ALS in PA v NJ

Now that I'm in college (oh boy), I'm now running with the campus Rescue Squad. So, now BigShow is an EMT in two states. Running with this squad in PA has exposed me to another side of ALS. In New Jersey, ALS by law is hospital based. Medics must work in pairs. For the most part they ride around in SUV's and meet the BLS line of sight on the way to the hospital. We are EXTREAMLY limited by this whole "hospital based" thing. My one squad is served by a total of three ALS trucks, for a population of 300,000, spanning from light urban areas to rural areas. My other county is currently served by 3 ALS trucks that serve our county alone, plus one that serves the northern half of ours, and the southern half of another. Thats four ALS units for a population total of 150,000 people, in a primarily rural area. Compare this to my current area, where ALS is run by local fire and EMS companies. We have a single provider ALS chase unit serving a suburban population of 30,000, with the nearest "second due" just 10 mins away. It seems like back home, waiting is the name of the game. We get to do ALOT of BLS skills in the back of the truck. However, sometimes, there is volume, and the response from communications is "No ALS available". It sucks to hear that, really sucks. Especially when you know that you have a 45 minute transport a head of you... The biggest obstacle to ALS in NJ is the hospital rule. I can see why they have it, the thought being if they are based out of a hospital (doesn't necessarily mean they are sitting at a hospital), they are better trained and have better oversight than if they were simply municaple based. However, I think this is counter productive. MICU ends up being that garage off the back of the hospital that no one really knows or cares about. They are paid horribly, with HUGE salary gaps between the Podunk hospitals and the big city ones, further more, the number and locations of the trucks are severely limited by the private funds the hospitals obtain. Not to mention, what would the hospital spend its money on? The flashy new CT/MRI/Surgery/Cold remedy machine or replace the aging Lifepak and Medic trucks? Compare this to ALS in my area of PA. There are more medics than you could shake a stick at. Each town has its own ALS ambulance or chaser veh. They all have decent equipment, flashy trucks, and perhaps best of all, they are all nice, and respect the opinion of the BLS provider. (SHOCKING I KNOW!) Compare this to NJ, where it seems that BLS is ALWAYS wrong, does ALL the lifting, better drive PERFECTLY, better be perfect at their skills, better have all the info, PMHx, SAMPLE, etc, and have the pt loaded, with their arm sitting out ready to go. Oh, and don't even dare touching ANY of their equipment. ALS in PA seems to think that we are all a team (WTF?), and that BLS is more than just a taxi service, as a group of professionals who can actually assist them! My question is simply this.. Why can't NJ have this? Why must we be limited by legislation that was written in the 1980's when paramedic was a new term in NJ? (unfortunately, we seemed to be behind the ball on ALS. My area didn't have ALS until 1985...a good 15 years after paramedic programs started popping up across the country, and even then it was a whole county away) The only solution the State DOH seems to have is allowing us to give Epi-Pens, and a pilot program in my county for LMAs. Instead of giving the BLS more skills, how about you give us more resources?

Riding the bus...

If there is one thing I absolutely despise, its firefighters complaining about running EMS. Now, I'm a firefighter and an EMT-B, so I see both sides of the "fence". Around here, in order to get a job as firefighter, you need to get your EMT. Plain and simple, no ifs, ands or buts about it. About a year ago, the local paid dept. was hiring, and low and behold, the people on my dept didn't qualify, because they didn't have their EMT. That's just the way it is now a days. In the systems where EMS is run by Fire, you always seem to get those people who constantly complain about having to ride the ambo. Well, the problem is, thats just they way the fireservice is these days. Saying "I don't like running ambulance calls" is like saying "I don't want to go to MVCs" 40 years ago in NJ, when the Rescue Squad handeld everything that was not a fire, and the fire department handeld none of it. The fire service is evolving, and certain firefighters seem to have a problem with it. Well, there are other jobs out there. These people are the modern incarnations of the HAZMAT haters of the 70's and 80's or the public education pudits. They are stuck in 1910. What do you think people said when FDNY started Rescue One about 100 years ago? I bet they complained "We are the fire department, we dont do that stuff", well you'd be hard pressed to find a large fire department that doesn't have a rescue truck (pittsburg doesnt count). Back to the "fence" comment eariler. That fence is gone. It started getting torn down when the first episode of Emergency premeird. There was a reason why doctors accross the county chose the Fire Department to become paramedics. It was a complement back then, and we should take it as such now. We need to think of the fire service as a buisness, we need to keep updating our products for tomorrow, or else the buisness fails. If you want to be running one engine with two guys on it, go a head, keep whining about running EMS, and we will see where it gets you....

Maybe I'm the one who is confused about the role of EMS....

So, had a nice little MVC in town the other night, go to the station, and hop in the officers seat of our 1st due Ambo. Of course I'm all happy because the ANSI Class 2 vests I had just ordered for the squad came in, and this would be their first officiall use. So we get there, going lights and sirens, and I'm all like "Dispatch, show us on location, establishing County Rd Command" (another Big Show moment) Upon size up, I find multiple EMTs from my station on scene commencing pt. care of approx 4 pts, 3 RMA, one transport, 2 Vehicle MVC, in the lane of travel, PD on location with traffic being controlled. However, significant fluid spill requireing FD. So I'm walking from one PT to another, accross the entrance for a supermarket lot, and some jerk off decideds he is gonna go around the accident scene, cut through the middle of it, and almost hit me because hey, he NEEDS to go to the store, Oh, well sorry that me and my accident decided to get in your way. Good thing I was wearing my ANSI II vest. So we make the decision that we are going to transport an elderly female, restrained driver, complainging of slight chest pain, however there is a difference in BPs on right and left arm, so we call out ALS just to check her out. As we are about to leave, we ask the husband if he is going to come with us to Big Tramua Center/Do it all hospital. "Oh well, I live on the way there so you all can just drop me off." "Um sir, if you can find the word 'taxi' on my ambo, i'd be happy to drive you to the hospital, but unfortunatly, in the best interests of your wife needed to go the hospital the fastest and quickest way (which happens to be the opposite way form where you live) and for the sake of my sanity and self respect, we can't" Like seriously, how self centerd was this man to think that we would just drop him off at his house!?! I don't understand where people get these ideas from. Not even on TV do you see things like this happening.

Man I have issues/worst April Fools ever....

So yesterday in school, a kid walks into class, a class that is taught by a fellow EMT, and this student said "HEY MR. ___, THE BATHROOM FLOODED AND A 7TH GRADER TRIPPED!" Of course I hear this and think "Head injury, LOC, AMS, C-Spine, Medevac, the big one, I'm going to work, best day of school ever" I start to stand up, at that time my teacher, who has been an EMT for a few more years than me (but is kinda jumpy...) is already half way out the door, and then the aformentioned student says "APRIL FOOLS"...and in the span of about 4 miliseconds, I go from huge whacker, big show, EMS, best day of school ever, immediatly to...fuck. worst.april.fools.joke.ever. I responded with "Hey ____, your cool....April Fools"

Brothers

Missed a "fire" today, a little bummed out at first, then realized it was nothing, so no big deal. Came in as a basement fire, PD arrived to a small fish tank on fire, hit it with the dry chem, and that was the end of that story. Then went to help the buddies from the FD put lights in my engine capt's truck. He now has two blue TIR3s in the grille. Looks pretty sweet. Made me think of something though...I think half the reason I throughly enjoy Fire/EMS is for the comradery, reguardless of who you are, where you come from, what your interests are, etc, your still a "brother" and you become friends with all the people on your dept, people who if it werent for meeting them at the Fire House, you probably would not be friends with. Maybe its because you see a side of a person you dont see anywhere else. Maybe its the fact that you can't afford to "dislike" some one who you go into hell with, and are relying on them not to kill you, or let you kill yourself. Reguardless of what it is, I think I can quite honestly say that I am better friends with people who are 2-3 years older than me and on the FD with me, than with people who I go to school with and share the same sense of humor with.

Signing on...

After following "A Day in the Life of an Ambulance Driver" and a number of other related blogs, I noticed that most of them were from the perspective of an experienced, older (relatively) EMT/Medic/Firefighter/Police Officer, I deiced the "blogospere" needed a young "whacker" Firefighter, EMT-B who is still in school and doesn't get nearly enough calls (by my standards at least). So, enjoy