NYPD vs FDNY

[MrBrown]

The Fire Service should handle extrication; thats their job, its what they have done for donkeys years and they are very good at it.

New South Wales in AU has Ambulance Rescue in some areas which provides extrication at road traffic accidents otherwise (like generally anywhere else in the world) its done by NSW Fire Brigades.

Locally speaking Ambulance Rescue (SERT) provides support to the Police Armed Offenders Sqaud, CBRN and medical support for USAR/high angle/cliff/cave rescue.

If somebody here needs to be cut out of a car, the Fire Service is very aware they need to work with/wait for Ambulance to take care of the patient.

Most road traffic accidents you can get an ambo in the back, through the windscreen, under the bus etc to get some initial assessment and stabilisation, collar, bleeding control/torniquet as appropriate, intravenous fluids or pain relief.

 

[Shishkabob]

Re-watched the video.


Look at 4:55 when the car is dropped. It's clearly evidence that chocks were in place, under the car when it fell. It's also clearly evident that the car did not drop all the way back down to it's original position, but at a higher position due to the chocks being in place.

 

[Shishkabob]

What do you do with a Trauma patient that an EMT cannot do? Pain meds? I would really love to know. I don't know the protocols you have with AMR. Here as a Basic, I can start an IV, give 250 ml of fluid. I can intubate patients with a Kingtube after the medic has missed 2 times.

I don't work for AMR anymore, but they sure as hell did not allow EMTs to do IVs, Kings, or ETI. My current agency allows EMTs to do Kings, and honestly if I need an airway while a patient is still trapped, chances are it will be a King.



You mean besides the ability to do a much better / thorough assessment?
Analgesia and sedation
More than your "250ml of fluid", if warranted. (Not to mention different kinds)
Intraosseous access
EJ
RSI / DAI
Spinal clearance



I can go on if you wish?

I would rather have a firefighter cut out a person out of a vehicle because they have been TRAINED doing that.

Yet another fallacy that I wish you would quit perpetuating.

EMS can, and in many places is, trained in it as well. Why not have them do it?

if EMS/Private Ambulance companies wanted to do Extrication, it would require the EMT's/Medics on board to also be held to a certain physical standard which then would certainly eliminate people from EMS..

How is that a bad thing?

 

[MassEMT-B]

if EMS/Private Ambulance companies wanted to do Extrication, it would require the EMT's/Medics on board to also be held to a certain physical standard which then would certainly eliminate people from EMS..

I have seen fat fire fighter. Where I use to volunteer almost all the firefighters were overweight and they had no problem doing extrications. Also being in shape for EMS isn't a bad thing. I don't want a partner that isn't strong enough and is going drop the person we are stair chairing most likely hurting me and the pt. I really don't care who does extrication as long as they know how to do it safely and efficiently.

 

[CAOX3]

Im pretty sure I could be trained to do just about anything including extrication.

The real question is what would be the benefit of having me do it opposed to the fire department.

 

[Shishkabob]

PS-- Anyone else see the hyper-rotation of the neck? He is prone with his chest to the ground, as evidence by his legs and left hand positions. His head is quite obviously rotated unnaturally to the left, almost to a 180.



Ouch.

 

[MusicMedic]

PS-- Anyone else see the hyper-rotation of the neck? He is prone with his chest to the ground, as evidence by his legs and left hand positions. His head is quite obviously rotated unnaturally to the left, almost to a 180.



Ouch.

i just noticed that.. yeah double ouch.. Mucho Spinal Damage there.. even if he survived he probably would have some degree of paralysis..

and from the looks of it the front of the car ran over his head before coming to a complete stop? the second tire almost ran over him agian?

this whole situation is Fubar

 

[clibb]

I don't work for AMR anymore, but they sure as hell did not allow EMTs to do IVs, Kings, or ETI. My current agency allows EMTs to do Kings, and honestly if I need an airway while a patient is still trapped, chances are it will be a King.



You mean besides the ability to do a much better / thorough assessment?
Analgesia and sedation
More than your "250ml of fluid", if warranted. (Not to mention different kinds)
Intraosseous access
EJ
RSI / DAI
Spinal clearance



I can go on if you wish?


Yet another fallacy that I wish you would quit perpetuating.

EMS can, and in many places is, trained in it as well. Why not have them do it?








How is that a bad thing?

A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.

 

[usalsfyre]

A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.

You mean he becomes a competent and knowledgeable clinician?

The big problem with most EMTs (and for that matter, a large number of paramedics) assessments is "you don't know what you don't know".

 

[Shishkabob]

A much better and thorough assessment, Really? Like put the patient on the monitor? What else?

So, a first responder will be as good as a doctor in assessing and treating trauma, correct? I mean, what's the doctor gonna do, an x-ray? What else?

I'll be the first to say that no provider should pull the "I was only educated to this level", as yes, a first responder, EMT, etc etc, can and SHOULD continue their education. Your assessment isn't soley based off your skills and your initial education.

But let's be honest here; the average paramedic has a deeper understanding of anatomy, physiology, and assessment than the average EMT. That's the very reason WHY they have different levels, and further schooling to do the levels. It's not an attack on EMTs. (Go through my last 3 years of posts and see my view on "Paragods" and EMTs)


(JPIN isn't average, he's a freak)

I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.

Guess I need to add more since you're fixated on the skill aspect;

Chest decompression
Needle cric
Surgical cric

 

[samiam]

Our police officers are triple cross trained EMT-B, Police, Fire Their main job is police work however they are usually first on scene and will stabilize and ASSIST as needed.

 

[Handsome Robb]

A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.

Stop before you say something more ridiculous, please.

Trauma isn't just "put the white stuff on the red stuff and drive fast"

 

[MrBrown]

A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.

This statement is the perfect example of sticking your foot in your mouth.

Patient assessment is not determined by what fancy toys you have at your disposal but yes, they sure do help.

 

[MonkeySquasher]

I agree! Anything that has to do with a patient's care is totally tied to patient extrication and rescue. Let's follow this concept!

So, an accident that needs patients extricated is DEF tied to patient care. This will require hydraulics which need a generator. We'll need a pump and water tank for the charged handline as required by NFPA, as well as proper extrication PPE, and possibly struts/jacks/rams/airbags/cribbing. This may also require set of irons, and cutter for the batteries. Also, a saw or two couldn't hurt, with extra blades and batteries/fuel. Also, tarps. If the vehicle is engulfed when we arrive, we would need airpacks to extinguish it, as required by both NFPA and OSHA. I would want to extinguish it myself to ensure I don't cause steam burns to my patient. If it's dark out, we'll need a light tower.... or four.

BUT WAIT! Little Timmy just fell down the well and is injured! Well now we'll need properly trained people, and at a minimum a few hundred feet of life-safety rope, a tripod, harnesses, rack, and other proper tech-rescue equipment and training. If this well is far from a roadway or down a ravine, we could also use a stokes basket and more rope and manpower, all rescue- and medical-related, of course.

But now, a tank is leaking some fertilizer and people are sick! Clearly only rescue-trained Paramedics can save they day, and we need to get to our patients. I now require Level A suits to go with my SCBAs, along with proper decontamination equipment and that watertank/pump/hose combination again. I'll retrieve and decon these people myself to ENSURE proper patient care.

What's that, a person swept away from a ditch during a storm? Well good thing we have our RIB and lifejacks (floaties?) along with cold-water-immersion suits, because when they patient gets onboard I'll need to monitor them for hypothermia, initiate rewarming, and possibly even perform CPR or intubation immediately.

And then I got to thinking, what if there's a workplace shooting and people are wounded inside? There's been multiple instances of workplace or school violence where deaths occur because rapid care wasn't given to victims. And I need to save them, so my rescue team will need ballistic helmets and protective vests, possibly shields. But now to protect ourselves and our patients, we'll all need to be armed. No sense going about this half-arsed.

....On second thought, maybe a tank, so we can just DRIVE ON IN THERE TO EXTRACT THEM OURSELVES. h34r:


tl;dr - I get it, EMS is still the redheaded step-child that is trying to make a name for itself. Fire is the bratty older brother who always gets the cool stuff and gets what it wants. The fact remains, we are three pillars of public service that cannot stand alone without the other two. We should each stick to what we do best. There's no denying, our common goal is proper service to our patient. My job is patient care, and if I feel there's an issue with my patient or extrication, I'll speak to the person doing it. Otherwise, I don't care who cuts the damn car, as long as my patient gets out. I am VERY EMS-oriented, and stress proper patient care at all times. But turning over anything related to patient treatment to us? It's a bit much.

 

[46Young]

Just more excuses, really. There's not a single reason why EMS cannot / should not do basic extrication.



Fire is essentially a big wasteful sink anyhow. Why not divert the funds from them to EMS? We do more work anyhow, and they do the little side-gigs that are hardly ever done but use to justify their budgets...

My understanding about the fire service, from the inside, is that we're a catch-all. Our job description, in a nutshell, is that we solve chaos. That's it.

We're not the power company, but we respond to wires down. We're not the gas company, but we respond to both inside and outside gas leaks. My department spent several days in the Huntington area of Fairfax County, which saw significant flooding, assisting the victims, helping them pump water out of their basements and first floors, getting them out of their homes, etc. Our USAR teams go to other jurisdictions and countries to help with natural disasters. We aren't the Coast Guard, but we do Swift Water Rescue. We're not locksmiths, but we're called to open up locked cars, and even people's homes. We do "Public Service" calls, which encompass everything from lifting Grandma off of the floor and putting her back in bed to clearing tree limbs off of the sidewalk.

This all hazards, catch-all, solving chaos mandate explains why the fire service got into EMS in the first place. In some areas, especially rural areas, EMS simply didn't exist until the local fire authority assumed that responsibility. I believe that my department is one of them, combined fire and EMS since the beginning. 1932 at the latest, it would appear:

http://www.fairfaxcounty.gov/fr/deptinfo/history.htm#pre

"1932 - Volunteer Station 1 (McLean) purchased the first Ambulance - a 1926 LaSalle."

If your department or agency was founded later than 1932, then fire based EMS was in existence before your orgainization was.

I suppose other departments noticed that these departments had been doing EMS, and decided that it's appropriate that they do the same. Some assumed EMS for the right reasons. Others, obviously, had more exploitative motives.

This all hazards mandate has led the fire service to assume whatever duties they can secure without opposition. This explains the Hazmat operations, TROT (Techincal Rescue), EMS, Fire Marshalls, Extrication, etc.

Yes, it's job security, and you can't really fault forward thinking individuals for seeking to secure their positions and careers. Besides, having these functions on your resume makes you quite marketable for another career after retirement.

 

[46Young]

Most cities fire workload is about 20% of EMS workload. How many fires realistically are there? How many HazMats?

80/20 or 70/30 would be an accurate precentage in favor of EMS if you were talking about call volume only. The real numbers are somewhat different. Let me explain:

Certain suppression unit responses involve much more than only one unit. For example, an inside gas leak uses two engines, a truck company, a medic unit, and a BC (4/1 ratio). An alarm bell always gets two engines and a truck. An MVA gets an engine and a medic unit unless it's a suspected pin job, then you get one or two squads (one for each dierction if on the highway), so it's 3/2, or 4/2. A box alarm gets four engines, two trucks, a heavy rescue, two BC's, an EMS supervisor, and a medic unit (two if the first gets a pt), so it's a 9/2 or 9/3 ratio. Add some more suppression pieces if you need a fire boat or multiple tankers to run a water shuttle operation. Don't forget rehab units and Light & Air units as well for second alarms, not to mention the extra engines, trucks, etc. that come with second alarms and greater. The medical aid calls where you get an engine with the medic unit can be argued in either direction depending on who you talk to.

A more accurate number would be net utilization for each unit, quantified by the number of calls each one responds to, tallied for fire, tallied for EMS, then compared for a more accurate ratio.

Alternatively, you could count net utilization hours by unit, but then that's an apples to oranges comparison when talking about run volume.

 

[46Young]

You're confusing "types of things done" for "calls done". Yes, they can "do" HAZMAT, but honestly, how many times does your average sized agency do that?

And honestly, each and every item you posted there, EMS will go to as well. HAZMAT spill? EMS is there. MVC? EMS is there. Fire? EMS is there. Yet, I don't have fire show up on a huge portion of my medical calls.




Sorry, it's a well documented statistic that EMS is a bigger portion of 911 calls than fire-related calls.. by a huge margin.

See the above post, in reference to net utilization per unit.

 

[46Young]

That's the problem, this is all region dependent. In my service area we get fire if it's a pin in or we need an LZ. That's it, so most MVCs have only EMS and PD. We respond to all structure fires and multiple department wildfires. So our workload is quite a bit heavier than the paid FD here.

You don't have any suppression units taking up a few lanes to protect the scene? That's a problem.

 

[46Young]

This is one of the things I seen pointed out numerous times in the comments on this incident. Even going with the assumption that the FD had determined it was a non-viable patient air bag operations always seem to take forever. I don't think I have yet to see them used efficiently.




I'm with Linuss on this one. There is no reason that extrication and firefighting have to go together. Or any of the other various specialized types of rescue training. I've found who does what varies significantly by region and demand.

Consider that a paramedic will make the best attempt to access and treat the patient during the extrication process. Consider that the extrication crew would like to avoid losing control of the vehicle and crushing that paramedic, the pt, and possible members of the squad working on the car. Extrication is not a three minute rush job. It can take up to an hour or more. This is why we have crush syndrom protocols that use NS, dextrose, bicarb, and possibly albuterol (at least here).

The cribbing and other shoring methods absolutely need to be placed properly before you can raise the vehicle with the bladders or whatever you're using. Up an inch, more shoring. Up an inch, more shoring. Rinse, wash, repeat.

From what I've seenand heard, the FDNY crews were moving with a purpose, and not like they're in a Chinese fire drill, which is what ESU looked like. It appears to me that the ESU person used spreaders to lift the vehicle (WTF?) and then lost control of it, causing the issue.

I worked in NYC EMS for five years, and I've seen many of these "who's phallus is bigger" contests between FDNY and NYPD ESU. Many of the ESU people have not ever done a cut job in their entire career. The FDNY Heavy Rescue crews live and breathe this stuff.

But you're right, there's no reason that extrication and firefighting have to go together. There's also no reason why they cannot coexist. IMO, the same is true for EMS and fire. IMO, for bost cases, (fire/extrication, fire/EMS) the situation is dependent on region and demand. One size does not fit all in the world of Emergency Services.

 

[fortsmithman]

A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.

Correct me if I'm wrong, but wasn't Linuss a working EMT before he went to medic school. So he wouldn't be one who went straight to medic school.