How to buff calls in NYC?

[Martyn]

And don't forget

Paramedics save lives...EMT's save paramedics

 

[gotbeerz001]

.....

 

[LACoGurneyjockey]

1) 15 years. 2) if you think a paramedic can deal with every situation that "goes bad" than you are obviously new to EMS. 3) Paramedics are great at treating many cardiac and respiratory problem but there is a huge list of things that paramedics can't do anything to fix.

 

[SeeNoMore]

Amazing. I had no idea this was a thing. I am trying to imagine a Volunteer Ambulance zooming up to assist with calls. Just amazing.

 

[DrParasite]

View attachment 2348

yes, silence occurs when one has a life outside of EMTlife.... I'd find a meme, but it's not worth my time.

I never understood this argument. Paramedics are specifically trained to deal with the most statistically common life-threatening issues. By virtue of additional training, paramedics are better equipped and better trained to handle these emergencies.

and yet, the state of delaware still doesn't require a paramedic on every ambulance.

Playing the "what if" game is simply burying your head in the sand. Yes, paramedics are great at treating cardiac and respiratory issues. They're also much better equipped to treat anaphylaxis, start treatment for sepsis, deal with hypoglycemia, hypertensive crisis, or manage an overdose, aren't they?

well, EMTs can give epinephrine for anaphalaxis (which is starting treatment), and if they hypoglycemic patient is conscious, can check BGL and give sugar orally. I do agree that a paramedic can do more, especially for more serious cases.

what can a medic do for a hypertensive crisis? last I checked, it was still establish IV access, monitor and transport to the ER. for sepsis, you are STARTING treatment, but the ER is actually fixing the problem. And what are you giving for a cocaine overdose? what about an alcohol overdose? If you are talking about a heroin overdose, sure, EMTs can give narcan too.

Tell me about the things that go wrong during a typically transport and what paramedics can't manage as or more affectively then a BLS crew?

what interventions are paramedics going to do for a stroke, that EMTs can't? or abdominal pain (outside of pain meds, of course)? or a multi system trauma?

DEmedic, think of it this way, out of all the calls you are dispatched to during a shift, how often are you taking the person to the ER? and how much does that compare to when the BLS crew takes them to the hospital without you?

Going one step further, then why doesn't your state require a paramedic on every EMS call? Using your logic, they should, because otherwise, people will be dying left and right

 

[chaz90]

DrParasite

I believe the original statement made by DEmedic was asking "what paramedics can't manage as or more effectively than a BLS crew."

This doesn't mean that ALS level care will make a difference in every case, but it does clearly mean that everything in the BLS scope of practice also falls under the ALS scope. If an ALS crew is confronted with a time sensitive CVA or trauma patient, they can load and initiate transport as quickly as a BLS crew if needed.

In direct answer to your questions, many systems, including my own, carry beta blockers for treatment of symptomatic hypertensive crises. The merit of their pre-hospital use is debatable, but it is still a treatable condition from what I carry in my drug bag at this moment. We can treat cocaine overdoses with benzodiazepines as necessary and provide treatment for cardiac arrhythmias when/if they appear. No, we do not fix the problem of sepsis, but initiating treatment with fluid, early recognition, and pressors in severe cases can certainly be important. 90% of the time, all we do is initiate treatment and not fix the problem itself, so I don't understand how you're using that as an argument against treating these conditions earlier.

Additionally, saying an EMT "can" administer various drugs doesn't mean it's not better used in the hands of a higher level provider. I'm all for patients or EMTs carrying Epi-Pens for early treatment of anaphylaxis. Administering it early is great and has a positive impact on mortality rates of anaphylactic episodes, but follow up care from a higher level provider with additional interventions and monitoring capabilities is certainly advisable. Same goes for Narcan. I've used the argument before that just because a lower level provider has a medication or intervention available doesn't mean they are the most qualified to use it. I consider myself halfway decent at performing intubations and reading 12 lead EKGs for a paramedic. If a cardiologist or anesthesiologist is available though, God knows they are more qualified than I and should be interpreting the 12 lead or intubating the patient. Same goes for EMTs and some of these interventions. If no one else is around, carry on with epi, narcan, CPAP, aspirin, and albuterol. If someone more qualified is available however and closer than the hospital, perhaps they should be using their additional education to more appropriately assess and manage that patient.

I can't speak for DE, but I don't think any of this really directly applies to whether a paramedic needs to be on every ambulance. That's an argument for another thread at another time.

 

[NomadicMedic]

I was writing a response, but @chaz90 hit all the high points, and was far more eloquent than I would have been.

 

[Tigger]

y

Going one step further, then why doesn't your state require a paramedic on every EMS call? Using your logic, they should, because otherwise, people will be dying left and right

What the law says and what the best practice is are not always the same thing. Not a new concept.

 

[NomadicMedic]

well, EMTs can give epinephrine for anaphalaxis (which is starting treatment)

But they certainly don't need any fluid, right? Or an Epi Drip? Benadryl? Maybe a surgical airway when it goes sideways? Nah. That's silly. Throw 'em in a BLS truck and drive to the hospital.

...and if they hypoglycemic patient is conscious, can check BGL and give sugar orally...

But if they can't swallow, they're SOL? That whole thing with D50 or Glucagon is silly. Throw 'em in a BLS truck and drive to the hospital.

what can a medic do for a hypertensive crisis? last I checked, it was still establish IV access, monitor and transport to the ER. for sepsis, you are STARTING treatment, but the ER is actually fixing the problem.

If you don't understand that a truly septic patient will require large bore access, a significant amount of fluid and may need pressors, well, that's a deficiency in your education. POC lactate to help rule in sepis anyone? Screw that. Throw 'em in a BLS truck and drive to the hospital.

And what are you giving for a cocaine overdose? what about an alcohol overdose?

Benzos? Yeah. I use those for stimulant ODs. Should I mention tricyclic ODs? Or Organophosphate poisoning? Or suspected or known cyanide poisoning? How about a kid who eats Grandma's beta blockers? I carry stuff for all of that. But you believe that someone should just throw 'em in a BLS truck and drive to the hospital.

If you are talking about a heroin overdose, sure, EMTs can give narcan too.

What happens when that narcan wears off and you realize that they had been given a boatload of opoid to counteract the crazy bath salt/cocaine reaction. Oh I know. Throw 'em in a BLS truck and drive to the hospital.

What else you got?

 

[Mufasa556]

Protocols would be so much easier to learn if the treatment for everything simply stated: Diesel Bolus.

 

[RedAirplane]

Thought you all might find this interesting:
http://www.nysvara.org/news/2008/dec/081221.pdf

 

[escapedcaliFF]

Im late to the party but let me give my 2 cents. Buffing should be illegal period. Its illegal in most states. CONS and AORs are assigned for a reason. Volunteer EMS is basically stealing from companies who have the authority to operate. Until we get away from volunteer EMS you can expect to contiue to see the low pay. You want an adventure and excitement join the military. I have a whole other speel about voluteer fire but thats for another time.

 

[adamNYC]

Military ain't for everyone

 

[Chewy20]

Neither is buffing calls like an idiot.

 

[escapedcaliFF]

Running around in a substandard ambulance with the siren and lights going to a call you where not dispatched to is dangerous plane and simple. Risk vs. reward and the reward is very small except to fill ego.

 

[H33]

Don't have enough free time to read all of this but my thoughts from what I have is that the idea of "buffing" is that it would add a lot of unknowns into the equation. I typically love all the help that I can get to show up, for the most part, but I am not certain that I would be comfortable handing over my patient to an agency that was not sent. In our state we can hand over to a lower level provider if they will have the capacity to care for the likely needs of the patients, and we have volunteer ems agency's and I have both played on them and turned patients over to them, but they work within the established system, not certain I would be ok with handing off to any one that just showed up regardless of if it said ambulance on the side or not, just my two cents on it.

 

[RedAirplane]

I don't think anyone is saying that "buffing" is the ideal solution. It is unsafe and leads to confusion.

In summary, it sounds like there are multiple ambulance companies not officially part of 911, but not officially banned either. This leads to the legal gray area discussed here, especially when, as some have suggested, you need to do this "buffing" thing to even get into a proper service.

I stand by my original stance: integrate everyone. It's not that hard to use a log-in/log-out system where a volunteer unit logs in with 911 communications, is assigned calls, and logs out when its "tour" is over. Although I don't live in NYC so I may be over simplifying something.

Sounds like the biggest barrier is politics.

 

[TransportJockey]

I don't think anyone is saying that "buffing" is the ideal solution. It is unsafe and leads to confusion.

In summary, it sounds like there are multiple ambulance companies not officially part of 911, but not officially banned either. This leads to the legal gray area discussed here, especially when, as some have suggested, you need to do this "buffing" thing to even get into a proper service.

I stand by my original stance: integrate everyone. It's not that hard to use a log-in/log-out system where a volunteer unit logs in with 911 communications, is assigned calls, and logs out when its "tour" is over. Although I don't live in NYC so I may be over simplifying something.

Sounds like the biggest barrier is politics.

Politics are the only reason a vollie service exists in a major metro with adequate professional EMS it seems.

 

[RedAirplane]

Politics are the only reason a vollie service exists in a major metro with adequate professional EMS it seems.

As for the exist/shouldn't exist debate, I don't think that's relevant here, but my $0.02 is that I am very pro-volunteer (I'm a volunteer so I'm obviously biased).

In any regard, they exist and that's not changing. If they vanish overnight, then there's one integrated EMS system. Otherwise, the system can either accept this condoned jumping of calls, or acknowledge the resources in use and organize them more appropriately.

 

[RedAirplane]

As an aside, someone in San Francisco appears to agree with some of my crazy ideas about ambulance deployment (namely, if there are resources in your area, USE THEM). Their latest EMS operation manual includes:

• Dedicated 911 ALS ambulances from SFFD, AMR, King
• IFT ALS ambulances from a bunch of companies
• All ALS ambulances (IFT or 911) required to have the mobile data computer
• IFT ALS units to switch off the computer when on an IFT call and turn it on between calls
• This allows tracking of positions of all available ALS resources in the city.
• Charlie, Delta, and Echo calls are passed to the nearest ALS ambulance, regardless of whether its an IFT or 911 ALS unit.
• Alpha, Bravo calls passed to 911 dedicated ALS ambulances

Source: http://www.sfdem.org

There are a few foreseeable hiccups there, but why couldn't something like that work in NYC? Volunteer ambulances simply turn on a data terminal and can thus be tracked just like FDNY when they are available for service?