How to buff calls in NYC?

[RedAirplane]

Most have some sort of field internship, but it varies by agencies. That is why NYC protocols are so restrictive. It should just be one provider. FDNY EMS has the Top class, but the hospitals may have better equipment. For example, FDNY didn't have CPAP (maybe still don't have)?

What does the field internship at your volunteer company look like, and what is the minimal requirement for ride time every week?

In the pilot episode of Emergency! ("The Wedsworth-Townsend Act") Dr. Kelly Brackett has a hard time accepting "paramedics" who get a 10 week first aid course as a replacement for doctors--he'd rather see more doctors and more hospitals.

Ultimately, he comes to support the paramedic initiative because they don't replace him, they augment him.

This is why, from my outsider's perspective, FDNY should embrace anyone who wants to play in 911 do so (provided they are fully qualified to BLS/ALS ambulance standards as provided by the jurisdiction). It should be coordinated so you don't have multiple needless units driving hot all over the place.

If you don't support that, you are essentially saying that you would tell a closer ambulance that it cannot respond to a true emergency in order to earmark it for a further away ambulance. That's unneeded lights/sirens driving, delaying patient care and possibly endangering the welfare of a patient, and seems plain dumb.

Hell, PulsePoint and many PSAPs across the country are working on using an app to notify citizens with First Aid or CPR training of a medical emergency in their area to get them to respond, but we can't even integrate such citizens who happen to have fully equipped ambulances? Certain areas in New Jersey are targeting a 2 min response time for 911 medical emergencies using the PulsePoint app, and it sounds fantastic, but I digress...

It's not like FDNY would vanish overnight. Instead, it would still run calls, response times would be lower with the volunteers playing, and all those extra miles driving to calls eventually taken by the volunteers would be saved. I still don't get the arguments around the quality of the provider. The volunteers are all licensed by the jurisdiction as EMTs or medics. Would you rather a "more seasoned" EMT/paramedic get there 10 minutes later than have somebody with all the training and tools (and who knows the community a lot better) get there sooner?

 

[RedAirplane]

"Do yourself a favor and stop talking. You have literally not said one thing that makes sense."

I am merely one of hundreds of volly members who buff on the regular in NYC. All I wanted was how to do it better plain and simple. Once I'm in 911, I'm out of the whole volly gig. It feels like **** to be 2nd on scene knowing that technically I dont really belong there.

Are you asking this as a volunteer or doing private IFT?

I strongly encourage focusing on your IFT to build up your medical knowledge BUT since "buffing" is common in NYC, consult locally. (In my investigation for one volunteer agency they have internal documents that have their dispatcher listen to radios and turn that information over to you on your radio).

 

[LACoGurneyjockey]

The volunteers are all licensed by the jurisdiction as EMTs or medics. Would you rather a "more seasoned" EMT/paramedic get there 10 minutes later than have somebody with all the training and tools (and who knows the community a lot better) get there sooner?

Yes, I would rather wait a few more minutes for a higher level of care. There are very few instances where a few minutes will make a difference in EMS. Id rather wait for a qualified Paramedic to respond than some jack-*** Ricky rescue driving around in his POV with lights and sirens, or this douche adamnyc wanting to get his **** wet in a wild ad exciting world where one is judged by the number or bic pen crics they've performed.
Volunteers are trying to make a hobby out of people's medical care. Because it's fun for them to play bad *** for a few hours on the weekend. But they have no place treating actual patients, And if I called 911 and this guy showed up with his Peter Griffin CPR Certified badge on his chest, Id lock my door and wait for real help.

 

[RedAirplane]

Yes, I would rather wait a few more minutes for a higher level of care. There are very few instances where a few minutes will make a difference in EMS. Id rather wait for a qualified Paramedic to respond than some jack-*** Ricky rescue driving around in his POV with lights and sirens, or this douche adamnyc wanting to get his **** wet in a wild ad exciting world where one is judged by the number or bic pen crics they've performed.
Volunteers are trying to make a hobby out of people's medical care. Because it's fun for them to play bad *** for a few hours on the weekend. But they have no place treating actual patients, And if I called 911 and this guy showed up with his Peter Griffin CPR Certified badge on his chest, Id lock my door and wait for real help.

I guess this is where I disagree.

Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are. And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.

As far as the higher level of care bit, if it's paramedic vs EMT, sure. But remember, they are licensed EMTs who have been through the exact same training. There is something to be said for a certain amount of professional experience, but I think volunteer providers can be professional (my org certainly tries) and conversely there's the occasional professional who provides sloppy care. So it should be about making sure providers are good, not lumping them into stereotypes based on their career track.

I certainly respect your point, but it hasn't convinced me.

 

[Flying]

Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are.

L&S are there to alert other drivers, legally bypass the traffic system, and not take an absurd amount of time to arrive.
They are NOT for reaching an emergency in the shortest amount of time possible by expecting other drivers to comply. That mentality alone is deadly.

And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.

Who wouldn't be pissed? In the end, we cannot design the system by appealing to probabilities.

 

[adamNYC]

Redairplane: Very well said!

What cracks me up is the assumption that all volly members are weekend warriors. Some may be, but there are others in leadership positions who currently work in 911, at least in my volly they are.

To answer if I buff in IFT, no. I do in volly, and my other thread was asking about those who do buff in IFT, out of my own curiosity.

 

[LACoGurneyjockey]

I guess this is where I disagree.

Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are. And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.

As far as the higher level of care bit, if it's paramedic vs EMT, sure. But remember, they are licensed EMTs who have been through the exact same training. There is something to be said for a certain amount of professional experience, but I think volunteer providers can be professional (my org certainly tries) and conversely there's the occasional professional who provides sloppy care. So it should be about making sure providers are good, not lumping them into stereotypes based on their career track.

I certainly respect your point, but it hasn't convinced me.

Ok, you found the one example that seems to support early CPR and early Defib, even if by volunteers or AdamNYC on his way to a dialysis call. But then why doesn't NYC have the highest rate of ROSC, or survival to discharge? Why do the leaders in these statistics exist in places with NO volunteer presence?
Your EMT class was 100-something hours, and that alone does not make you professional. It does not make you qualified to the same level as, in this example, a 5 year FDNY EMT. They have not been through the same training, because you didn't go through an academy. You went thru EMT school. That's it. That's the only similarity.
Look at the most effective EMS systems in the country, or even better outside the US, and take a look at the volly presence there. It's non existent. Because it doesn't work well. It's filling a void that isn't a void. You're not needed in NYC, because there's a professional system in place.
Rural Montana is fine, backwoods Illinois, sure. But why do we have volunteers, who aren't needed, the the middle of a major urban city center.

 

[Tigger]

I guess this is where I disagree.

Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are. And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.

That is not why we have lights and sirens, otherwise we would be using them that way. Instead, we use them primarily based upon a misguided public perception. You pay lip service to the fact that the vast majority of 911 medical calls are not time sensitive, yet blow right past that to cardiac arrests, which make up a very, very small subset of calls. It does not make sense from a resource utilization perspective to have enough ambulances to reach calls in four minutes (your above standard) even though it only matters (probably less than) 1% of the time. At no point in any business (healthcare included) is it sensible to design a system to based on 1% of the tasks.

As far as the higher level of care bit, if it's paramedic vs EMT, sure. But remember, they are licensed EMTs who have been through the exact same training. There is something to be said for a certain amount of professional experience, but I think volunteer providers can be professional (my org certainly tries) and conversely there's the occasional professional who provides sloppy care. So it should be about making sure providers are good, not lumping them into stereotypes based on their career track.

I certainly respect your point, but it hasn't convinced me.

I really do not think you understand the the difference between paid, professional providers who run many more calls than volunteers, who do this as a hobby. Not to mention that such hobbyism does not do much for the image and compensation of the industry.

 

[Tigger]

Redairplane: Very well said!

What cracks me up is the assumption that all volly members are weekend warriors. Some may be, but there are others in leadership positions who currently work in 911, at least in my volly they are.

To answer if I buff in IFT, no. I do in volly, and my other thread was asking about those who do buff in IFT, out of my own curiosity.

I doubt that the majority of volunteer EMS providers are also fulltime EMS providers, so I don't get it. A few doesn't make it ok. And again. EMS is not a hobby, yet so many insist on making it while also whining about increased standards.

 

[RedAirplane]

That is not why we have lights and sirens, otherwise we would be using them that way. Instead, we use them primarily based upon a misguided public perception. You pay lip service to the fact that the vast majority of 911 medical calls are not time sensitive, yet blow right past that to cardiac arrests, which make up a very, very small subset of calls. It does not make sense from a resource utilization perspective to have enough ambulances to reach calls in four minutes (your above standard) even though it only matters (probably less than) 1% of the time. At no point in any business (healthcare included) is it sensible to design a system to based on 1% of the tasks.

I really do not think you understand the the difference between paid, professional providers who run many more calls than volunteers, who do this as a hobby. Not to mention that such hobbyism does not do much for the image and compensation of the industry.

The crux of my point is not that we should ADD resources to have a really good response time for the 1% of calls, but rather, that the resources are sitting there and saying "pick me! pick me!" so in the case of the truly time-sensitive incident it seems silly not to use them.

Of course, that means having some way to track their location and notify them rapidly.

Out of curiosity, what do you make of the citizen responder initative discussed here?
http://www.newjerseynewsroom.com/he...time-in-country-goal-of-sub-2-minute-response

 

[akflightmedic]

You have to be tuff, to work a code in the buff...

 

[RedAirplane]

I doubt that the majority of volunteer EMS providers are also fulltime EMS providers, so I don't get it. A few doesn't make it ok. And again. EMS is not a hobby, yet so many insist on making it while also whining about increased standards.

Bit of a tangent, but since you bring up the volunteer vs paid thing, do you thing an all-volunteer service can be professional? I tend to think if it is done correctly, yes it can.

From the Virginia Beach EMS website:

The Virginia Beach Department of Emergency Medical Services is the largest volunteer-based rescue service in the country with over 1150 volunteers serving the city of over 430,000 residents.

Did you know that you are seven times more likely to survive cardiac arrest in Virginia Beach than in most other communities in the country?

 

[RedAirplane]

You have to be tuff, to work a code in the buff...

Huh?

 

[sirengirl]

That, right there, is exactly why I really like doing IFT work. Sure, 911 is fun/flashy and all... but those IFT calls are great (even the discharges) because you get to read those discharge summaries (and sometimes more) and can start really getting into the pathology of your patients. Many times those patients you take to a SNF will be more sick than many people you'll encounter on the street, even though those D/C patients will be quite stable. As you begin to understand what's going on, you'll start seeing things in your "emergency" patients...

This. I worked IFT for 8mos before getting hired at my 911 agency. I STILL work at my IFT part time, I've been here for 3 years this month. I learned more about chronic care, trachs, home vents, hospice, and clinical meds and pumps there than I did at school, whether I realized it or not. Don't get me wrong, I hated it and I was going nuts, but now I appreciate what it does for me. I read every single chart. I read symptoms, histories, meds, surgical notes, x-Ray and MRI results, everything. And I TALK to my patients. I have conversations with them and learn from them, too. And let me tell you what, learning how to safely transfer a dissecting AAA; transporting an active brain bleed 40+ miles; taking a confirmed C2 fracture over an hour to a trauma center because it's raining and the chopper isn't flying; working my *** off- alone- in the back of an ambulance to keep someone alive who has 3 large bore IVs pressure infusing, WITH dopamine, but still can't get their SBP above 60- for 50 miles on an interstate- those, my friend, THOSE are the things that help teach you how to save lives at 911, when you do have 4 sets of hands to help you and your destination is 10-15 minutes away.

You get these jobs to learn something. What you learn will save your future patients. If you're not learning where you're at, move somewhere else. And learn something.

 

[ERDoc]

I doubt that the majority of volunteer EMS providers are also fulltime EMS providers, so I don't get it. A few doesn't make it ok. And again. EMS is not a hobby, yet so many insist on making it while also whining about increased standards.

I can't believe I am going to do this but I have to stick up for Adam on this point. A large number of EMS providers and FFs in NYC start out as vollies in the suburbs and usually continue to volley while they are working for FDNY.

 

[ERDoc]

You have to be tuff, to work a code in the buff...

I might have had a t-shirt that said that at one time, but I am not saying I did.

 

[Tigger]

The crux of my point is not that we should ADD resources to have a really good response time for the 1% of calls, but rather, that the resources are sitting there and saying "pick me! pick me!" so in the case of the truly time-sensitive incident it seems silly not to use them.

Of course, that means having some way to track their location and notify them rapidly.

Out of curiosity, what do you make of the citizen responder initative discussed here?
http://www.newjerseynewsroom.com/he...time-in-country-goal-of-sub-2-minute-response

I don't think that the volunteer agencies should exist except in cases where geography makes it too difficult to maintain adequate full time staffing. Even then, I sit here in my station as a paid provider covering well less than 10 thousand people in a 300 square mile area. If we can afford it, FDNY can afford to have a slow station or two.

Though you say that the agencies should be the same in terms of care, they are not. Every respectable service I have worked for has had an extensive new hire program as well as mandatory continuing education that far exceeds recertifcation requirements. And while volunteer groups can do this, it is not a common practice. There is just too much variability to allow so many different volunteer groups to operate in the greater system, even if they were actually a recognized part of the system.

As for the citizen responder initiative, I am alright with that. Such individuals are not EMS resources and do not require the upkeep of being treated as such.

 

[Tigger]

I can't believe I am going to do this but I have to stick up for Adam on this point. A large number of EMS providers and FFs in NYC start out as vollies in the suburbs and usually continue to volley while they are working for FDNY.

I suppose that is a regional variance. I know few fulltime providers here that volunteer on their days off and there are plenty of opportunities. These organizations are lucky to have these providers, but my issue is more with the organizations themselves. I don't like that so many allow EMS to be a hobby and there is no such thing as free. Volunteer organizations do cost money, and they do compete for resources within the EMS system. If they are not a needed part of the system, funding (whether grant or otherwise) should be directed to where it is needed.

 

[46Young]

In the pilot episode of Emergency! ("The Wedsworth-Townsend Act") Dr. Kelly Brackett has a hard time accepting "paramedics" who get a 10 week first aid course as a replacement for doctors--he'd rather see more doctors and more hospitals.

Ultimately, he comes to support the paramedic initiative because they don't replace him, they augment him.

This is why, from my outsider's perspective, FDNY should embrace anyone who wants to play in 911 do so (provided they are fully qualified to BLS/ALS ambulance standards as provided by the jurisdiction). It should be coordinated so you don't have multiple needless units driving hot all over the place.

If you don't support that, you are essentially saying that you would tell a closer ambulance that it cannot respond to a true emergency in order to earmark it for a further away ambulance. That's unneeded lights/sirens driving, delaying patient care and possibly endangering the welfare of a patient, and seems plain dumb.

Hell, PulsePoint and many PSAPs across the country are working on using an app to notify citizens with First Aid or CPR training of a medical emergency in their area to get them to respond, but we can't even integrate such citizens who happen to have fully equipped ambulances? Certain areas in New Jersey are targeting a 2 min response time for 911 medical emergencies using the PulsePoint app, and it sounds fantastic, but I digress...

It's not like FDNY would vanish overnight. Instead, it would still run calls, response times would be lower with the volunteers playing, and all those extra miles driving to calls eventually taken by the volunteers would be saved. I still don't get the arguments around the quality of the provider. The volunteers are all licensed by the jurisdiction as EMTs or medics. Would you rather a "more seasoned" EMT/paramedic get there 10 minutes later than have somebody with all the training and tools (and who knows the community a lot better) get there sooner?

The voluntary hospitals, the NYC 911 participating members, have units that are under contract with FDNY, and are given a CSL (post), just like FDNY units. These hospitals basically take the place of FDNY units. What I'm saying is that it would be better to have those hospital units be FDNY units instead. Service delivery is not affected (still the same amount of units), and there is uniform QA/QI, discipline, union regs, platoon schedule, academy training, etc. I'm not sure what you mean by saying (that I'm saying) that a further away ambulance would be responding, and endangering the welfare of a patient.

I worked for a hospital that really had its act together, great providers, and was militant with it's QA/QI. I really enjoyed working there, but this firemedic position was much better for my family and I, rather than sitting on street corners for 35-40 yrs (403b, no pension), with an extremely high cost of living. I also worked per diem for a few other hospitals, and observed it to be a mixed bag, very inconsistent KSA's of their EMT's and medics, and the work ethic varied widely as well. Some were per diem, and worked full time elsewhere, so they didn't much care if they got caught doing something unscrupulous. I feel that it is better to have just one agency provide EMS for an area. Volunteers can enjoy a greater degree of latitude with negligence and offenses where career people would get nailed to the cross, because they're volunteering. I've seen it in several states that I've worked previously.

 

[46Young]

Bit of a tangent, but since you bring up the volunteer vs paid thing, do you thing an all-volunteer service can be professional? I tend to think if it is done correctly, yes it can.

From the Virginia Beach EMS website:

A volunteer headcount tells us nothing; how many consistently put in hours, and how many do it once a week or less, or for only 4-8hrs at a time? Where I work, the volunteers work sporadically, some just come in for like 5 hrs, some do a couple of shifts a week, and some only show up for bingo, the installation dinners, and EMS standby events.

You know as well as I know that an all-volunteer department will not stand the test of time. I've researched the history of several departments in my area - they start out 100% volunteer, then a few weekday daytime paid crews, then a few stations staff during the week 24hrs, then some stations are 100% career and some are 100% volunteer, then eventually every station has 24/7 career personnel. This may differ in rural areas where the pay is abysmally low, and volunteers are all they can get.

Near to where I work, in a combo fire/EMS department, one volunteer first due has two 100% volly stations, and one combo station. Every year the county wants to put a 24/7/365 ALS bus in their houses, but the vollies get it pushed back. Meanwhile, they use copious amounts of automatic aid from several different counties that have mostly career units, to run their calls, because they can't keep their rigs staffed, sue to dwindling participation.

My problem with an all-volunteer organization is that typically the required hours to remain active are less than would be needed to fill every unit 24/7. You're not going to "fire" a volly because they can't pick up extra shifts, you'll just brown out those units. There is also the issue of ongoing training - it is difficult to get everyone to the inservices and drills, since the vollies ay have jobs, family requirements, etc.