NYPD vs FDNY
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DesertMedic66
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Take 2 transporting ambulances out of service to help with 1 extrication instead of using a fire engine that doesn't transport. I can see the extended time on scene do to the ambulance having to clean up all their extrication equipment along with medical equipment. Talk about stretching out resources.
There is a difference between thinking outside the box and making a smart decision while thinking outside the box.
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As opposed to an engine? What happens of theres a fire in that district while they're working the extrication?
Staff it adequately, and it's not a problem.
What I see is a whole bunch of people arguing for the delivery model they're comfortable with, without examining other options. The FD might be the best way to provide rescue. But it might not be either.
Shishkabob
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How many extrications have you worked?
Let's just assume it's a single car MVC with a single patient:
Most ambulances are medic/basic. Show me a medic who hasn't worked a train wreck critical patient by themselves, and I'll show you a medic with minimal field experience (or in a multi-medic response agency). If a patient needs more than 1 provider due to being critical / "something going wrong", you better have a second ambulance there anyhow, as honestly, in a situation such as that, an EMT isn't going to cut it.
If you get the patient out and start transporting, you still only have the Paramedic in the back with the patient as the EMT will be driving... so that really didn't help much, did it?
If the situation warrants a provider in a car, you're really only ever going to fit one provider in there, and as far as my experience goes, it's always been the medic for extended extrication. (Though I have my partner crawl through the car on non-critical... air bags scare me!)
I have, and will, take a second ambulance out of service to back me up (or me back up another crew), if it is believed that the second Paramedic will be a benefit.
Just being honest here.
Let's just assume it's a single car MVC with a single patient:
Most ambulances are medic/basic. Show me a medic who hasn't worked a train wreck critical patient by themselves, and I'll show you a medic with minimal field experience (or in a multi-medic response agency). If a patient needs more than 1 provider due to being critical / "something going wrong", you better have a second ambulance there anyhow, as honestly, in a situation such as that, an EMT isn't going to cut it.
If you get the patient out and start transporting, you still only have the Paramedic in the back with the patient as the EMT will be driving... so that really didn't help much, did it?
If the situation warrants a provider in a car, you're really only ever going to fit one provider in there, and as far as my experience goes, it's always been the medic for extended extrication. (Though I have my partner crawl through the car on non-critical... air bags scare me!)
I have, and will, take a second ambulance out of service to back me up (or me back up another crew), if it is believed that the second Paramedic will be a benefit.
Just being honest here.
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The Fire Service are absolutely genius at turning people's car into bits and getting them out, while we do have Ambulance Rescue (SERT) they are more tactical/Police Armed Offenders/high angle medical support to the Fire Service sort of thing.
If some bloke needs his to be cut of his car here, the Fire Service are very aware they need to wait until Ambulance has the patient properly stabilised (as best as possible) and enough pain relief administered as appropriate, Brown tells you those goggles and crash gloves come in handy!
Of interest in New South Wales in Australia; their primary sources of extrication are Police Rescue and rurally ASNSW Rescue. It would appear that NSW Fire Brigades are not overly involved.
If some bloke needs his to be cut of his car here, the Fire Service are very aware they need to wait until Ambulance has the patient properly stabilised (as best as possible) and enough pain relief administered as appropriate, Brown tells you those goggles and crash gloves come in handy!
Of interest in New South Wales in Australia; their primary sources of extrication are Police Rescue and rurally ASNSW Rescue. It would appear that NSW Fire Brigades are not overly involved.
Shishkabob
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The Paramedics assessment can and should dictate what sort of methods are required for the patient. Unstable patients don't have the luxury of time that stable patients do, where you have more time to troubleshoot issues that arise.
I spent a lengthy amount of time on scene last shift thinking of the best way to move a patient from his couch to our stretcher, 3 feet away, causing the least amount of pain. That was AFTER I had already started an IV and gave fentanyl.
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True that, do you not get inside cars?
If some bloke pinned by his nunngered legs under the dashboard is that crook we put on a helmet, crash gloves and goggles and go in through the backseat or passenger seat or have the Fireys pry a door open with a crowbar and do what we need to in order to stabilise the patient as best we can while the Fireys get him out.
Kiwi (and Australian) ambo's are no strangers to wrecked cars' backseats, upside down cars, crawling under a bus etc
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I'm not making the argument that the FD has no place in extrication, just that its role shouldn't be assumed because they're the Fire Department. The area I'm from (NOVA) has adequate FD resources, a ton of extrication and technical rescue geniuses, adequate staffing on the squads ect to make extrication work.
Where I'm at now? We have questionable training, spotty coverage and lowest-bidder equipment by our county volly FDs, and a paid FD in town that may respond if they have no other incidents to attend to and if the pin is confirmed with one, sometimes two people. Meaning we have to get on scene and confirm the pin, wait for the vollys to scratch the call, then call the paid department. It would make a hell of a lot of sense for us to staff a vehicle like this:
with a supervisor and another person. This type of truck could carry a set of hydraulic tools, basic access gear ect. The hold-up? Funding....
Where I'm at now? We have questionable training, spotty coverage and lowest-bidder equipment by our county volly FDs, and a paid FD in town that may respond if they have no other incidents to attend to and if the pin is confirmed with one, sometimes two people. Meaning we have to get on scene and confirm the pin, wait for the vollys to scratch the call, then call the paid department. It would make a hell of a lot of sense for us to staff a vehicle like this:
with a supervisor and another person. This type of truck could carry a set of hydraulic tools, basic access gear ect. The hold-up? Funding....
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Shishkabob
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I've been known to and have no problem doing it if I think it will benefit the patient.
But if it's a car with undeployed airbags, I have no qualms asking the firefighters if they want to get in instead, while I "supervise"
Infact, I have a scar on my left arm from my last extrication... back in May.
(I NEVER get the good MVCs. One of the other trucks in my county gets a rollover every other shift, if not EVERY shift... all my MVCs are either very minor or self-extricated... gah)
Sounds like you blokes have such fun in the wild wild west. The last decent road traffic accident for Brown was like two years ago, some young guy pinned under the dashboard by his nunngered femurs.
*Brown rolls up in a beat up pickup truck, Dixie Chicks music blaring, spits on the ground, adjusts large cowboy hat and hip pouch full of suxamethonium
Can Brown come play frontier ambo now?
And before you say anything Natalie Maines is hawt
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Shishkabob
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We're in a rural county with high speeds (70mph) and no road barriers separating the lanes... it happens often.
My first true fatality as a 911 medic was NYE in an MCI MVC when I was first truck on, with 8 patients and 1 fatality. The most critical of the patients self extricated (which was amazing), while it took about 30 minutes to get the 7 patients out of the other vehicle.
Took over an hour to get the body of the fatality out... that's how mangled it was.
We have a lot of rural roads here, two lane, no barriers, winding, blind corners etc so for the the rural Paramedics really nasty road traffic accidents are not uncommon. Sad thing is the rural blokes are the thinnest-spread and the Fire Service are all volunteers so might be a while before you get cut out but hats off to those rural volunteers they give 200%
HEMS and PRIME Ambulance Doctors are frequent sights at our RTAs
Out in the sticks you get big heavy combination vehicles (tractor-trailers) and tractors and farm equipment involved too, people stuck under 4WD vehicles down the back of the farm, legs and other appendages lopped off by tractor PTOs and whatnot.
Brown remembers some bloke who got stuck in his little Japanese car under a rolled eighteen wheeler, poor bloke was super deluxe style crook.
HEMS and PRIME Ambulance Doctors are frequent sights at our RTAs
Out in the sticks you get big heavy combination vehicles (tractor-trailers) and tractors and farm equipment involved too, people stuck under 4WD vehicles down the back of the farm, legs and other appendages lopped off by tractor PTOs and whatnot.
Brown remembers some bloke who got stuck in his little Japanese car under a rolled eighteen wheeler, poor bloke was super deluxe style crook.
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Shishkabob
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[youtube]http://www.youtube.com/watch?v=LuNjOfan0zA[/youtube]
Martyn
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I think our figures speak for themselves: http://polkfire.polkfl.com/Information/StatisticalInformation/tabid/90/Default.aspx
Lets face it, Polk County (just about the biggest county in Florida) is a fire/ems system. Judging by the figures below if they didn't go to EMS calls and interfere then seems to me they would just be sitting on their butts all the time. Can of worms now open!!!
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Martyn
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Quote from Polk County EMS website:
As I see it it is all about fire wanting a bit of the action to justify their huge budgets
As I see it it is all about fire wanting a bit of the action to justify their huge budgets
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I could take three ambulances out of service or one ambulance and an engine company with tools out of service and get same number of people on scene. Which drains the system more?
And if I send three ambulances, I still have no fire protection, no fluid control, and nothing beyond basic hydraulic cutting equipment (which to be fair is often what is found on an engine company in some areas, though the guys around here have struts and cribbing for stabilization).
Aidey
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For the record, I rarely see our major FDs here have a hose pulled for fire protection or any kind of fluid control. Heck, I can count on one hand the number of times I've seen someone cut a battery...or even remove the keys from the ignition.
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This makes sense. But is it necessary for you to actually cut up the car? Surely if you told the responding fire crew that you had a critical patient they would get the picture and do what they can to provide a rapid extrication? The person on the tool doesn't need to be a medic, they need to be good at cutting cars into pieces carefully. I agree though, the highest level medical provider should be calling the shots at an extrication.
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In your situation that makes tons of sense considering that you are the only full time emergency service around besides a sheriffs department or something. I'm sure they too are stretched very thin, and have no interest in rescue services. But for areas that have 24/7 FD coverage with good staffing and equipment, wouldn't it make sense to save more ambulances for EMS calls?
Cup of Joe
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In my opinion: EMS should be all about the patient. Police should secure the scene and continually assess and maintain scene safety. Fire should be responsible for extrication of the patient.
On a scene of a bad, one car MVA that requires extrication, police should place their cars and flares to protect the scene from coming traffic, and the officers themselves should make sure traffic keeps moving around the scene, as well as keeping an eye out on the scene for anything that could make the scene unsafe. EMS should be focused on the patient. Fire should stabilize the vehicle and start cutting. Lets say something in the video happened, where PD decided to lift a car without it being stabilized, EMS should say "That's not safe for our patient" and Fire should say, "That's not the best way to get the patient out."
On a scene of a bad, one car MVA that requires extrication, police should place their cars and flares to protect the scene from coming traffic, and the officers themselves should make sure traffic keeps moving around the scene, as well as keeping an eye out on the scene for anything that could make the scene unsafe. EMS should be focused on the patient. Fire should stabilize the vehicle and start cutting. Lets say something in the video happened, where PD decided to lift a car without it being stabilized, EMS should say "That's not safe for our patient" and Fire should say, "That's not the best way to get the patient out."