EMS systems similar to FDNY

[STXmedic]

Thanks, how often do you get to do that?

Resuscitation efforts weren't ceased, as chest compressions were done enroute to a hospital, closest cardiac center which wad maybe 5 minutes away, the guy died in the er.

I have no idea what it was for, maybe for calcium? Or the fact that he did shock like 5 times.

Me? Never. Though that may change in the next 6 months or so. Chaz would be the better person to comment on that.

My guess (how I could see it playing out here) is that they called for an opinion for a refractory VF patient, and med control advised to continue resus and transport. Purely speculation, though. It may just be a really crappy system where they have to call for common interventions on dead people.

 

[lukgiel]

Me? Never. Though that may change in the next 6 months or so. Chaz would be the better person to comment on that.

My guess (how I could see it playing out here) is that they called for an opinion for a refractory VF patient, and med control advised to continue resus and transport. Purely speculation, though. It may just be a really crappy system where they have to call for common interventions on dead people.

It was a fun call nonetheless. My first cardiac call, and one of my first calls.

Why do you think that'll change in 6 months? Are you switching jobs?

 

[NomadicMedic]

Could have been for the calcium. Or bicarb. Or mag. Or to stop wasting everyone's time.

FWIW, Seattle Fire Medics call for everything. The orders are very seldom denied, but even for a simple ACS patient, they have to call, present the patient to the medic one doc and ask permission for ASA, Nitro and morphine. Every time.

 

[lukgiel]

Could have been for the calcium. Or bicarb. Or mag. Or to stop wasting everyone's time.

FWIW, Seattle Fire Medics call for everything. The orders are very seldom denied, but even for a simple ACS patient, they have to call, present the patient to the medic one doc and ask permission for ASA, Nitro and morphine. Every time.

How is it wasting anyone's time, that's the turn the discussion took

 

[chaz90]

How is it wasting anyone's time, that's the turn the discussion took

Continuing efforts on a non-viable corpse=Wasting everyone's time.

"Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."

 

[lukgiel]

Continuing efforts on a non-viable corpse=Wasting everyone's time.

"Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."

I'd still shock once more to be on the safe side:rofl:

 

[STXmedic]

"Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."

Okay, this made me chuckle.

 

[TransportJockey]

I can count on one hand the amount of times I have had to call for orders in my rural 911 setting. Basically everything we do is on standing orders. .. And our scope is not narrow by any stretch of the imagination

 

[NomadicMedic]

I'd still shock once more to be on the safe side:rofl:

And that's why you carry the bags...

 

[lukgiel]

And that's why you carry the bags...

It was a joke
Oh, and the bags are always on the stretcher, not much carrying.

 

[46Young]

@46young

I forgot to mention, I do not agree with you saying that nyc protocols are strict, on the contrary, they are very lax. Here, it is up to the medics discretion as to the administration of medications, in other places, Especially where transport times are long, you have to call medical control for everything

I looked at the 2014 REMAC protocols. They are restrictive compared to other areas like Wake Co. NC, just to give one example.

IDK if things have changed, but when I was a medic in the NYC 911 system from 2005-2007, we had to call to get permission to "jump" protocols if we needed to treat a patient with several things going on. Also, we were restricted to just the OLMC options listed after we run through the standing orders.

Here, our protocols are guidelines - we can give or withhold a medication/intervention so long as we can justify why, we can pull from several protocols at the same time when needed, we can call OLMC for anything within our scope appropriate for the pt, not just what's listed as options, and we have a lot more stuff as standing orders when compared to NYC REMAC. for example, we don't need to call to run Dopa, give additional benzos for Sz, repeat epi IM for the anaphylaxis or asthma (we can start an epi drip as well for anaphylaxis), our choice of fent or MS for pain mamagement, we have Ketamine for EDP's, we don't need to call for peds IV access for asthma, anaphylaxis or resp. arrest, CPAP is not resticted to just APE pts, and we also have the Lucas II, KingVision, and we can do field Cricothyrotomy, not just neede cric.

I feel that we have a lot more lattitude to do what we need to do, with less hassle, so long as we can give a good reason why we did what we did (or didn't do) afterwards.

The 2014 NYC REMAC protpcols are much better than what I had to make do with when I last worked in the system, but there are many other systems that have much more freedom.

 

[lukgiel]

I looked at the 2014 REMAC protocols. They are restrictive compared to other areas like Wake Co. NC, just to give one example.

IDK if things have changed, but when I was a medic in the NYC 911 system from 2005-2007, we had to call to get permission to "jump" protocols if we needed to treat a patient with several things going on. Also, we were restricted to just the OLMC options listed after we run through the standing orders.

Here, our protocols are guidelines - we can give or withhold a medication/intervention so long as we can justify why, we can pull from several protocols at the same time when needed, we can call OLMC for anything within our scope appropriate for the pt, not just what's listed as options, and we have a lot more stuff as standing orders when compared to NYC REMAC. for example, we don't need to call to run Dopa, give additional benzos for Sz, repeat epi IM for the anaphylaxis or asthma (we can start an epi drip as well for anaphylaxis), our choice of fent or MS for pain mamagement, we have Ketamine for EDP's, we don't need to call for peds IV access for asthma, anaphylaxis or resp. arrest, CPAP is not resticted to just APE pts, and we also have the Lucas II, KingVision, and we can do field Cricothyrotomy, not just neede cric.

I feel that we have a lot more lattitude to do what we need to do, with less hassle, so long as we can give a good reason why we did what we did (or didn't do) afterwards.

The 2014 NYC REMAC protpcols are much better than what I had to make do with when I last worked in the system, but there are many other systems that have much more freedom.

So it seems like remac protocols are getting to be more up to the medics judgement which is good, even though there are medics who I wouldn't want touching me haha.

For the bls protocols, I think they are adding two new medications in 2014 Protocols

 

[Jon]

Continuing efforts on a non-viable corpse=Wasting everyone's time.

"Mother, may I please stop compressing the chest of this dead body? I've thrown all my drugs at it, their EtCO2 is measured in decimal points, and their EKG looks like the topography of Delaware."

You sir... you win the internet today.

 

[Jon]

So it seems like remac protocols are getting to be more up to the medics judgement which is good, even though there are medics who I wouldn't want touching me haha.

For the bls protocols, I think they are adding two new medications in 2014 Protocols

Actually, it sounds like REMAC is just coming into what I've had in PA for the last 10 years (and that's STATEWIDE, and you're not even there yet), in that I can do MUCH without orders, but I still have protocols I must follow, and times where I need base command.

The problem of "there are medics I wouldn't want touching me" is a HUGE problem in your system. FDNY isn't alone in that, by any means, but thats a big deal. You need competent providers, and a good QA/QI system to ensure they are.

Are you seeing that perhaps FDNY isn't as awesome as you think?

 

[lukgiel]

Actually, it sounds like REMAC is just coming into what I've had in PA for the last 10 years (and that's STATEWIDE, and you're not even there yet), in that I can do MUCH without orders, but I still have protocols I must follow, and times where I need base command.

The problem of "there are medics I wouldn't want touching me" is a HUGE problem in your system. FDNY isn't alone in that, by any means, but thats a big deal. You need competent providers, and a good QA/QI system to ensure they are.

Are you seeing that perhaps FDNY isn't as awesome as you think?

I'm not thinking that FDNY is the best thing since sliced bread, but it is where I want to work, out of the many companies and hospitals here, it's the best option for me.

My goal is to not be a medic like that, but be the best damn medic and patient care provider, as I'm sure so does everyone on this forum, which is why we're here, to un wind, learn and ask questions

 

[46Young]

So it seems like remac protocols are getting to be more up to the medics judgement which is good, even though there are medics who I wouldn't want touching me haha.

For the bls protocols, I think they are adding two new medications in 2014 Protocols

NYC REMAC is definitely getting better from what we had in 2007. Looking back, it was like being in the stone age.

Advantages that NYC has over most other systems is that it's tiered, and that there are a lot of poor people that do not take care of their health. The result is that medics get to see a lot of critically ill people on a regular basis, use their protocols a lot, and the BLS can also handle a lot of stuff on their own, and also be able to start treatment on ALS patients if they're greater than ten mins. away.

Outside of NY (and a few NJ systems), the BLS don't do much more than drive the medics, and the medics run mostly BLS and just start lines and run a few 12 leads here and there. If I had to choose, I'd go with restrictive protocols and a lot of critically ill patients, rather than an all-ALS system with good protocols and an affluent, healthy population that I have here. 90% of my transports are VOMIT - vitals, O2, monitor, IV, txp. I've never been so bored with EMS in my life. I got my best experience in NY, but I'm making mountains of cash now haha