loved one are one of those 1000, you are not going to want to die because an ambulance couldn't get to the scene in a reasonable time. I am not talking about the knee sprains and stubbed toes. They can wait as long as they need. These people should not be included in the response time evaluation. I am also not talking about using CUPS, I am talking about clinical judgement in deciding if a pt is unstable.

The ambulances do NOT carry the same meds as they have in the ER. Do they have dobutamine, levophed, neosynephrine drips, or Natrecor for CHF? Any rigs carry Nipride or tridal? How many medics have put in central lines on pts with no peripheral access? Again, I am not putting down the prehospital providers. Most of them do an awesome job. As far as cracking chests, it is done more than you are obviously aware of. It is done 1-2 times per month at Stony Brook and almost as frequently at BMH.

Please tell me how response time to scene does not affect your call received to 21 at hospital time. I fail to see how a part doesn't affect the whole (especially when it is one of the largest parts).

[the other brother]

ban every volly if we were paid we could weed out the girls and the bad apples

ban every volly if we were paid we could weed out the girls and the bad apples


I dont see how being "paid" would remedy this situation.


I know of a "paid" department that has "girls", drug abusers, women/spouse abusers, thieves, drunks, assaults on brother firemen, arrests for patronizing prostitutes, DWI arrests, etc etc etc.

Somehow I don't think a "pay" check would make a difference...........

In over 99% of calls, none of those procedures is necessary-less than 1% of patients are truly Unstable, although if you knew protocol, you'd know we dont use cups anymore. Response times do not equate with time of call to arrival at hospital!!!The hospital may be 5 or 25 miles away. If they're that "critical"-use aviation. 10year olds who sprain their knee at dance class shouldn't be using the time and all the others may be "treated" by the paramedic until transport. They are not Mds, but again ,a CC can keep over 99% of our patients until 21 at the ER. No one needs to do surgery on the ground - you guys make yourselves a bit too important. The same drugs and aed are applied on scene as in ER. Not too many chests are cracked open except on TV.

1% sounds like a low number, but let's put it in perspective. I don't know the exact number, but let's say that SCEMS responds to 100,000 calls per year. If 1% of these pts need one of those procedures, or one of the many that have not been mentioned, that mean there are 1000 pts per year that need them. So, you may not see every critical pt, but they are out there and need to be taking care of in an expeditious manner (in the ER, cath lab or OR). In the limited population that you see as an individual provider there may not be many critical pts but when you look at the population overall there are quite a few. You can say that 1000 is not that many in the grand scheme of things, but if you or a loved one are one of those 1000, you are not going to want to die because an ambulance couldn't get to the scene in a reasonable time. I am not talking about the knee sprains and stubbed toes. They can wait as long as they need. These people should not be included in the response time evaluation. I am also not talking about using CUPS, I am talking about clinical judgement in deciding if a pt is unstable.

The ambulances do NOT carry the same meds as they have in the ER. Do they have dobutamine, levophed, neosynephrine drips, or Natrecor for CHF? Any rigs carry Nipride or tridal? How many medics have put in central lines on pts with no peripheral access? Again, I am not putting down the prehospital providers. Most of them do an awesome job. As far as cracking chests, it is done more than you are obviously aware of. It is done 1-2 times per month at Stony Brook and almost as frequently at BMH.

Please tell me how response time to scene does not affect your call received to 21 at hospital time. I fail to see how a part doesn't affect the whole (especially when it is one of the largest parts).

True that! Some common sense.

This crap should be taken down. This is a FD thread. Not a "care giver" thread.

This crap should be taken down. This is a FD thread. Not a "care giver" thread.

Oh please, it takes a little more intelligence to do EMS. "Ugh, fire, put water on, ugh, it go out. Let's go drink beer."

EMS calls are the only way the FDs can try to justify their exorbitant budgets.

We are here to help the public, not help ourselves. If we can not provide the best service for the PUBLIC then lets change the system to meet the public's need.

[only me]

what do we do when 2 3 or 4 calls come in at the same time. do we just take care the firsr one .their is no way to take care of all of them in a reasonable time .we do the best we can as vol;s. if we pay someone 8 to 4 he or she can only one call at a time .if two come in only one is handle the vol;s handles others.vol;s drive from home to f d then to call it takes time my hats off to the vol's

In a countywide system when one area gets 3 or 4 calls ambulances from ajoining areas would be assigned to those calls. The rest of the units would be repostioned in the area to reduce response times. The Islip medics do this all the time. With the exception of the 3rd division how many times does 5 ajoining districts get hit with 3 ambulance calls at the same time.

In a countywide system when one area gets 3 or 4 calls ambulances from ajoining areas would be assigned to those calls. The rest of the units would be repostioned in the area to reduce response times. The Islip medics do this all the time. With the exception of the 3rd division how many times does 5 ajoining districts get hit with 3 ambulance calls at the same time.

What Islip Medic units? They used to have 7, now they are lucky to have 3 or 4 working. Losing proposition for North Shore!