Week 1 Done, and walking in my apartment door at midnight

Completing tonight's lecture marks 1 week and 1 day of Paramedic class over. Tonight was the first night where we stayed almost all four hours and got out at 10:15 PM. Previously we've been released between 8:30 and 9:00 PM.

We only covered Medical-Legal issues tonight and while the review was useful, it seemed really repetitive from EMT-Basic class. Though this time, instead of the instructor throwing out scenarios that we, the students, might encounter in the field, we instead asked the instructor if the actions we took while encountering those scenarios were legal. A few highlights from tonight's discussion:

"I'm a volunteer and we took a patient to the hospital on our rig. The ER was packed and we were waiting forever in triage. Since I had to get to my real job, I hopped a ride with another truck from my agency and left my partner at the hospital with the patient. Is that abandonment?"

"Our medical control physician works 8AM-4PM, so we don't have online medical direction outside those hours. Can I administer a med that usually requires online control and let the doc know the next day?"

"We got in a fight with the police, and after they Tazed my patient, they refused to allow us to take her to the hospital. The police threatened to arrest us. Do we have liability if the police take her away and she has a heart attack?"

"Can parents consent for their children over the phone? How do we get them to sign the form?"

"I can't believe how hard it is to RMA someone in New York, back in Jersey if the patient can move the pen, he can RMA. Is that cool?"

The Road of 1000 Miles Begins with the First... Day

The first day of Paramedic school is over. Things were pretty low key. We talked about course policies and procedures, expectations... and the insane amount of work: clinical and didactic coming up in the next year. I can't say I didn't expect it though.

We had today off in memory of 9/11 (this class takes place in Manhattan after all), and Day 2 starts at 7PM Wednesday!

Can't wait to actually start learning stuff!

If case you're wondering, you can see exactly which program I'm a part of here.

The Long Road Ahead...

Good Lord! PARAMEDIC School starts this Monday!!!! Whoa! Aaahh! Help!

Another Map

While existing as a bored, empty shell in my present state of insomnia, I created yet another map. This time, Google gets all the credit for the software and instead of charting all the Manhattan Hospitals, I have plotted the only the trauma centers for the Five Boroughs.

The map is available for your perusal here.

A short hiatus...

The past several weeks were hectic. During this time I took a break from writing here, but also had final exams and GRADUATED COLLEGE!!! You didn't miss much since EMS-wise it's been pretty laid back -- sans the job where I found out 'mostly but not completely - unconscious' patients don't like having NPAs applied.

However, I'm out of NYC for a short while and back in my little town in Upstate New York. One of the more interesting happenings in this suburban locale was the 80+ y/o female, driving her car along one fo the town's roads and managed to wedge it nicely between a hill and the utility pole she cracked. My FD was called for an extrication, but essentially all we had to do was open the passenger door and yank her out, easier said than done since the car was pointed downhill at about 70 degrees. Not so bad, the pt wasn't injured but after she told us she was "trying to avoid all the mud all over the road..." (I turned my head and not only was there no mud on the road, but it was dry and clean as a whistle), we decided to ship her off to the ER. No harm done and the power company replaced the damaged pole. The next day (I KID YOU NOT!), we're toned out for a PIAA (personal injury auto accident) on the same road. Turns out it's the same pole struck. Let's just say the power company wasn't too happy. No injuries noted, but this 80+ y/o woman is c/o back pain, so she gets boarded and shipped out.

I hear new telephone poles are going for $1500 these days. I wonder if Medicare covers...?

Reaching to our friends at Tech Rescue. Your response makes us proud. We're with you in the mourning.

This is unbelieveable!!

Check out this video of a news broadcast from a Fox station in St. Louis.



I couldn't believe it when I saw it.

Governor Corzine Follow Up

Here is a follow-up story from the New York Times, printed today, to the story I posted earlier.

April 14, 2007

In the Spotlight, the Politics of Buckling Up

By LISA W. FODERARO and KEN BELSON

As constituents and public officials wished Gov. Jon S. Corzine of New Jersey a full recovery from his injuries in a car accident, many were shaking their heads that someone who is so smart, and has so much to lose, would put himself at risk by apparently not wearing a seat belt.

Such was the surprise that the issue became an instant corollary to the main news that Mr. Corzine had been so seriously injured, with multiple broken bones, that he needs help breathing from a ventilator and faces months of rehabilitation.

In interviews and on the Web, people in New Jersey and from around the country expressed incredulity over the state police superintendent’s statement that the governor routinely refused to wear a seat belt. Some accused the Democratic governor of hypocrisy, even arrogance. A few called for his resignation.

Many said that if it turns out that Mr. Corzine was not wearing a seat belt when the crash occurred, he should receive a citation for violating the state’s mandatory seat belt law. The fines are $20 and court costs are $26 per violation. Others wondered why the state trooper driving the car did not insist that he wear one.

“What is he thinking?” asked Marsha McMillan, 22, a worker at a store in the Hamilton Mall in Mays Landing, N.J., several miles from the crash site. “It’s almost bizarre. I bet even the strangest of rappers and punk rockers wear seat belts.”

Comments in a similar vein appeared on popular political blogs and local Web sites, like Baristanet.com in Montclair, N.J., as well as the reader forums of several local newspapers.

Jon Rantzman, 67, of Walnut Creek, Calif., who posted a critical comment on the Empire Zone blog of The New York Times Web site, said in a phone interview: “A governor, any governor, should be a role model, not a scofflaw. How can we pass a law and fine the citizens of New Jersey for not doing something” that the governor “gets away with”?

Safety organizations, in the meantime, cited the severity of Mr. Corzine’s injuries as further evidence of the importance of seat belts.

“It’s unfortunate and tragic and another very high-profile reminder that we still have a ways to go to convince some people to wear their belts,” said John Ulczycki, executive director of transportation safety at the National Safety Council.

Even though New Jersey may be perceived as a dangerous place to drive, traffic statistics tell a different story.

According to figures from the National Highway Traffic Safety Administration, the number of traffic fatalities in New Jersey is well below the national average. And a record-high 90 percent of drivers and front-seat passengers in New Jersey wore seat belts in 2006, the eighth-highest rate in the country. (The state of Washington is No. 1, at 96 percent.)

Statistics show that 46 percent of passenger vehicle deaths in New Jersey in 2005 involved people who were not wearing seat belts, according to state police records.

While mandatory seat belt laws were strenuously opposed in many quarters when states first started enacting them in the mid-1980s, they are now so much a part of the culture that even toddlers know to buckle up before a car starts moving.

So what might cause Governor Corzine and the others to break the law in such a risky way?

“Even the worst nervous Nellie in the world has some glimmer of a sense of invulnerability, and all of us have some of that,” said Dr. Tony Stern, a psychiatrist in Westchester County, who admits he does not wear a seat belt “100 percent of the time” himself. “And someone who is a doer and an alpha male and a multimillionaire is going to have more than the average sense of invincibility.”

The former governor of New York, Mario M. Cuomo, said in a phone interview yesterday that he, like Mr. Corzine, preferred to sit in the front seat. And while he initially found seat belts somewhat uncomfortable, he said he wore them out of a sense of duty, given the fact that he had signed the nation’s first mandatory seat belt law in 1984.

“I remember the violent opposition it received,” Mr. Cuomo said. “People didn’t like the idea of being forced to strap themselves in. When we adopted the seat belt law, it was the most unpopular thing I had done as governor.”

In New Jersey, which passed its own law shortly afterward, the use of seat belts has been on the rise. The rate was 74 percent in 2000, when New Jersey made the law stricter, allowing police officers to pull over vehicles to issue seat belt citations. Previously, they could issue such citations only if the car had been pulled over for a separate offense.

About half the states now have the stricter form of the law, and organizations like Mothers Against Drunk Driving, a nonprofit group, are pushing for the rest to follow suit.

It is not clear whether the governor will get ticketed. New Jersey State Police officers have the discretion not to issue citations for seat-belt violations.

New Jersey’s Seat Belt Law applies to drivers, all passengers between 8 and 18, and all front-seat passengers. The law makes the driver responsible for proper seat belt use only by those younger than 18.

Few people interviewed suggested that Governor Corzine would suffer any lasting political consequences.

“Whenever there is a tragedy like this, I think whether it hurts or helps in the long run has a lot to do with how the victim handles it,” said Peter J. Woolley, a professor of political science at Fairleigh Dickinson University. “Corzine could become an apologist and a spokesman for traffic safety and seat belt use.”

Robert Strauss contributed reporting.

NJ Governor Injured

The following story has been in the news these past couple days in the Tri-State area. Thoughts and prayers go out to Mr. Corzine. Reposted from the New York Times.

April 13, 2007

New Jersey Governor Is Injured in Car Crash

By DAVID KOCIENIEWSKI and DAVID W. CHEN

CAMDEN, N.J., April 12 — Gov. Jon S. Corzine underwent surgery on Thursday night after a car accident in which he broke his left leg, sternum, collarbone, six ribs on each side and a lower vertebra, state police and other government officials said. He was in critical but stable condition at midnight, sedated and on a breathing tube.

Mr. Corzine was in the front passenger seat when his state police vehicle swerved to avoid an apparently out-of-control driver on the Garden State Parkway and hit a guardrail. He was flown by helicopter to Cooper University Hospital in Camden, where he received seven units of blood and a metal rod in his leg during a two-hour operation that ended about 11:30 p.m.

“He has what we call multisystemic injuries,” Robert F. Ostrum, Cooper’s director of orthopedic trauma, who led the surgical team, said in a midnight briefing for reporters here. “Injuries to his chest, lungs, to his legs, and he lost a significant amount of blood.” Asked whether Mr. Corzine was lucky to be alive, Dr. Ostrum said: “Yes.”

Mr. Corzine is scheduled for two more operations, Saturday and Monday, to clean up the wounds, Dr. Ostrum said, adding that it would be “days to weeks” until he was lucid enough to conduct state business, and three to six months before he could get around fairly well. Though the governor sustained a cut on his forehead, Dr. Ostrum said a CAT scan showed no brain injury.

Richard J. Codey, the State Senate president and a Democrat like Mr. Corzine, stepped in as acting governor during the surgery, and is expected to remain in charge as long as Mr. Corzine is hospitalized.

The state trooper who was driving the Chevrolet Tahoe that was carrying Mr. Corzine was flown separately to Cooper, and asked that no information about his condition be released. Samantha Gordon, an assistant to the governor who often travels with him, was also hurt in the accident but walked into the Camden hospital unassisted shortly before 8 p.m.

After delivering a speech to the New Jersey Conference of Mayors at the Trump Taj Mahal casino in Atlantic City, Mr. Corzine was on his way to Drumthwacket, the governor’s mansion in Princeton, for a meeting between the Rutgers women’s basketball team and Don Imus, the talk-show host who was fired on Thursday for making a racist and sexist remark about the players.

In a 9 p.m. news conference at the hospital here, Col. Joseph R. Fuentes, superintendent of the New Jersey State Police, said that a red pickup truck entered the highway “erratically from the shoulder,” causing a white Dodge Ram pickup truck to swerve left. The governor’s driver, State Trooper Robert Rasinski, swerved to avoid the white truck, but hit it, and then slid into the guardrail, with the impact on the passenger side.

Colonel Fuentes said neither weather nor speed appeared to be a factor. He said Trooper Rasinski did “an excellent job handling the situation, considering that a car swerved into his path.”

The driver of the white truck stopped, he said, but the red truck did not, adding that state police will be examining cameras on the highway in hopes of identifying the red truck.

Governor Corzine was traveling, as he normally does, in a two-car caravan. Officials said the two troopers in the car following Mr. Corzine stopped to care for him rather than chase the red truck.

Mr. Fuentes said he was unsure whether Mr. Corzine was wearing a seatbelt; he often does not.

James Freund, a volunteer emergency medical technician, said he happened upon the scene and saw Governor Corzine, his glasses off, pulled from the car head first on an board used to immobilize the spine. “The only thing you could verbally hear from him was that he was moaning,” Mr. Freund said. “It looked like the car made a direct impact on the left guard rail and kind of hopped over it.”

Mr. Freund said that he saw the injured trooper give the thumbs-up sign to a fellow trooper, and that a swarm of firefighters and some 30 law enforcement officers, “looking like C.I.A. agents, dressed in black, with earpieces coming out,” surrounded the scene. He said the helicopter arrived at 6:25 p.m.

“It was obviously someone important,” he added. “I was assuming there was a fatality.”

New Jersey faces a $2 billion budget deficit that Mr. Corzine must close by July 1, and questions have been raised about the fiscal and legal soundness of the state’s accounting of its troubled pension system. He has been criticized by Republicans and others for failing to disclose the extent of his financial gifts to a former companion who is also the head of the state’s largest union. And all of this is taking place at a time when federal prosecutors have subpoenaed records from the governor’s office, and legislative offices, as part of a broad inquiry into Trenton’s often-murky budgetary practices.

More immediately, he was scheduled to leave Saturday for a five-day trade mission to Israel, his second international trip since becoming governor last year.

Dr. Ostrum, the surgeon, said the governor’s most severe injury was an open femur fracture, in two places, that pierced the skin. Surgeons used the longest rod and longest screws they had to repair the bone, and it still was not quite long enough for the 6-foot-3 governor. “Governor Corzine has a very long leg,” he said. “He’s got a significant rehab ahead of him,” he added,” but “there is no risk that he will lose his leg.”

Despite the seriousness of the injuries, Mr. Corzine’s pulse and blood pressure remained stable, Dr. Ostrum said, adding that he was lucid and talking to doctors when he arrived at the hospital. The doctor described the broken vertebra as “a nothing fracture,” and said he would give the governor a sling “for comfort” to heal the collarbone. The broken ribs and sternum were what necessitated the breathing tube.

The accident occurred at Mile Marker 44.5 in Galloway Township on the parkway’s northbound lanes, about five miles north of the Atlantic City Expressway. At Drumthwacket, the Rutgers team, which made it to the N.C.A.A. championship game but lost to Tennessee, arrived at 7:45 p.m. expecting to see the governor. Mr. Imus had arrived earlier by limousine. Half a dozen news reporters and photographers waited outside, and a news helicopter flew overhead.

They spent three hours in Drumthwacket’s library, departing shortly before 11 p.m., without commenting on their meeting.

David W. Chen reported from Trenton and David Kocieniewski from Camden, N.J. Lawrence K. Altman contributed reporting from New York, and Tina Kelley from Princeton.

National Registry

Aside from DTs National Registry woes, I don't have to jump through nearly as many hoops to get my certification. In fact, I don't have to jump through any at all. As a New York State provider, we are a "Non-Registry" state, which is great because it means my certification lasts for three years instead of two, and I don't have to deal with an external bureaucracy (NYS DOH is actually pretty good). Unfortunately, it also means that should I want to work in another state, I'm pretty much screwed. So I finally bit the bullet and (having done a recert class in the past year) decided to do the paperwork and pay the fees to get registered. Thus... today I had the fun (really!) experience of taking the computerized written exam, and hopefully, in a few days I'll know if I'll be allowed to prepend the letters "NR" to the front of my "EMT-B."

The Future Lies at Your Feet

I accepted a job working for the government of the State of New York... the paperwork should be arriving in the mail any day now. All those lovely I-9s and W-2s and Health Insurance Enrollment forms. Not to mention a union membership in PEF.

Meanwhile, I already know where my office will be. Here's a photo courtesy of the Wired NY website:



Yes... that's Ground Zero in the foreground...

Spoke too soon!

About my post about Spring in New York.... I guess I can't say as much about Spring in Maryland. Looks like fellow blogger Maddog is having a fine old time!

Spring in New York!

The best part about Spring in New York, aside from the warm weather, sunny skies, and overall more pleasant aura: flu season is over! At last a hiatus from running calls for runny noses and general malaise!

Of course, Spring also means the start of allergy season, bringing.... calls for runny noses and general malaise.

Woe is me!

Paramedic

So I've resolved to enroll myself in a paramedic class, or as they say here in New York: AEMT-P. (One step above AEMT-CCT, followed by EMT-I, EMT-B, and CFR).

I got a job working for the State of New York as a Junior Engineer when I graduate in about a month, so hopefully, starting September, I'll be going to school at St. Vincent's Catholic Medical Center in Downtown Manhattan doing the evening -P class.

Wish me luck, and I'll keep you updated!

All ALS all the time?

There are those who believe that the idea of "all ALS all the time" is the best policy for providing EMS to the masses, and believe it or not, I'm not here to debate that fact even though I am a BLS provider myself. There are also those ALS providers out there who believe that BLS providers should not be able to make a determination about whether a patient needs ALS care. Surprisingly, I'm not here to talk about that either. Rather, let me tell you a story:

We're called for a 27 y/o female having an asthma attack. Our crew is fast today, and everyone is assembled and we're off in the ambulance in record time: 4 minutes after the initial call marks our arrival on scene. Walking into the lobby of the building, I find the patient sitting in a chair, barely moving any air; she states (barely) that she has a previously diagnosed case of childhood asthma, but doesn't have an albuterol inhaler. A quick listen to the lungs, and she has wheezes on the exhale; also a tinge of cyanosis to her lips. This is not a healthy person. My partner starts a more detailed workup, and I get on the phone to medical control for a request to administer nebulized albuterol, which we carry on board. The request is approved and we begin administration of the medication and start prepping her for transport.

My next call is for ALS backup. Stair chairing and getting her out the door has already run us through a couple minutes and the 1st dose of albuterol is almost already run dry to no relief to the patient. I'm back on the phone to Med Control and get an order for "continuous albuterol administration -- no dosage maximum," which is technically not in protocol, but I'll worry about my two unit dose maximum when I get there. Move onto the stretcher and loading into the back of the ambulance, I see a FDNY rig quickly approaching from down the street, "Good," I think, my ALS has arrived. The two guys from the FDNY rig get out and walk up. Judging from the confused look on their faces, I know the question to ask them.

"You guys ALS?"

"No.... what's up?"

"Asthma.... bad. You guys know if they have ALS en route?"

"I don't think so."

I hesitate a second, thinking, and my thoughts reach the same conclusion as the FDNY EMT's who urges: "you guys just go, don't wait."

My thoughts exactly. Already a third of the way through the second dose of albuterol, and no change in the patient's status. She's still struggling valiantly for breath. 'This is probably my second worst asthma case I've ever done,' I think. The worst one ended with the patient intubated... luckily for the patient, I suppose, she won't, and can't be subjected to that today... at least not in the field.

I'm driving so I hop into the cab of the bus. I take a second to bring up the hospital notification number on the phone, hit the SEND button, hit the sirens, put the truck into DRIVE and we're off. I tell the ER what we're bringing them. Conveniently, we're only three minutes out. Arrival in the ER brings our rush into the trauma room and the "Green team" descends on our patient. Finally, quickly, she gets some advanced treatment and interventions. A happy ending to a frantic twenty-minute procedure of getting the struggling patient to the hospital, quickly and alive.

By the way, at the end of it, when my crew of three were bringing in another patient a little while later, a now freely-breathing young women in hospital gown gave us all hugs and thanks. Guess BLS isn't so bad after all. But the conclusion of the story is, this is the second time in a month when I thought I needed ALS and didn't get it. All ALS all the time is well and good, but how about all ALS when you need it, all the time? In a city like New York, you'd think that ALS would be available when needed. The facts of the matter are that FDNY*EMS does not use EMD dispatch, and does not work with the voluntary and volunteer organizations operating in the City limits. How many lives have been lost because advanced care was not sent where it was needed? How many patients received ALS for whom an accurate determination of need was not established by the dispatcher? How does the public allow shabby, poorly-run systems to continue to exist?

In the Navy

When I first started working as an EMT, I had just got certified and was working for my local volly fire department during a summer home from college. We got called to the "Better Spaces" home, an 'assisted living' community for people suffering with Alzheimer's. I think most of you remember your time in this position, you didn't really know what you were doing: you had your training to guide your actions, but no experience.

I'm running lead on this call for a 86 y/o male with a fever. I've got the Chief, who is decidedly hands-off for this one, and another college-aged firefighter, not trained in EMS, except that he picked up the art of taking vitals somewhere along the line. We do first-response, and the Hudson ambulance service reports a delay in the time of arrival of their rig. In fact, when I start talking with the guy, he's appears fairly healthy and we find him in the dining room (how the staff found out he had a fever in the middle of dinner, I will never know) sitting calmly at a table.

I introduce myself and start the routine I was taught in class.

"Hi, I'm a EMT with the fire department, how're you doin'?" I ask.

"Oh, I'm good! I'm feeling pretty well, and I'm just sitting here eating dinner.... what do you want?"

"Well, we were called here for you because you have a fever."

"Ah. I see," A puzzled look on his face, "I really feel fine. All of this is probably not necessary."

"Well, my partner here is going to check you blood pressure and pulse if you don't mind."

"..."

"You alright?" I ask as he seems to have momentarily blanked out. He blinks and I ask about the vitals again.

"What...... oh. Yeah, sure, whatever you need. Why're you guys here?"

I feel like I may have answered this question already, but.... seeing as we're in a home for Alzheimer's patients.... "Well, the staff called us because you have a fever, apparently. I'm going to take your temperature now, OK?"

"Sure," he replies, and I stick a probe in his ear: 100.2 F. Geez, I don't know what all the hubbub is about. Well, with baseline vitals unremarkable, EMT-Basic training states to begin OPQRST, and obtain a SAMPLE history.

"When did your fever start?"

"I have a fever?"

"Ummm, yeah." A staff member fills in the blank that they routinely take temperatures every evening before bed. I see. "And when did you take his temperature?" I ask the staff member. Blank stare answers that question. Right then, so proceeding right along...

"Does anything make it better or worse?"

"Make what better or worse?" asks my patient.

"Your fever."

"What fever?"

'Oh, Lord' I think. I look over at my Chief, who is happily engaged in conversation with a young blond nurse in a flowery frock. Firefighter partner has started wandering around looking at the artwork in the dining room.

"Have you felt sick recently?"

"Nope, I'm healthy as a horse!"

Skipping the rest of the history of the illness, I remember I need SAMPLE and AVPU.

"Do you know your name?"

"Sure, I'm Jim."

"Do you know where you are?"

"I'm at home."

"Do you know the day of the week?"

"Yeah, today is Sunday."

'Well, that's not right,' thinks I, seeing as it was Wednesday.

"What's the date?"

"Oh, It's October 14th, 1943. Speaking of dates, I had a cute, little one last night...." he smiles and winks, "yep, got me some shore leave for the weekend and had a little hook-up, if you know what I mean!"

I'm speechless for a moment... I start to open my mouth and I shut it. "What do you do?" I ask, stalling.... somehow I know asking for his allergies and past oral intake, etc., won't get me too far.

"I'm a hand on an ocean going tug," he replies, "we're in port for a week, so I thought I'd look up some gals that I know."

The grin on his face is contagious and tragic all at the same time. I can't even begin to relate to the patient. Here is a man who has lived his whole life, and now, nearing the end, the doors of his memories for the past 70 years are shut. The only memories accessible to him at this moment places him the morning after a one-night-stand he once had, with a person who now probably has grandchildren of her own, and yet, it seems like it was just yesterday. In a sense, the reality he's living at this moment is almost better than the reality that actually exists. The triumphant attitude of a virile young man facing the adventures of youth has to be far superior to that of a frail, elderly gentleman, stuck confined to four thin walls with locks to keep you inside - the smell of urine and sponge baths always prevalent. Is this the way the brain keeps us sane, in response to conditions that would surely drive us insane? Is this the way a body, barely able to respond to the demands of life, much less the enjoyment and full expectations of it, cope with the disappointment of a machine worn well beyond the limits of its construction? Alzheimer's is a terrible disease, I've been told, robbing its sufferers from their faculties. And yet, this smiling, talkative soul in front of me, older than my own grandparents, is enjoying life just as fondly as he ever could.

We chat a little more about things and wait for the ambulance to show up. When they arrive, the medic doesn't bother asking for a report from me. In and out. Jim is loaded onto the stretcher for another unnecessary ride to the hospital that Medicare or his insurance company will have to pay for. The assisted-living community I learn later has no medical resources, so for any ailment, no matter how small, 911 is dialed and EMS is summoned to transport its residents to the ER.

I've seen enough of this home to know that most of those who live here aren't nearly as active as my patient today was. Many go through the day barely aware of their surroundings. I've taken calls here where the patient, after falling down in their room, with copious bleeding from certainly painful injury to their arm or to a leg, can barely comprehend the simplest questions, or even tell us if there's any pain at all.... the only indicator yelling or screaming when a site is touched or pressed upon, or maybe not. Yet.... what is happening in their minds? As the world progresses and time continues around them, what reality and what present are they interacting with? Is it possible that they're in a better place? As a patient is picked up, bandaged, and carried to the ambulance, are they vividly reliving their time on shore leave?...smiling, winking, laughing, and enjoying the art of living.

Cool! A nifty map!

With the help of a great site created by Phillip Holmstrand, I was able to plot and map the locations of every 911 receiving hospital in Manhattan, as well as specify the trauma centers (in orange). This is a screenshot of the map created and an interactive version can be found by clicking the image. Enjoy!

Ooooooh...pretty....

I just wanted to put this up. Good ole Fair Lady. Excuse the unskillful removal of license plate numbers and name. It is a nice truck though, isn't it?

The Maze Known as a College Campus

As a New Yorker, I'm fairly accustomed to finding my way around the city easily enough. And while I'll admit to the small difficulties every once in a while, like where exactly do I get off on the Canarsie line to transfer to the Crosstown Local (and by crosstown I mean Brooklyn/Queens); in Manhattan north of Houston is easy enough to find: The numbered streets go East/West, the numbered avenues go north/south.

I bring this up because a most amazing phenomena occurs every third or fourth day as I look out the 9th Floor window of my apartment onto Amsterdam Ave, and my college campus beyond it.

"So what is this strange occurrence?" You ask.

"Why, it's an FDNY ambulance traveling north on Amsterdam Ave., slowing as they approach the intersection and the gates to the main entrance to campus, then gradually stopping. In fact, they look....lost! You can see into their vehicle as their poor heads search the area, turning left, right, up, down. The the driver takes his foot off the break pedal and the FDNY rig pulls a U-Turn in the intersection, slowly, and starts heading back south."

Three minutes later they're back again. Same routine. They know that they're not in the right place, but probably close. They travel north this time, past the wrought iron gates, but once again, back they return, fruitlessly traveling north and south, pulling U-Turns while, I can only assume, their patient waits -- panic slowly setting in, until a campus Public Safety officer walks up to them, listens, gives directions, and off they zoom to save the day. This is where my ambulance service comes in. Our ability to excel in our service to our community of 50,000 students, faculty, visitors, and staff lies very much in the fact that we can respond directly to a location much faster than ye standard Citywide ambulance.

For example, this is a photo of a building on campus:

When yada-yada person calls into the 911 system and says, "Hi, I'm whoopie-wheepie, and I'm having a heart attack, and I'm in Shapiro Hall at The University." Citywide EMS dispatch will send all sorts of folks over, who will promptly not know where to go for several minutes at least. On the other hand, when same person calls x99 and contacts campus' Public Safety, we get the call, and we know exactly where Shapiro Hall is. In fact, we even know to ask for a clarification since there are actually TWO Shapiro Halls in existence. Thus, we hop in our truck, off and away, and establish patient contact in a much more efficient fashion than would otherwise be attainable through the municipal system.

Though this efficiency does not come easily. We require of our new Drivers that they memorize almost every location for each named building on campus, a list of about 100 places, each with it's own physical address, and some buildings with multiple addresses, as well as multiple buildings with a single address! What fun!

I've been working on a document for several months now, and tonight we are presenting it to the rest of the corps. It is essentially a standardized route listing for each possible location on campus. Here is an excerpt:

Schapiro Center
PRIMARY - Access through Peters Hall entrance on X St. Take your first left and walk past loading dock to the giant Freight Elevator. When returning to vehicle, remember that only the freight elevator reaches this level, and not the regular passenger elevators.

(2) – Access through entrance to Schapiro building on X St. requires changing elevators at Campus level. Beware, the first set of elevators are very slow.

(3) If responding to a call above the above the 7^th floor in Shapiro, try going through Mensche Hall Sky Bridge. Access is given by the 10^th floor of Mensche Hall. Use this is you like parking in the grove.

As you can see, there is a Primary route of access, and two alternatives. This may not make any sense to you, but by referencing other landmarks on the campus, this allows for a more streamlined approach to access to locations. The next steps will be distilling this down to something that anybody can use, especially for FDNY fire and EMS, NYPD, and anyone else who may be conducting emergency responses to our campus. Hopefully, in providing the municipal agencies with a listing of buildings with their corresponding physical addresses, and the best way to get into them, we can make this maze of a campus much safer (even if it means loss of business to my volunteer ambulance service)! Now, anyone know how to get FDNY to listen?

Why send an Engine company anyway?

Dispatched to a call for a "22 y/o female fell down the stairs with a head injury," I think first "Woohoo!" as the tones go off, then "Hmmm, this might be interesting," as the dispatch comes across. Little did I know how interesting.

The FDNY*EMS system is an entirely separate entity from the FDNY Fire system (and entirely separate from Fair Lady). They have different radio systems, different dispatch networks with different computer systems, different chains of command, and they don't even talk to each other. In fact, surprisingly, they also have different 10-Codes, which despite NIMS, both organizations are completely married to, and I would be surprised if "10-84" changes to "Arriving" anytime in the next 25 years (Nevermind that arriving is easier to say with one less syllable than 10-84).

Despite this, when the Citywide EMS system gets swamped, like it did last night, FDNY*EMS starts sending Engine companies to the serious medical calls. Since we're unaffiliated with FDNY completely, there is also the possibility of a dual dispatch if someone calls the University's Public Safety emergency line directly, and also calls 911, this also occurred last night. We arrived on scene to find the engine company, with their crew of CFRs, already tending to the patient. I dropped my partner and a Probie off at the front door, and went to stage the ambulance a little farther down the street. NYPD and Public Safety were also already on scene. After parking, I grab a stair chair and head into the building about 30 seconds after my partner entered. After I enter the foyer, I pass a firefighter who says, "You're going to need a backboard." I drop the stair chair, do the twirl, and head back to the the rig. Things progress nicely from there. My partner and the Probie do a nice job stabilizing C-Spine at the foot of the staircase, and we secure to a backboard.

I got the full story eventually from a friend who told me that the patient tripped at the landing on the top of the stairs and rolled all the way down to the bottom, head over heels. About 20 feet. Technically this is major trauma criteria, so even though the pt was negative for AMS, and PE revealed over some abrasions to her head and bruising to her arm, I called a notification to the trauma center, and we hustled to the hospital.

After we clear from the call, my crew sits together for a quick post mortem review. This is when my partner tells me that when she first arrived on scene, the FDNY firefighters had a 4x4 out and were pressing it against the pt's head. No manual stabilization of C-Spine, no collar out, no backboard. This suddenly struck me as odd since it was an FDNY firefighter that had originally told me that the pt would need backboarding to begin with. So, basically, the FDNY crew knew what needed to be done, but didn't bother doing it.