FDNY ambulances are only equipped with books of city maps. EMT workers say they could increase their emergency response time with GPS devices.
City ambulance drivers use paper maps on emergency runs
– Cabbies have them and you probably do, too. But believe it or not, city ambulance drivers don’t have GPS devices to help them respond to emergencies.
EMT crews are sometimes forced to use paper maps to reach victims, resulting in delays when responding to life-and-death emergencies. Workers and union leaders say.
It’s just a day-to-day occurrence of guys saying, I have to look it up on the map”. That adds a minute or two”, said Patrick Bahnken, president of the union that represents city EMTs.
Ambulances used by at least five local hospitals have GPS, as they act as a “helpful supplement” to the crews, a New York Hospital spokeswoman said. Since Boston installed GPS in its ambulances five years ago, it’s made “a huge difference,” especially for new workers, an EMS spokeswoman said.
FDNY spokesman Steve Ritea confirmed that the ambulances don’t have the cheap gizmos, but said that response times are improving regardless. Average EMS response times to emergencies were 6 minutes and 41 seconds and 41 seconds last year, down from 7 minutes and 52 seconds a decade earlier. Each unit has a “detailed citywide map”, and crews know their terrain, Rites said.
Technically, the FDNY’s 500 ambulances do have GPS, but the $50 million system installed in 2006 only allows dispatchers to track their routes through signals. The devices on ambulances have “limited capacity,” so they can’t handle the mapping software, city officials said last year.
Ambulance crews have a set terrain, but responders are sometimes called away from it for big emergencies. New streets have also popped up in the outer boroughs, making the maps obsolete, workers say.
“It’s not a once-in-a-while-thing,” one EMT said.
Earlier this year, for example, it took an extra 20 minutes to get to a man who was having a heart attack. He lived on a new street near Staten Island Mall that wasn’t on the truck’s Hagstrom map, a worker said. The man survived.
Some crews resort to bringing their own GPS devices, but that’s against the rules and they could be punished if caught, Bahnken said. -8-2-10-
BILL TO HELP EMTs; a bill recently introduced by Councilwoman Gale Brewer could help ambulance drivers by requiring building owners to post addresses on the front of their property. Not having the numbers sometimes confuses drivers searching for victims, said Brewer, who is pushing City council leadership to get behind the bill. “if there’s a number, it makes it easier for the emergency responder. Every second counts,” a police spokesman said.
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T h e E m o t i o n a l A s p e c t s in H e a l t h C a r e
As an EMT we deal with a wide variety of emotional reactions.
One can experience when faced with trauma, illness, dying, or death.
You must discuss the possible reactions that a family member may exhibit when confronted with a dying patient
You must state the steps as an EMT to approach to family members, when are confronted with death and dying
You state the possible reactions that an EMT family may exhibit due to their job involvement as a part of the EMS
You must recognize the Signs & Symptoms of critical incident stress
You must determine the possible steps that the EMT may take to help
reduce or alleviate stress
You must to determine scene safety
You must discuss the importance of Body Substance and Isolation (BSI) in wide scenarios
You must describe the consecutive steps, we should take for personal protection from airborne & blood borne pathogens
You list the personal protective equipment that is necessary for every following situation: Crime scenes, Exposure to airborne pathogens, Exposure to Blood borne pathogens, Dealing with Hazardous material scenarios, Rescue operations, Violent scenes are part of our daily routine. 800 List
As providers of health care, as an example, doctor need to look after themselves, in all respects, because an ill physician is in no position to render any professional care as she or he was trained to do. The same applies to all health Care providers and this goes beyond the physical factors.
There are many factors and situations that can interfere with the EMT ability to treat the patient.(e.g.)“A terminal ill patient might wish to die at home, and the family might call for help when death is imminent”. At some times, even the most experienced healthcare providers have difficulty overcoming personal reactions and proceeding without hesitation. Patients need to be removed from life threatening situations. The personal health, safety, and well being of all EMT are vital to an EMS operation. Part of your training consist in recognize any possible hazard and protect yourself from those scenarios. These scenarios will range from personal neglect to environmental and human made threats to your health and safety. Today, sixty percent of all deaths are attributed to heart diseases with an aged range from 1 to the age 64, trauma is another leading cause of death. This occurred either quite suddenly or after a prolonged terminal illness.
The environment of death has changed since our nation’s earlier days, and it no longer a home setting scenario. The setting of death is somewhere else, like in hospitals, hospices, at work place, or on the highway. Illness can be much more drawn out and much more removed from daily life. Life support systems an impersonal care remove the whole experience of death from most people’s awareness. The mobility of families also makes it less likely that there will be extended family support when death does occur.
Although. Life support measures need to be given to patients who are severely injured and you also may be called upon to recover human remains from highway accidents, or aircraft disasters, or for a mass casualty incident. In all these scenarios you must be calm and act responsibly as a member of the emergency medical care team.
You must also realize that even though your personal emotions must be kept under control, these are normal feelings that everyEMTmust deal with such situations. Somehow, this struggle to remain calm in the face of horrible circumstances contributes to the emotional stress of the job.
It is important to remain calm to perform effectively when you are confronted with horrifying scenarios, injuries or life threatening illness. A kind of self control is needed to respond efficiently and effectively to the suffering of others. This self control is developed through the following:
A dedication to serve humanityOngoing experience in dealing with all types of physical and mental distressBe appropriated and professional trained.You must be prepare to deal with a daily mental fatigue and physical stress that you must cope as a result of caring for the sick and injured. Usually you are going to deal with scenarios of death and dying which challenges you every day with a new reality of human weaknesses and his/her survivorsemotions.
IN CLASS YOU WILL LEARN HOW TO MANAGE Traumatic Emergencies e.g.
Broken bones, etc. Medical Emergencies, Patient assessment,
PEDIATRIC Emergencies Child Poisoning, Clearance of airway
MEDICAL Emergencies Behavioral Emergencies -Mental status,
1. Leaving the Cuff's lower edge about
an inch above the bend of the elbow, place the cuff over your bare arm, close
the cuff around the arm, and then stick the Velcro together at the ends of the Cuff.
2. Place the earpieces of the
stethoscope in your ears and place the stethoscope bell at the side of the cuff
away from your heart and over the brachial artery, which is found in the inner
area of your bent elbow. The Stethoscope is a convenient measure device for listening sounds the various sites,has a point of contact known as the stethoscope's Bell. The two earpieces at the other end of the stethoscope enable to hear the "steady" -within the normal rate-, a Thump in the brachial artery.
3. Tighten the screw at the side of the
rubber bulb and squeeze the bulb.
Air is pumped into the
bulb, and thus the cuff expands.
4. The Cuff is inflated until the blood
flow through your brachial artery stops.
With sufficient compression, the cuff cuts off blood flow through
the artery, and no sound is heard in the stethoscope. The pressure in the cuff
is increased rapidly to 30 millimeters of mercury above the point that no blood
flow is taking place through the cuff when no sound can be heard in the
stethoscope or when a pulse can no longer be felt in the wrist.
5. Turn the screw again to loosen the
valve in the bulb and to lessen the air pressure.
Pressure is then decreased so that the rate of drop is 2
millimeters per second. When the pressure falls to the point that blood begins
to flow through the artery again, the number that the column of mercury has
risen to at the first sound heard in the stethoscope is the systolic blood
pressure (SBP), the first number in the blood pressure reading.
6. Look at the column of mercury to see the number at that
pressure point.
7. When the Cuff decompresses to the
point that blood flows freely in the artery, the sound is no longer heard in
the stethoscope.
The number next to the top of the column of mercury when the sound
ceases is the diastolic blood pressure (DBP), the second number in the blood
pressure reading.
8. Again, look at the column of mercury
to see the number at that pressure point.
Patient Assessmentis, without a doubt, The most important skill that you will learn during your experience as an EMT student. Without "assessment" ability, the EMT will never 'know' when it's appropriate to apply a Kendrick's Extrication Device (KED,) or IF helping the patient self-administer an "EPI-pen" is indicated, or "how much" oxygen the patient "really" needs. It IS the basis from which ALL other decisions will be made. Actually the 'Entire Scope' of the "skill" goes well beyond the patient. The properly "honed" skill will include an 'assessment' of the patient, that's true, but it will also include an 'assessment' of the environment (the scene,) as well as a 'pre-assessment' of the "call," so that, when you arrive at the scene, you will 'grab' the proper equipment (stretcher type, 'treatment' adjuncts, personal protective equipment, etc.) to better prepare yourself to deal with the patient.
The "first step" in the entire process actually begins before your involvement, with a properly trained dispatcher. The dispatcher, who takes the initial call for help, should 'collect' as much pertinent information as is available, so that the "dispatch" is a complete one. Knowing "where" you are going, a familiarity with the "location," and an understanding of the "problem," are all 'pieces' of information that will help you make a proper "pre-assessment." While responding to the scene, 'armed' with the information supplied by the dispatcher and associating that information with your available equipment, your knowledge of the area, and your 'ability' to deal with the upcoming anticipated problems, will better prepare you (mentally and emotionally) to deal with this patient. That "preparation" will also serve to present an 'organized' group of rescuers to onlookers, family members, and the patient, when your ambulance arrives at the scene, adding to the degree of "professionalism" perceived by the 'public.'
Once at the scene, a proper "patient assessment" begins with an 'assessment' of that scene. As a matter of fact, the entire process of "patient assessment" is one that starts out very "general" and as the process continues, the focus becomes more and more specific.
Here you can download the Patient Assessment Drill Sheet
(This may include a "Rapid Trauma Assessment"or a"Detailed Physical Exam"depending on
the outcomeof the "Hx and/or
PE")
·Ongoing
Scene Size-Up
As mentioned above, your 'evaluation' of the scene should begin during the dispatch process, assuming that the dispatch was 'complete.' But any 'scene' is a dynamic entity, changing from minute to minute, and an "up-to-the-minute" evaluation of this scene will actually begin as you arrive. When approaching the scene, park the ambulance a reasonable distance from the scene, but DO NOT enter the 'scene' with your emergency vehicle. At most scenes, law enforcement personnel will, most likely, have arrived first, and should have already defined the 'borders' of this scene.
The "steps" involved in this "scene size-up" include"
Body Substance Isolation (BSI) Always Preventions
Scene Safety for the Crew?
Mechanism of Injury (MOI)
Nature of Ilness (NOI)
Number of Patients? MCI?=over 6 pts? is Crew Enough to Handle the Job?
Need for Additional Help? PD, FD, BLS, ALS, PC?
Consider In-Line Immobilization of the C-Spine
With no intent to insult your propriety, please consider the two words, spoken more often by the majority of Emergency Service Providers when arriving at the scene of any major incident..."Oh Shit!" - 'Mother F ck" - "F cks" -"Big F ck Balloon". etc.
We offer these words as a quote, understanding that they are NOT within the acceptable limits of conventional conversation. They do, however, express the reaction that many who arrive at this scene initially formulate (whether spoken or unspoken.) This "initial" reaction can lead to a sense that some immediate engagement in this scene is, not only appropriate, but expected by those already on the scene. DO NOT GIVE IN TO THIS SENSE OF URGENCY. As a matter of fact, your first action is NOT to run into this scene (as an Emergency Service Provider, you should not RUN anywhere,) but to stop. Take a nice deep breath (be careful not to get 'run over' by the other providers running to the scene) and look around.
Tunnel Vision: Those providers running to the scene are concentrating on the "problem" expressed in the scene. They may be unaware of the 'cause' of the "problem," and under such circumstances are more likely to become part of the "problem." They may very likely be experiencing a phenomenon called "Tunnel Vision," and the 'experience' can be deadly. While "looking around" as suggested above, be aware of several things: Any additional Emergency Services traffic approaching the scene Any "civilian" pedestrian and/or vehicular traffic attracted by the scene (People 'traffic' will MOST LIKELY be experiencing "Tunnel Vision" and they are not looking 'for' you or 'at' you. The probability of injury to you, as a result of their Tunnel Vision is VERY HIGH.)Any environmental problems (heat, extreme cold, mud, ice, unstable ground, darkness, other conditions that limit your vision or ability to safely navigate the terrain, etc.) The presence of any hazardous materials, or POSSIBLE presence of such materials (spilled gasoline, leaking gas, airborne powders, unmarked "containers" of unknown substances, etc.)[As an 'aside,' please be aware that the company charged with the 'responsibility' for moving the greatest amounts of hazardous materials over the public highways (in most of the world) is United Parcel Service (UPS.) They accept and manage that responsibility very well, and although the number of vehicular accidents involving UPS trucks is not unusually high, the likelihood that a UPS truck is carrying some hazardous substance is information that should be noted at any such accident.]
Broken glass
Jagged metal
Downed electrical lines
Crime Scene -The possible presence of "evidence."
All of this "input" is intended to provide YOU with a 'platform' from which to make a SMART DECISION: "Do I enter the scene, or not? And, if so, what Personal Protective Equipment (PPE) will I bring with me?"
If the scene is found to be 'unsafe,' DO NOT ENTER IT, unless you can render it 'safe,' or until it has been made 'safe' by others.i.e. Fireman, PD, Bomb Squad.
Basic EMT Skills neccesary to performe V.Signs and Patient History. The Vital Signs are five: Pulse, Respiration, Blood Pressure, and Body temperature.
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