Ok, say you’re right and the supervisors do ALS interventions on scene. In most states if that happens they then have to ride in with the BLS unit. What then? Just hard for me to believe that a true “active shooter event”doesn’t get even a single ALS unit
Who responds on a medical branch call ??? In route etc.
- Thread starter firebusteremt
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An active shooter MCI response is essentially for the medical operation within the warm zone. Their objective is to start triage, provide hemorrhage control and manage patient airways and to get the patient out of the warm zone.
Their equipment is almost only limited to tourniquets, dressings, skeds, triage tags and hemostatic agents. The Conditions Cars carry a RTF Deployment Bag with two types of tourniquets, pens, chest seals, decomp needles, quick clot gauze & pressure bandages and a laminated checklist. (Although this is doctrinal.)
In a lot of cases the ALS ambulance wont be able to do anything the BLS crew cant do (with some exceptions, however each RTF has two conditions bosses assigned which is where anything that the BLS crew cannot due will be done.) Their objective is to get the patient out of the warm zone where they can be treated more thoroughly by other crews and then to the hospital. They don't want to have any treatments take longer then needed in the warm zone especially when there is still a threat.
Additional crews/resources are always going to be on standby especially as more patients are reported.
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I have found that doing the BLS skills in a most rapid fashion, getting into a transport ambulance and starting out for the closest appropriate hospital without delay while doing the required ALS skills enroute to the hospital has always served the patients well.
Paramedics usually don't like to admit it but the BLS will save the day in this instance. Not saying their is no role for the ALS especially when the number of victims exceeds the available transport resources and you are in a designated treatment area where some advanced skills might be needed and performed so I would always ask for a Paramedic unit(s) to be assigned.
When you actually look at what the ALS can do above what the EMT's or CFRD Firefighters (NYC specific) have likely already done for the patient and the feasibility and safety of doing those skills in a moving ambulance (not easy) you will likely rethink your approach and the need for ALS. IV fluids don't carry oxygen only blood does that so don't get all wrapped up in needing to start a one. In my experience that only slows things down. I'll give you the chest decompression because that will turn things around quickly but even that requires a good size needle and some landmarking to be successful so it might not be as easy as your thinking. Get in, get out and get moving. Focus on the BLS.
My experience is NYC specific, we have many ambulances and our hospital system is robust so out transport times are not likely as long as others in different parts of the world. The key take away is that one approach does not fit all situations. Know your response district. If you go mutual aid then get to know that district also. Develop a plan that works for your system. What works in NYC might be great for us but not for you. Lastly, Drill,Drill,Drill. Include ALL of your assets - Police,Fire,EMS,Hospitals, have a traffic plan and include any other agency in your town/city that is going to have a positive impact on your ability to give the greatest number of individuals (that includes us !) the greatest chance getting back to their families in one piece- .
Remember - The police will stop the killing - The rest of us stop the dying. It won't be an easy day but then again nobody ever said it would be.
Paramedics usually don't like to admit it but the BLS will save the day in this instance. Not saying their is no role for the ALS especially when the number of victims exceeds the available transport resources and you are in a designated treatment area where some advanced skills might be needed and performed so I would always ask for a Paramedic unit(s) to be assigned.
When you actually look at what the ALS can do above what the EMT's or CFRD Firefighters (NYC specific) have likely already done for the patient and the feasibility and safety of doing those skills in a moving ambulance (not easy) you will likely rethink your approach and the need for ALS. IV fluids don't carry oxygen only blood does that so don't get all wrapped up in needing to start a one. In my experience that only slows things down. I'll give you the chest decompression because that will turn things around quickly but even that requires a good size needle and some landmarking to be successful so it might not be as easy as your thinking. Get in, get out and get moving. Focus on the BLS.
My experience is NYC specific, we have many ambulances and our hospital system is robust so out transport times are not likely as long as others in different parts of the world. The key take away is that one approach does not fit all situations. Know your response district. If you go mutual aid then get to know that district also. Develop a plan that works for your system. What works in NYC might be great for us but not for you. Lastly, Drill,Drill,Drill. Include ALL of your assets - Police,Fire,EMS,Hospitals, have a traffic plan and include any other agency in your town/city that is going to have a positive impact on your ability to give the greatest number of individuals (that includes us !) the greatest chance getting back to their families in one piece- .
Remember - The police will stop the killing - The rest of us stop the dying. It won't be an easy day but then again nobody ever said it would be.
Well said! Even as a medic outside of NYC I can agree with your statements, especially about blood vs fluids. Luckily we’re seeing an increase in services carrying and offering blood products but they’re still the exception, not the rule.
Back when I was still working as a paramedic for 2 separate hospitals in NYC I was a buff. I used to try to get assigned to 10-75 fires and many times the dispatcher would tell me to remain in service that the call type did not require an ALS unit. I could never understand this. If you're a firefighter injured in a fire wouldn't you want the highest level of care there for YOU? I don't remember the specifics, but there was a LODD in Brooklyn in the 80's in which a Hatzolah paramedic intubated a firefighters stomach and he died from this. Always wondered why FDNY leadership didn't want a 911 medic unit on a fire for their people.
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^^^^^CONTINUED REST IN PEACEBROTHER....
New York Daily News
https://www.nydailynews.com › 1995/03/07 › fire-lieute...
Mar 7, 1995 — Lt. Raymond Schiebel, 49, married and the father of three, was comatose and on a respirator last night, battling damage to his brain, kidneys, ...
FIRE LIEUTENANT FIGHTS FOR HIS LIFE MEDICS EYED ...
New York Daily News
https://www.nydailynews.com › 1995/03/07 › fire-lieute...
Mar 7, 1995 — Lt. Raymond Schiebel, 49, married and the father of three, was comatose and on a respirator last night, battling damage to his brain, kidneys, ...
That was then, I had the same experience when I tried to get assigned to a 10-75, very different now. ALS,BLS and officer going out the door on the 10-75 and at the same time Fire is turning out when the box is loaded up. If I’m not mistaken it’s automatically done via CAD link no phone calls required. I think what caused the change was a study done on fire fighter fatality. Mainly medical causes with trauma while still being a hazard on the fire ground it is occurring less than medically driven events.
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I'm not in the mood to give the Daily my money, but I need to know. How did they end up putting the tube in his stomach instead of his lungs, I read a bit before the 3.99 message popped in my face, a Paramedic said they we're following protocol. What protocol we're they even talking about?
No, all FDNY EMS ALS units are staffed with two paramedics. Some ALS procedures (i.e Adenosine) are near impossible with only one medic.
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It's very easy to miss during intubation and go into the stomach. I don't know a medic who hasn't done it, but the difference is realizing it quickly and correcting it.
Near impossible with only one medic?
Unless FDNY EMS is Critical Care Licensed, then that’s an invalid statement. And even if they were, Adenosine is a poor example for your argument.
Not in NYC. Could be in other parts of NY State. The fly cars in NYC were staffed by 2 regular medics in the late 80's , an ALS certified Officer and a regular Paramedic in the late 90's and again in 2018ish. Three separate attempts at gettin the program up and running. All three attempts abandoned for one reason or another.
I have to agree, Intubation under the best of circumstances can be challenging for some. The key to a misplaced tube is as stated - take all precaution to avoid missing the tube in the first place and if (when) you do miss the tube - recognize, own and correct your mistake forthwith. Any number of things can cause you to misplace the tube. For example, unusual or edematous upper airway anatomy, soot in the airway, vomit, patient clenches down or equipment failure. Make sure you have the correct tube size and type / size blade for the procedure, was it white, bright and tight ? Don't forget your suction unit. Very important for clearing the secretions. Or maybe...just maybe the Medic is not as sharp as they think they are and need more practice time in the sim lab.
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BEMS began fielding "Paramedic Response Units" sometime in 2019. No transport capability and was a "equipment carrier." Any run they went on had to have a BLS Ambulance Assigned. In 2020 the program was ended and the vehicles were instead given to Supervisors.
Generally speaking, that is used for MCI incidents, and it depends on the type of and scale of the incidents. For fires, which is most common, 2 BLS, at least one ALS, and a supervisor
Interestingly, PRU fly cars are back now again. They started a new pilot in the Bronx and Harlem.