Saturday, September 23, 2006

MARS: "Mutual Aid Response System"

There once was a little pig called MARS. He was the system set up by the FDNY administrators to send jobs to and recieve requests from EMS agencies not affiliated with the Fire Department, or field requests from agencies for additional resources, including ALS, Fire, PD, HazMat, and more. Unfortunately this little pig is dead, and we're not talking about freshly killed. No, we're talking carcass hit by a bus years ago, and all that remains is a clean little skeleton that the flies have long since left.

You see, as one of two volunteer ambulance agencies headquartered in Manhattan, and the only one in service 24/7, we are relatively small. We have a group of eagar college students by day / EMT by night that staff our single ambulance. Mainly, we serve the campus: but since the university is the third largest landholder in the city, that area is relatively large. We crank a good 700 calls a year.

OK, enough shameless self-promotion -- The real problem is Big Red has a very long history of not paying attention to or establishing links with other agencies in the city. While many agencies outside of the Manhattan proper seem to have more success, within the city, there is not much support. Here are the problems with MARS:

1.) No Training -- Us college kids have never been trained in using MARS by the Fire Department. What we know is limited to what gets passed from the Seniors to the Freshmeat.

Solution: One FDNY rep could spend an hour talking about how to and when to inplement the radio system*

2.) VHF -- The Fire Department is on VHF. We're on UHF. MARS is essentially a radio based system. There is a work around where we use our cell phone to call the MARS number, but that's just ridiculous! Can you imagine calling a dispatcher on the phone only to tell them that you're 10-XX.

3.) 10-Codes. They're all different. 'Nuf Said.

4.) It's easier to call 911 -- Yes, that's right. Our current system for when a drunken 250lb. football player starts wailing on my crew. Step 1: Run! Step 2: Dial 911. Step 3: Dispatcher sends an RMP (Radio Motor Patrol -- The guys with guns!) AND another BLS unit.

5.) BLS arriveth -- #1 reason to call for help: Request ALS. #1 response from FDNY after requesting ALS for our patient through 911: BLS car.

6.) Computer Assisted Dispatch -- Yeah, we don't have it. Do you know what it costs to put one of those systems in your truck!?! Unlike the Voluntary units (for-profits), the Fire Department (the professionals), the volunteers don't make money (we don't do cost-recovery), hence we can't afford toys.

7.) CPMU has NYPD -- The other volunteer EMS unit in Manhattan is dispatched by NYPD. Their radio system works just fine: it the police system! (Might I mention how odd it seems for every other agency in the five boroughs to talk with Fire, but the Central Park Medical Unit talks with Police -- even if it is the Central Park Precinct.)

8.) Disaster Strikes! -- Please don't, hopefully it won't happen again, but the way things are going, it's bound to sooner or later. Then what?

Someone help!



*PS: Any fire folk out there: Could we borrow your training academy? We've looking for a place to do EVOC.

Wednesday, September 06, 2006

Back on Campus

As promised, here is the down low on EMS in a chemical plant. A little background info to start with:

I worked over the summer in a small-to-medium sized chemical plant in Upstate NY. Located in Rotterdam Junction there were two side to the plant, the "Chemical" division, and the Performance Resins Division (PRD). I worked mostly with PRD, but also spent some time on the ChemDiv side, and also at the Waste Water Treatment Plant (WWTP). The ChemDiv manufacturtures alkylphenols from phenol raw material. A decidedly boring process, but extremely dangerous. Phenol (and alkylphenol) will kill you in under a minute if you get exposed to a 3"x3" splash of it on your skin. PRD uses the alkylphenol produced in ChemDiv, reacts it with formaldehyde and produces resin. The resin is sold to company who use it in many different products, but the most prominent customer is Goodyear which puts loads of it in their tires.

I've been holding off on writing this entry for a while because I wanted to see some EMS in action. The plant has a First Response Team that could respond to any medical emergencies, and they also took care of fire, confined space rescue, and incident command.

The biggest hazard in the plant is response to phenol spills. As mentioned above, it's nasty stuff if it gets on you. Luckily, there is a treatment. Polyethylene Gylcol, or PEG, is effective in stopping the action of the phenol, and application to an area of exposure alternating the PEG with water is essential. PEG stations are located throughout the plant. Initial response is straightfoward and usually a person exposed is able to start treatment on his own, and with the assistance of a coworker, can do an effective job. The FRT will be contacted by radio, and an ambulance will be called as well.

Here is where things could get hairy, I believe. All the workers in the plant are trained to the precautions to take when handling and being around the material. The FRT members are EMTs who can provide more initial care. However, the personnel staffing the ambulance, assumedly from an outside municiple or commercial agency would not have the training necessary to avoid accidents or becoming contaminated themselves through contact with the patient. Many EMTs (and hospital staff, as well) are trained in use of PPE to avoid bloodborne pathogens, but I know of very few who are trained in chemical precautions. For example, many solvents will easily penetrate or even dissolve latex gloves. With nitrile gloves you're a lot safer, but they still won't protect you from fuming chemicals or agents.

The plant I worked for had a visitor's video that was shown to all guests, but in an emergency situation where transport to a hospital is critical, ambulance personnel may very well be quickly shoved into a situation where they were not trained and are not prepared for. Here are the lessons learned: (1) Scene Safety!!!! -- more important than ever in an industrial setting. (2) Proper PPE -- Most hazards can be mitigated by protecting yourself. (3) Advanced Preparation and Knowledge -- If you know that there is an industrial facility in your jurisdiction, ask them to bring someone to your agency to give a presentation on the risks, hazards, and precautions they should take when they respond. You can also simply try going up to the front gate and asking for a quick overview yourself.