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This past weekend was the premiere of the Chronicles of EMS first episode. It premiered both at a live event in San Francisco and on the internet through a UStream live feed. If you missed it live don’t worry. The entire episode is viewable here:

Powerful stuff isn’t it? Way better than NBC’s Trauma, more engrossing than Paramedic: Life on the Streets, and most importantly in my opinion is that it is heralding things still to come.

I see CoEMS as the industry’s Paul Revere… alerting it’s citizens and the world that there is a revolution taking shape. It’s a grassroots movement that has been seeded beneath our very feet and has the potential to grow and effect real change in the systems so many people, both providers and patients, find complaints with.

5 Things You Can Do To Help The #CoEMS Movement

Just like any grassroots movement looking to effect real change, the CoEMS movement depends on the passion of those who support it to spread it’s message. Here are some really easy things that YOU can do to help the cause:

• Share the video on Facebook
• Tweet about the video on Twitter
• Sign-up for the CoEMS Newsletter
• Join the CoEMS Social Network!
• Write your own blog post and link to the Chronicles of EMS Premiere Episode!

Real change doesn’t start at some agency in a land far far away.

It can start right where your sitting.

It can start with you.

Ever since the New York Post’s half-truth article about FDNY and the NYC Vollies, I have been approached by people who know that I am involved with them asking me when they were in fact closing. The fact is, that unless they are already in dire financial stress (which quite a few are), the NYC Vollies are not closing.

Apparently I am not the only one. Here is a Letter to the Editor of the Queens Chronicle who ran a much better story although the tone was similar as the Post article:

Dear Editor:
We write with interest in response to your front-page article featuring Queens volunteer ambulance corps in peril (“FDNY shuts out ambulance corps,” Jan. 21). Since this publication many of our members have been personally stopped on the street numerous times by residents with great concern over the perception of the potential closure of our ambulance service, the Woodhaven-Richmond Hill Volunteer Ambulance Corps. We would like to go on record in assuring all our residents that WRHVAC in the foreseeable future is not closing.
Actually, quite to the contrary, our ambulance service within the past year has seen a marked increase in call volume and the amount of tours which we have been putting out on the street to better service our communities. WRHVAC has a good and professional relationship with both the FDNY and hospital-based units which we interact with on an everyday basis. We are committed to providing the best, most professional service possible to the communities of Woodhaven, Richmond Hill and Kew Gardens.
This is not to deny that presently or in the past there have been issues between the volunteer and municipal (FDNY) sector. This being said, we hope that any issues which the volunteers have with FDNY will come to an immediate resolution reached professionally and tactfully on the party of both parties. WRHVAC hopes that recent articles in papers will not affect the ongoing relationship which most ambulance corps have with these units.
The WRHVAC is an all-volunteer ambulance service. To maintain our service we depend on committed communities members like you! If you are interested in getting involved please call us at (718) 296-7918.
The officers of the
Woodhaven-Richmond Hill VAC
Woodhaven
Editor’s note: Nothing in the article or an editorial supporting the ambulance corps implied that any might close. If you missed either item, find it in the archives at queenschronicle.com.

I wonder if this is the reaction those involved with the articles expected.

I highly doubt it.

Full Disclosure: I am a member of the Forest Hills Volunteer Ambulance Corps in Forest Hills, Queens and have been a member of that Corps since 1994

This is post #1 in a series. You can read post #2 here.

The alternate title of this post was “The Post When All The Vollies Cry Foul And Want My Head On A Spike“. Why would that be the case? Because the truth can hurt.

There was recently an article in the New York Post regarding the decision of the FDNY to remove NYC Volunteer EMS Agencies from their computer aided dispatch (CAD) system. I caught word of the article through an e-mail and then there was a post on it from Firegeezer.

So let’s look at what the claims being made are and what the truth actually is:

The Fire Department has booted the city’s volunteer ambulance companies from its emergency 911 system, The Post has learned. – NY Post Article

Truthfulness of Statement: False

The vollies have not been booted from the NYC 911 system, because they were never IN the NYC 911 system. Volunteer agencies have their own “hotline” phone numbers, have their own dispatchers, and their own run numbering systems. They are separate entities that do have a mutual aid agreement with the NYC 911 system lead agency, FDNY.

“They call us all the time. If not through their system, they call us on the mutual-aid radio system or just call us directly,” said Gunning, who also heads the Glendale Volunteer crew. – NY Post Article

Truthfulness of Statement: True and False

During the days of NYC*EMS, they maintained the Mutual Aid Radio System (MARS). This system gave each volunteer agency a radio designation based on their borough of service, so a 93 unit was from Brooklyn and a 94 unit was from Queens. It’s true that back in the days of NYC*EMS the vollies were called over the radio, but ever since FDNY inherited this system they did absolutely nothing more with it and THIS is what FDNY is actually ceasing operations of.

“If it weren’t for us, patient wait times would often be much longer. We get called in when the FDNY doesn’t have an ambulance to send. This change comes at the patient’s expense,” said Alan Wolfe, president of the Forest Hills Volunteer Corps. – NY Post Article

Truthfulness of Statement: True and False

The truth is that the NYC vollies generally respond to calls they hear over the NYPD radio or the FDNY BEMS radio. Yes, the truth is the volunteers “buff” or “jump” calls that are dialed into 911. Their response however does NOT mean there is no available unit. In fact, more often than not, the assigned unit responding continues in even though a vollie unit has decided to respond.

It is true that more often than not the volunteers WILL get to the scene faster than the assigned unit. This is for a number of reasons:

• The volunteers are traditionally very knowledgeable of their specific geographic location
• The volunteers are often already in the area whereas the assigned unit may be coming from an out of the area post or hospital
• The volunteers have a burning desire to get there first… which can be both good and bad

As for the expense of the patient… financially speaking volunteers do the job for free, but the vast majority of the agencies will still bill the patient’s insurance.

The medics who ride the units all have the same qualifications and certifications that any other medic units have. Many of the volunteers, in fact, are off-duty FDNY medics. – Firegeezer

Truthfulness of Statement: More False than True

First let’s clarify the term “medic” here is used very loosely. Out of the 35 (and I question that number too) reported agencies in NYC, I can think of only 3 or 4 that are providing ALS. Everyone else is a BLS agency using BLS providers.

Additionally, while the state certifications are the same, many of the volunteers are NOT employed with FDNY. In fact for that matter I think FDNY employees are the minority of the volunteers. I believe there is a far greater number of EMS professionals employed by both hospitals and privates volunteering their time than the municipal workers.

The volunteer squads are not only saving the city a lot of money, but they are seriously reducing response times in many instances. – Firegeezer

Truthfulness of Statement: False

The volunteer squads do not save the city ANY money. It is true the squads do not receive tax funding, but their existence does not decrease the budget in any one place. As for the response times, technically since the vollies are not in the system that measures response times (and haven’t been) they are in fact statistically not reducing any response times either.

In Conclusion… To Be Continued

In conclusion, there is no change to the status of the NYC volunteer agencies, because they are in all reality irrelevant to the emergency response in New York City.

But does it have to be that way? Are the NYC volunteers destined to close their doors and be a footnote in the history of emergency care in the city?

I say no. It doesn’t have to be that way. In my next post I’m going to explain the current volunteer system and what is wrong with it, and in my third post I will explain how (in my opinion) the volunteers can fix it.

Full Disclosure: I am a member of the Forest Hills Volunteer Ambulance Corps in Forest Hills, Queens and have been a member of that Corps since 1994

Jason Fait, the ambulance operator involved in a fatal 2006 intersection accident, was acquited of vehicular homicide yesterday. Fait and his partner were uninjured after he drove his ambulance through a red light at an intersection in Hempfield Township and collided with an SUV fatally injuring the driver of that vehicle, Frank Scalise Jr.

Video of the crash recovered from the ambulances DriveCam was played in the courtcase as evidence. Fait’s lawyer, Ken Burkley, attributes the argument that Fait did not intentionally run the red light as the deciding factor.

How much the DriveCam video aided in that argument is of course up for debate.

Sources: WTAE and Statter911

Yesterday I read this article from the blog at Cleveland.com and immediately shared it on my Facebook Page (and through that on Twitter as well). The news coming out of Cleveland is that their EMS system will “reject some calls on minor ailments to save money” in an effort to make up a deficit.

I’m going to call it how I see it.

First of all, this is the biggest news to come out of Cleveland since Howard The Duck crash landed there and discovered that Lea Thompson had grown up since her days at Space Camp. To have this aggressively progressive protocol come out of Cleveland puts them on the radar big time.

On one hand this is the sort of thing that I hear from EMTs and Paramedics when they talk about improving EMS. They all seem to be focused on being able to perform this action… denying transport to so called “frequent fliers” and “system abusers”. Now the Cleveland system isn’t actually placing the decision in the hands of the providers, but of the trained Emergency Medical Dispatchers. As a former communications center manager and someone who has been EMD trained I can tell you that the system can provide better results than no training or guidance when followed through on, but still is not a 100% guarantee for accuracy. As an EMT, I KNOW that the information in the call is more often wrong than it is right, and I know it isn’t ALWAYS the EMD’s fault.

Which leads me to the other hand, and the problem of picking and choosing who actually gets help. If you read the comments of the news article there is already an existing undercurrent of “only taxpayers should receive services” and “let the non-paying poor fend for themselves“. This decision, although under the guise of making service determination by over the phone “triage” and resource availability is really the first step to providing service to only those that can afford it. It’s important to understand that the Emergency Medical Treatment and Active Labor Act (EMTALA) does not specifically regulate ambulance services therefore leaving the requirements for emergency care up to local jurisdictions. In other words, eventually Howard The Duck is going to be shit out of luck when he gets his bill smacked up because he’s an undocumented immigrant without health insurance.

I’m going to be watching the Cleveland system, as I’m sure many of you will be as well. I however am going to make my prediction now, that the system will indeed have a sentinel event within a year and it will be under more intense scrutiny than ever before.

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If you are a resident of Queens, you are undoubtedly aware that last year Parkway Hospital was forced to close by the State of New York, and then in February both St. John’s Queens and Mary Immaculate Hospital closed in bankruptcy. This left approximately 125,000 annual emergency room visits to be absorbed by other local hospitals.

Perhaps it is just coincidental karma or the work of the nefarious minded that the sign at Elmhurst Hospital (which absorbed a majority of St. John’s patients) sent a different message than what it’s city employed administrators intended. The darkened bulbs changed the sign from Elmhurst to lmhurt.

The dirty truth is that Elmhurst Hospital has not had the best reputation for expedient emergency care, even before the closure of the other 3 hospitals. The population of Queens continues to be under served and there is no sign of it improving anytime soon with or without Universal Healthcare.

The sign says it all…

Photo Source: Asylum via The Bitter American

Not surprisingly, Trooper Daniel Martin has been placed back on active duty by the Oklahoma Highway Patrol after being cleared of the most recent accusations of excessive force.

Trooper Daniel Martin originally gained notoriety from a Mother’s Day confrontation with Paramedic Maurice White while he was transporting a patient. During the confrontation, Trooper Martin attempted to place Paramedic White under arrest using a chokehold.

This confrontation was caught on video by a family member who uploaded it to YouTube where it has been seen over 1.5 million times. Even with public outcry, the patient speaking out, and numerous calls for Trooper Martin to be fired, in the end he only received a 5 day suspension.

Trooper Martin had been placed on administrative leave when this latest accusation was made. Amazingly, it only took the Oklahoma Highway Patrol a month and a few days to conclude this investigation and make its findings known. The decision about the incident with Paramedic White on the other hand took two months time with clearly visible video evidence both on the Trooper Cam and from an independent source.

So kudos to the Oklahoma Highway Patrol for speeding up their process! By my count, Trooper Martin has now had 3 months paid vacation, so obviously the real losers are the citizens of Oklahoma who are paying his salary.

In response to the Influenza Vaccine shortage New York State Department of Health Commissioner Doctor Richard F. Daines has instructed NYS Healthcare Providers to use vaccinations with a higher mercury level than previously considered safe for use as ordered by New York State Public Health Law Section 2112.

In a letter dated October 29, Dr. Daines points to the vaccination shortage as the primary reason why these vaccines that were disqualified for use previously because of the mercury level from the vaccine preservative Thimerosal. The FDA and CDC have encouraged all vaccine manufacturers to cease using Thimerosal since 1999. It is important to note that the recommended consumption amount has been based on methyl mercury toxicity levels and Thimerosal is actually a derivative of ethyl mercury. The FDA continues to recommend that pregnant women, women of childbearing age who may become pregnant, nursing mothers and young children do not consume certain kinds of fish that may contain high levels of methylmercury, the same at risk groups from the H1N1 Influenza Virus.

While the letter does instruct providers that informed consent is required for vaccinations, and consent should only be given to patients and parents authorized to provide consent, this does not change the fact that the NYS DOH has probably now stricken parents and pregnant women with the fear of mercurial poisoning from a vaccine that is already hotly debated.

More Information: Thimerosal in Vaccines from the FDA

Download: NYS DOH Thimerosal Waiver Letter

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See what happens when I go down to Florida for a few days in the interest of my own mental health? Sanity suddenly strikes the New York State Department of Health regarding the influenza vaccination mandate.

Last week New York State Commissioner of Health Richard F. Daines, MD submitted a letter regarding the previous influenza vaccine mandation for healthcare workers. He opens the letter by suspending the mandatory vaccination:

In August 2009 the State Hospital Review and Planning Council (SHRPC) adopted on an
emergency basis 10 NYCRR Subpart 66-3, requiring certain health care facility personnel to be vaccinated with influenza vaccines. I am writing to inform you of my determination pursuant to Section 66-3.2 of those regulations that supplies of seasonal and 2009 H1N1 influenza vaccines are not adequate and that such vaccines are not reasonably available. Therefore, I hereby suspend the requirement for the health care personnel to be vaccinated against both influenza viruses for the current influenza season (through April 1, 2010).

This suspension means that the temporary restraining order against the mandatory vaccinations is a mute point. While the scheduled October 30 hearing may still happen, the results those lawsuits have sought has already happened. What that hearing may however effect is this part of the letter from Dr. Daines:

The current emergency regulation mandating influenza vaccinations for health care workers will expire on November 11, 2009, and a second emergency regulation would not have the desired effect during the current H1N1 influenza season or the expected seasonal outbreaks expected later this year and in early 2010. Therefore, no new emergency regulations will be promulgated. Instead, the DOH is advancing a permanent regulation requiring health care personnel in these settings to be vaccinated. Draft regulations will be published soon for a period of public comment.

So while the mandate will not be enforced this year… they are looking to make it a permanent policy probably in time for next year.

The vaccine manufacturers are no doubt rejoicing.

Download: NYS DOH Letter

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The New York Times is reporting that an acting New York Supreme Court Justice has issued a restraining order temporarily halting the mandation of the controversial H1N1 Vaccine for New York State Healthcare workers.

The restraining order was issued by Acting New York State Supreme Court Justice Thomas J. McNamara in response to a lawsuit filed by three Albany Medical Center nurses who state that the mandation is a violation of their civil rights, and merged their lawsuit along with two other similar suits from New York State United Teachers Union and New York State Public Employees Federation.

The New York State Department of Health is planning to fight the restraining order, and has cited that the state has upheld similar requirements for vaccinations such as Rubella and Tuberculosis.

Justice McNamara will hold a hearing on October 30 regarding all three of the cases that he merged together.

The vaccine mandation was signed into law on August 13, 2009. It affected EMTs and Paramedics employed or contracted by healthcare facilities while free standing municipal agencies were apparently exempt due to the verbage used.

Source: New York Times Blogs

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